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Postnatal depression (PND) is a type of depression that many parents experience after having a baby. It can affect any parent, regardless of whether they've suffered from a mental health condition before. Postnatal depression is linked directly to giving birth and is a common problem, affecting 1 in 10 women within a year of giving birth.

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First Steps Nutrition Trust is an independent public health nutrition charity. We endeavour to fill practical and policy-relevant information gaps and provide resources for health workers supporting eating well from pre-conception to five years.

Our Mission

To influence policies which enable the safe, appropriate and optimal feeding of infants and young children in the UK, and to protect them from commercial interest.

To ensure that the importance of good nutrition from pre-conception to age five remains on everyone's agenda.

To provide conflict of interest-free information on infant milks marketed in the UK, and to promote better regulation and marketing of breastmilk substitutes.

To provide resources for health workers to support them in their work with pregnant women and young families.

Our Resources:

Are put together by nutrition experts and are regularly updated.

Can be used in Unicef UK Baby Friendly Initiative accredited settings.

Are available as free pdf downloads for use by anyone promoting better public health on a not-for profit basis.

Everyone who works at First Steps Nutrition Trust feels passionately about the need for better information and support for good nutrition - and good food - from pre-conception to five years.

First Steps Nutrition Trust is supported by generous individual donations and conflict of interest free grants. First Steps Nutrition Trust does not work with organisations or individuals that work with, or take funding from, the breastmilk substitute industry and we reserve the right not to sell them our subsidised resources.

First Steps works with and supports a number of organisations including Unicef UK Baby Friendly Initiative, the Baby Feeding Law Group, the Obesity Health Alliance, the Children's Food Campaign and the APPG on Infant Feeding and Inequalities.

First Steps Nutrition Trust host and regularly update their partner site infantmilkinfo.org which contains comprehensive information about infant milks (for 0-12 month olds) available on the UK market.

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

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If you suspect your baby of having a tongue tie (sometimes known as frenulotomy or ankyloglossia), or if a tongue tie has been diagnosed by a health professional, a referral may be made to our midwife tongue tie practitioners. The referral must be made by completing the Tongue-tie_Referral_Form and forwarding by email to: dgft.tonguetie.assessment@nhs.net. On our receipt of this fully completed form, we will contact you by telephone within a week.

During the telephone call, we will assess the need for you to attend an appointment at the Tongue Tie clinic. Clinics are held three times a week and are located on the ground floor of Russells Hall Hospital in the Paediatric area of the Women and Children's Outpatient Department. This is the first department on the left if you enter the hospital by the Maternity entrance.
If your baby was born at Russells Hall Hospital or you live in the Dudley borough, please contact the infant feeding team who will provide you with feeding support and assess your baby for tongue tie. The team can be contacted by calling 01384 456111 ext. 3887 or emailing dgft.spmwif@nhs.net.

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If you suspect your baby of having a tongue tie (sometimes known as frenulotomy or ankyloglossia), or if a tongue tie has been diagnosed by a health professional, a referral may be made to our midwife tongue tie practitioners. The referral must be made by completing the Tongue-tie_Referral_Form and forwarding by email to: dgft.tonguetie.assessment@nhs.net.

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If your baby needs a supplement of expressed breastmilk or formula, a nursing supplementer can help you enjoy the closeness of breastfeeding while your milk production increases.

You can use a supplementer to:

Stimulate breastmilk production while feeding infant formula or expressed mil, without using bottles.

Breastfeed an adopted baby.

Breastfeed as a non-birth parent.

Maintain breastfeeding if your milk production isn't able to meet your baby's needs eg insufficient glandular tissue.

Maintain breastfeeing if your milk production is compromised eg breast surgery or reduction.

Encourage a baby who is reluctant to breastfeed.

Breastfeed a baby who is unable to feed effectively because of sucking or health problems. However this will only work if you baby can feed well enough to obtain milk.

How it works

A nursing supplementer lets a baby get any supplement he needs at the breast without using bottles. The supplementer container holds the milk, which travels through a tube into your baby's mouth while he breastfeeds. As he swallows, he continues sucking, stimulating your milk production.

If you are breastfeeding expressing your milk, and giving top-ups to your baby, you may find it simpler to use a supplementer, which allows all the feeding to happen at the breast.

A good latch-on

It's especially important that your baby latches on deeply at the breast when you are using a supplementer. Get help with positioning and attachment so your baby can get milk from the breast as well as from the supplementer.

Different supplements

Expressed breastmilk Your expressed breastmilk is the first choice for a supplement. If your baby has feeding difficulties, expressing will help you maintain and increase your milk production. To find our more about increasing your supply, see our article How to Increase Your Milk Supply. And for more information on Expressing Your Milk our article can help.

Donor milk Human milk banks provide pasteurized, screened donor milk.

Infant formula Concentrated and ready-to-feed forms of infant formula are less likely to clog nursing supplementer tubing than powdered forms. Although expensive, ready-to-feed formula may also be more convenient when you are out and about or at home without help. Powdered infant formula is not sterile, so always follow the NHS guidelines for preparing it.

Available products

Disposable bag system This uses disposable sterile plastic bags with a top opening and a single tube. Milk only flows when a baby sucks and it is discreet to use as the bags are not bulky or noisy. You can also feed lying down without fear of leaks. When your baby sucks, the flow increases as the flow of milk from your breast decreases. This reinforces proper suckling, making the most of your milk production. (As in photograph above.)

Bottle system This system uses a bottle with a tube for each breast, making switching sides easy or for twins. Each tube can be clamped. Three tube widths are available. Sets can be cleaned and reused. (As seen in the photograph below.)

Homemade system You can make your own supplementer using an ordinary baby bottle, bottle teat and an infant nasogastric feeding tube (size #5 french, 52-75 length). Tubing can be obtained from online suppliers. (As seen in the first and last photos in this article.)

Cut a small hole in the bottle teat so the tube fits tightly. Thread the tube through the teat from the inside and attach the teat normally so the end of the tube sits in the supplement. The tube end is rounded and won't hurt your baby's mouth. Pierce a second hole in the teat, or use a teat with a vent to allow air in so your baby won't need to suck harder as the bottle empties. The bottle needs to stay upright. You may find tucking it into your bra keeps it in place.

How to use a nursing supplementer

Introduce the tube into your baby's mouth along with the breast at the very beginning of a breastfeed by placing it between your baby's upper lip and cupped tongue. If your baby doesn't like the feel of the tube on the roof of his mouth try placing it so it lies along his tongue. Or, slip the tube into the corner of your baby's mouth once he is well-attached at the breast.

You may need to extend the tube past the end of your nipple - experiment to see what works for your baby. The tube can be secured to your breast with medical tape. Taping along the tube is generally more secure than taping across it.

To hold the tube in position some mothers use fabric sticking plasters cut from a long strip. They thread the tube under the non-sticky sections.
The tube can be easily removed while the plasters stay in place, reducing skin irritation from tape removal and providing a guide for positioning each time.

Milk flow - too fast or too slow?

Constant milk flow can cause ineffective feeding as your baby will not need to actively suck to get milk. When using a supplementer you will see the milk travel along the tube to your baby's mouth. Adjust the tube position and container height so your baby gets milk quickly when he starts sucking. Check he isn't overwhelmed with milk, especially if he has heart or breathing difficulties or is premature.

Slow down the flow of milk by lowering the milk container, raising the tubing or using thinner tubing. Or pinch the tube to slow or stop milk flow. If using the bottle system, stop milk flowing by clamping the tube in the slots in the bottle likd. To speed up milk flow, raise the bottle, use wider tubing or use two tubes at the same breast. You may need to adjust the tube in your baby's mouth to create more suction.

Cleaning

To avoid having to throw away tubing when milk had dried inside, force cold water through the tube at least three times straight after use, using the bottle of a 5-10ml syringe. Using warm water may cause fat to cling to the sides of the tube.

For commercial supplementers follow the manufacturers' cleaning instructions. For homemade systems, follow the NHS guidance when cleaning the bottles and teats. Wash the tubing with hot soapy water, rinse with clean water and force air through the tube (or spin the tube fast) to dry. Take extra care if using infant formula. Store the clean supplementer parts in a sealed container in the fridge.

Nasogastic tubes should not be boiled, steamed or chemically sterilised as they are not designed for multiple uses. If your baby is at a higher risk of infection, a commercial system may be a safer option than a homemade system. Replace the nasogastric tube when it starts to stiffen, after about a week.

Eliminating supplements

The use of infant formula is sometimes essential to meet a baby's nutritional needs. You may need to use formula as a stopgap measure, while you work to increase your milk production. Supplementing with formula without protecting your milk supply may reduce the duration of your breastfeeding experience.

Over time, you may be able to reduce the amount of supplement your baby needs as your milk production increases. Expressing in between feeds will signal to your breasts to make more milk and give you some milk for the next feed. For more on Increasing Your Milk Supply, see our article.

Begin the feed with your baby taking milk just from the breast. When he is no longer swallowing regularly start the supplementer. If your baby is reluctant to nurse at all, start the milk flowing at the beginning of a feed to get him started. As your breasts start to make more milk you will notice your baby takes less supplement, especially at certain times of day.

For more information on managing and reducing supplements see My Baby Needs More Milk and Relactation and Induced Lactation.

Seek support

Whether using a supplementer as a temporary or a long-term solution, support from your local LLL Leader and group can be a great help. For individual face-to-face help or a home visit, you could also consult a board certified lactation consultant (IBCLC) or specialist breastfeeding clinic.

Written by Karen Butler, Sue Upstone & mothers of LLLGB. Photos courtesy of Lynn Adams, Rae Vacher Lowe and Alison Widdup.

Further reading
Comfortable Breastfeeding
My Baby Needs More Milk
My Baby Won't Breastfeed
Expressing Your Milk
Hand Expressing Your Breastmilk
How to Increase Your Milk Supply
Using donor milk and formula to support breastfeeding
Nipple Confusion
Relactation and Induced Lactation

Mothers' stories
In praise of at breast supplementers
Breastfeeding with a nursing supplementer

LLLI articles
At breast supplementer nursing

Books
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Exclusively Pumping Breastmilk. Casemore, S. Gray Lion Publishing, 2014
Making More Milk Second Edition. Marasco, L and West, D., NY: McGraw-Hill, 2019.

Other websites
Homemade Supplemental Nursing System
NHS leaflet: Guide to bottle feeding
Increasing milk production

Nursing Supplementers
Please note: LLLGB does not endorse any particular breastfeeding product, aid or device or brand. La Leche League GB supports the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly Resolutions (referred to together as "the Code"). For more information about LLLGB's support of the Code, see here.

Nursing Trainer System: www.lact-aid.com
Supplemental Nursing System: www.medela.co.uk

This information is available in printed form from the LLLGB shop.

Copyright LLLGB 2022.

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Nursing Supplementers - La Leche League GB

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If your baby needs a supplement of expressed breastmilk or formula, a nursing supplementer can help you enjoy the closeness of breastfeeding while your milk production increases. You can use a supplementer to: Stimulate breastmilk production while feeding infant formula or expressed mil, without using bottles. Breastfeed an adopted baby.

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Babies can be unsettled for many reasons and it can sometimes take time and effort to work out the cause. Our page The Unhappy Breastfed Baby can help you determine whether your baby's behaviour is due to something other than an allergy.

But when you have ruled out most of the obvious causes and your baby is still, unhappy, colicky, experiencing dry and itchy skin or passing mucousy stools you may wonder whether they could be reacting to something in their diet or environment, or something in your own diet.

Certain medical conditions can have symptoms similar to those of an allergic reaction. It may be wise to rule these out before deciding whether a baby's symptoms are due to an allergy or food intolerance.

A baby's immune system is immature at birth.

Colostrum, or early milk, is rich in antibodies, particularly secretory IgA (SIgA), which provide a protective coating inside a baby's intestines. Mature breastmilk continues to provide protection, helping to prevent potential allergens from reaching a baby's blood.

Exclusive breastfeeding generally helps to protect against allergy but it may still occur.

If any immediate family member ( siblings or parents) has an allergy eczema, hay fever or asthma, it makes it more likely that the baby could develop allergies.

Food intolerance

A food intolerance does not involve an allergic reaction but can cause similar symptoms. It occurs when a baby has difficulty digesting a particular food. You may not need to stop giving your baby a food to which he is intolerant-reducing the amount may be enough.

Food allergy

A food allergy occurs when a baby has an immune response to specific foods. There are two types of food allergy reactions; immediate and delayed. A baby can have either or both.

Immediate reactions are also called IgE-mediated alllergies. This is because the baby's immune system creates specific IgE antibodies to a certain food. If a baby is given the specific food they are allergic to, the IgE antibodies will recognise it and cause the rapid release of chemicals, including histamine, that trigger inflammation and allergic symptoms. Symptoms appear within minutes, or up to 2 hours after eating the food responsible.

Delayed reactions are called non-IgE mediated allergies because they are not controlled by IgE. Instead it is believed such reactions are regulated by immune cells. Symptoms appear 4-72 hours after eating the food.

It is wise to see your GP or health visitor if your baby is showing signs of allergy, but some symptoms are more worrying than others. Seek immediate medical help if your baby has signs of an anaphylactic reaction: sudden onset of breathing difficulties, swelling, or collapse, with or without a rash, after physical contact or eating a particular food.

Allergy symptoms

Food allergy symptoms occur in several different body systems; the tummy, airways and skin. An Allergic baby will usually have symptoms in more than one body system, but need not experience all the symptoms to indicate allergy. Many of the following allergy symptoms can also occur in normally developing children for other reasons.

Time

Immediate: within minutes or up to 2 hours

Delayed:
within 4-72 hours

When nursing

Baby hungry for the breast but pulls away after a minute or two, arching the back and screaming*

Skin

Itching
Inflammation**
Hives/nettle rash
Swelling, usually around the lips, face and eyes

Itching
Inflammation**
Eczema (dermatitis)

Tummy

Reflux
Loose or frequent poos
Blood or mucus in poo
Tummy pain
Infantile colic***
Food refusal or aversion
Constipation
Inflammation in the nappy area**

Airways

Cough, chest tightness, wheeze, noisy breathing, trouble breathing
Itchy nose, sneezing, runny nose, nasal congestion, conjunctivitis

Cough, chest tightness, wheeze, noisy breathing, trouble breathing

Other

Anaphylaxis: sudden onset of breathing difficulties, swelling, or collapse with or without a rash

Reduced growth, along with one
or more tummy symptoms above
Lethargy

*This may also be caused by a fast let-down. See Too Much Milk and Oversupply for
more information if you think that this may apply to you.
**Inflammation appears red on lighter skin, and darker brown, purple or grey on darker skin.
***Colic is defined as repeated episodes of excessive and inconsolable crying in an infant that
otherwise appears to be healthy and thriving.

Environmental triggers

An irritant is something that causes damage to the skin. Eczema (also known as dermatitis) and dry skin rashes can be caused by mild irritants such as bubble bath, baby wipes, skin cream, fabric conditioner or laundry detergent. Many mothers find avoiding unnecessary products or using a different product improves things. Reading packaging can help avoid problems with common irritants such as lanolin and perfumes. Use fragrance-free products whenever possible. Be aware that herbals can also be allergenic and irritant - being natural does not necessarily mean a product is any less irritating. Hay fever symptoms and other ear, nose and throat symptoms can be caused by spring and summer pollens and other airborne allergens such as dust.

Identifying the problem food

If your baby is having only your milk
Food allergens in the mother's diet can pass through into the breastmilk so a breastfed baby can have an allergic response or intolerance to something in the mother's diet.

Consider:

Are you taking any laxatives, medicines, vitamins, iron tablets or other supplements?

Do you drink lots of caffeinated drinks? Coffee, cola, tea and some pain relievers, cold remedies, weight control aids and diuretics contain caffeine. Chocolate contains a substance called theobromine that can have a similar effect to caffeine if you eat a lot.

Have you recently eaten a new food or any particular food in large amounts?

Are there any foods that you don't like but have decided to eat during pregnancy or breastfeeding because you think they will be good for you and your baby?

Are there foods that you crave? What foods do you snack on when you have a bad day?

Depending on how sensitive your baby is, removing or cutting down on the offending items in your diet may well solve the problem.

If your baby is also having infant formula or solids
The majority of babies don't need anything other than mother's milk before about six months - no infant formula, drinks or solids. Babies who have started solids can be sensitive to certain common foods until they are a little older.

Consider:

Could your baby be reacting to the drinks or solid foods he is having?

Is he on any medication or vitamin supplements?

Could he be receiving other drinks such as infant formula or juice, or solid food, from anyone else without your knowledge?

Infant formula or follow-on formula is usually cow's milk-based and a common, avoidable cause of allergy. Babies do not need follow-on formula at all.

Removing the offending food from your baby's diet for now should solve the problem; they may be able to tolerate it in a few months time. If you think your baby may be reacting to a prescribed medication that they have to take, speak to your doctor, who may be able to prescribe an alternative.
Common problem foods which may be eaten by a baby or a breastfeeding mother include:

Milk and other dairy products such as butter, yoghurt, cheese, whey, casein, caseinate, lactose

Egg

Peanut

Soy

Wheat

Fish

Sesame seeds (in tahini and hummus)

Lupin/lentils (including chickpeas which are in hummus)

Shellfish; crustaceans (e.g. crab, lobster, crayfish, shrimp, prawn), molluscs (e.g. mussels, oysters, squid)

Fenugreek is closely related to peanuts

Tree nuts (almonds, hazelnuts, walnuts, cashews, etc.)

Celery and celeriac

Mustard

Common foods that can be involved in intolerance or irritation but not usually allergy:

Sulphur dioxide and sulphites, benzoates, glutamate, salicylates, dietary amines

Citrus fruits, strawberries, tomatoes

Certain additives, artificial colourings, flavourings and preservatives

These can turn up in the most unexpected places so do check everything consumed including drinks and medicines. For example, some juice drinks contain milk, and wine can contain milk, egg or sulphites.

Cutting out suspected foods

If your baby is exclusively breastfed, you may need to follow an elimination - reintroduction diet. It can help to keep a food and symptom diary.
When eliminating major food groups take care to ensure you continue to eat a healthy and balanced diet. Your GP may be able to refer you to a dietician if you wish.
Only cut out one food at a time and allow 2-4 weeks to see if your baby's symptoms improve. If there is no improvement in this time, then the food is unlikely to be the culprit and can be reintroduced. Consider cutting out a different food.

If symptoms do improve, reintroduce the food slowly to confirm the food allergy. However, if your baby has previously experienced a severe or immediate reaction, ask your GP for specialist support before reintroducing the food.

Note: Usually a cow's milk protein allergy (CMPA) predicts an allergy to other animal milks (e.g. goat or sheep milk), and in some cases soya. If you plan to cut out dairy you may wish to cut out other animal milks and soya at the same time, then reintroduce them each individually.
Seek immediate medical help if your baby has shown anaphylactic signs, such as a rapidly developing rash, breathing difficulties, or swelling.
A note on eczema

Elimination - reintroduction diets should not be done due to the presence of eczema alone.
Some children who have a food allergy do have eczema, but most children who have eczema do not have a food allergy. If the only symptom is eczema it is unlikely to be caused by a food allergy. It is worth noting that frequently eating a particular food may mean a baby learns to tolerate it. If the food is stopped, for example during an elimination diet, there is a risk that tolerance may stop and an IgE mediated allergy (including possible anaphylaxis) can form. If you think your baby's eczema is due to a food allergy it is best to speak with your GP about allergy testing or to get referred to an allergy specialist.

Introducing solid foods

Human milk contains tiny traces of whatever foods a mother herself has been eating. This is the ideal way to prepare a baby gently for the eventual introduction of solids. The best foods for your baby are usually healthy foods selected from your diet. Solids can be introduced when your baby can sit up (with or without support) and starts reaching out for the food on your plate. For more information, see Starting Solid Food.

If your baby is under the care of a paediatrician for allergies, talk to your specialist team about how to introduce specific allergenic foods.

Body tolerance levels can change

Being allergic or intolerant to something means that your body is sensitised to it, but the symptoms you display may vary in each particular instance; sometimes you may not display any symptoms. Your body's allergen tolerance level changes based on many factors including stress and your general health, so its ability to react to immune threats also varies. If your immune system is affected by more stressors than usual, you may show symptoms of an allergy/intolerance more readily.

Seek support

It can be quite an effort to be an allergy detective with a fussy baby on your hands, so seek information and support. The good news is that small changes to your diet could make a big difference to a baby with a food allergy or intolerance.

An LLL Leader can help you determine the most likely cause of your baby's symptoms. Local LLL groups are great for practical and moral support and you may find others there who have had similar experiences. Your GP or health visitor can help diagnose food allergy and refer you to specialist services for testing and advice.

Did you know?

If a baby reacts when their mother drinks milk or has dairy products, this is a sensitivity to cow's milk protein, not lactose intolerance.

Most infant formulas contain cow's milk, often referred to as whey based or casein based.

Soya, the basis of some infant formulas, is also a common allergen.

Infant formula may contain fish oils and vegetable oils (e.g. palm, rapeseed, coconut, sunflower).

Medicines and supplements can contain other ingredients that are potentially allergenic.

If you or a member of your immediate family has an allergy or intolerance, your baby is more likely to have one too.

FAQs

Q. Do I have to give up breastfeeding if my baby is allergic to something in my milk?
A. No; eliminating the offending food from your diet will remove the allergen from your breast milk enabling you to continue breastfeeding if you wish to. See section Cutting out suspected food.

Q. Will my baby outgrow his food allergy?
A. Possibly; some children do, some do not. Children are most likely to grow out of cows' milk, egg and soy allergies.

Q. I thought I was not meant to feed my baby egg/peanut/etc. until they were over 1 year old?
A. This was old advice. Recent research shows introducing allergenic foods from around 6 months old may help the baby to learn to tolerate the food. Introducing the food later can make it more likely that the baby will develop an allergy to the food.

Q. What's the difference between cow's milk protein allergy (CMPA) and lactose intolerance?
A. True lactose intolerance (reduced capacity to digest lactose) is very rare in babies and is diagnosed within days of birth. Temporary lactose intolerance or lactose overload (too much lactose for the baby to digest) can cause tummy symptoms similar to an allergy. Lactose is produced in the breast, regardless of the mother's diet. Seek support if you suspect your baby has symptoms of lactose overload. CMPA is an immune reaction and can cause symptoms in many body systems. Breastfeeding mothers of children with CMPA generally need to exclude all cow's milk protein from their diet - including milk, cheese, yogurt etc. See section Cutting out suspected food.

Q. Should I avoid eating a food my baby is allergic to if I become pregnant again?
A. No; as long as you are not allergic to it and it is not one the foods you usually need to avoid in pregnancy (such as undercooked meat) eating a particular food in pregnancy has no effect on the development of allergy.

Q. Is my baby allergic to a food because I ate it whilst pregnant?
A. No; eating a particular food in pregnancy has no effect on the development of allergy.

Q. If I have another baby will it develop allergies too?
A. Possibly; if you have a sibling with allergies you are more likely to be genetically predisposed to develop allergies. However, having an older sibling decreases the risk of developing allergy.

Written by Sue Cardus, Robyn Halliday and mothers of La Leche League Great Britain
Endnotes

1. Andreas, N., Kampmann, B., Le-Doare, K. Human Breast Milk: A review on its composition and bioactivity. Early Human Development, 2015; 91 (11): 629-635.

2. Muraro, A et al. EACCI Food Allergy and Anaphylaxis Guidelines. Primary prevention of food allergy. Allergy, 2014;69(5):590-601.

3. NICE Guideline [CG116]. Food allergy in under 19s: assessment and diagnosis, 23rd February 2011, https://www.nice.org.uk/guidance/cg116 (accessed 26th Jul 2020).

4. NHS. Contact dermatitis, https://www.nhs.uk/conditions/contact-dermatitis/causes/ (accessed 26th Jul 2020).

5. Muraro, A et al. EAACI Food Allergy and Anaphylaxis Guidelines. Diagnosis and management of food allergy. Allergy, 2014; 69 (8): 1008-25.

6. Young, M. Editorial: Elimination Diets in Eczema-A Cautionary Tale. JACI: In Practice, 2016; https://www.jaci-inpractice.org/article/S2213-2198(15)00573-5/pdf

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
BREASTFEEDING ANSWERS - A GUIDE
FOR HELPING FAMILIES: SECOND EDITION.. Mohrbacher, N. Nancy Mohrbacher Solutions inc., 2020.
MILK MATTERS: INFANT FEEDING AND IMMUNE DISORDER. Minchin, M. Geelong: Alma Publications, 2015.
BREASTFEEDING WORKS! EVEN WITH ALLERGIES. Noble, R. Brisbane: Complete Publishing, 2017.

Online information:
LLLGB website
Unicef Research on Allergies
NICE Guideline [CG116]. Food allergy in under
19s: Assessment and Diagnosis
GP Infant Feeding Network: Cow's Milk Allergy
National Eczema Society
Anaphylaxis Campaign
CMPA Support

You can buy this information in printed form from our shop.

Copyright LLLGB 2022

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Allergies & Food Intolerances - La Leche League GB

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Some babies have allergies or food intolerances.

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sandwellbfn | Instagram, Facebook | Linktree

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Impartial, evidence based information and support for Sandwell families.

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The Breastfeeding Network | Independent Breastfeeding Support

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The Breastfeeding Network (BfN) is an independent source of support and information for breastfeeding women and others.

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Sandwell and West Birmingham Hospital's NHS Trust commission The Breastfeeding Network charity to provide free, non-judgemental, evidence-based information to all Sandwell families.

Our friendly peer support team can help with establishing and continuing breastfeeding, expressing, bottle feeding, weaning from breastfeeding and introducing solids. All Sandwell families are welcome to access our service. We will support you in your feeding choices. Whatever your question, or if you just want to chat to someone please get in touch.

Website
https://sway.office.com/AV3vLL0ZqlErecU4
Type of services available

Interactive antenatal workshops

1:1 Telephone/video support

Face-to-face sessions

Virtual drop-in groups on Zoom (please refer to drop-in locator)*

Breastfeeding support at Barnardos Baby Clubs (please refer to drop-in locator)*

Walking groups

Contact details

Social media and other links

Please be aware that emails and messages to our Facebook page will be seen by a small team of peer supporters.

Supporters / Funders

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Sandwell and West Birmingham Hospital's NHS Trust commission The Breastfeeding Network charity to provide free, non-judgemental, evidence-based information to all Sandwell families. Our friendly peer support team can help with establishing and continuing breastfeeding, expressing, bottle feeding, weaning from breastfeeding and introducing solids. All Sandwell families are welcome to access our service.

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National Breastfeeding Helpline - Helpline

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Infant Feeding | Sandwell and West Birmingham NHS Trust

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You are here: On this page Breastfeeding is normal, natural and the healthiest way to feed your baby but it is not always easy. This is especially true if you do not get the right support.

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You are here:

On this page

Health visitors are registered nurses/midwives who have additional training in community public health nursing.
The Health Visiting Service is rated as Outstanding by the Care Quality Commission.
In Sandwell, health visitors work from bases in each area of Sandwell. The team includes community nursery nurses, staff in training and administrative assistance from our health visiting contact centre. Each team is lead by a team leader.

Health visitors work with other professionals as part of the Primary Healthcare Team. These include GPs, Midwives, Early Years Workers and Children's Centre staff.

Services

Health visitors work with parents and carers who have new babies, offering support from the antenatal period until your child starts school at five years. Health visitors may see you at home or in clinics and invite you to join groups and networks run by either us or our colleagues such as nursery nurses or children's centre staff.

Every GP practice in Sandwell has a named health visitor.

We offer advice and information on a wide variety of health issues in order to promote and encourage healthy lifestyles for you and your family. We offer developmental reviews of your child for early detection of any problems. To address any concerns you may have and provide appropriate advice and support.

Each family can expect as a minimum five contacts.
These are:

Antenatal contact

Postnatal visit between 10-14 days of birth

Six to eight weeks after delivery

Nine to 12 months

Two to two-and-a-half-year-old

Health visiting teams provide four levels of service:

1. Community - services provided in the local community.

2. Universal - contact at key stages offered to all families.

3. Universal Plus - support when you need it.

4. Universal Partnership Plus - ongoing support for families/children

Health visitors can provide help with a wide range of issues related to the health and wellbeing of your children. In addition to this, we can provide support and advice for a range of public health issues such as:

Stopping smoking

Postnatal depression

Domestic abuse

Safeguarding advice

Contraception and sexual health

SEND and identifying needs

Developments are offered to all children via the Ages and Stages Questionnaire (ASQ) with enhanced screening using Schedule of Growing Skills (SOGS) when indicated. In addition, screening support can be provided by a specialist speech and language therapist, who is embedded in the service to support early identification of Speech, Language and Communication Needs (SLCN) and signposting to available resources via the website:

All early year settings, including nurseries, childminders, and family hub practitioners have access to WellComm Screening training and resources to enable early identification of SLCN and provide early intervention and support to parents until the referral from ISEY is accepted

Health visitor referrals into the Inclusive Services Early Years (ISEY) provides access to support for children and their parents.

Early Help

When we all need extra help:

At times, we are required to take a partnership approach, particularly at times when it is difficult for one single agency to deliver effective support. This means we work alongside a number of services to help you, your child and family.

We would do this to:

Provide effective whole family support' to prevent escalation into statutory services, to ensure families thrive, build resilience and have ambition.

Create the space for services to work together proactively, identifying and solving problems rather than reacting to crisis.

Take action to support you and work with you and your family as soon as a problem emerges. This can be at any stage of your child or families life and we're here to help when you can no longer cope on your own.

Help your family achieve its full potential.

Our goal is to improve the quality of family life, help children and young people have the best possible start, and to enable children to be safe from harm, happy, healthy and learn.

The Best Start Programme

This service helps pregnant women with their physical and emotional health, as well as those women in their first year of motherhood.

They receive practical tips on their parenting skills, and advice on how to strengthen relationships with close family and friends, including their baby, which in turn ensures that their child will achieve their full potential. Women taking part will be offered six home visits in the antenatal period and 12 home visits from birth to one year. In certain circumstances the Best Start Programme can continue until the child's second birthday.

The clinic is based at Yew Tree Healthy Living Centre, Redwood Road, Walsall, WSS 4LB.

For more information about the Best Start Programme email swbh-tr.SWBH-GM-FNP@nhs.net or call 01922 423 001.

Baby Clinics

Baby clinics are held throughout Sandwell.

Currently, baby clinics are by appointment only. If you are concerned about your baby or your baby's weight, please call the contact centre on 0121 612 5021. You will then be referred to your local health visiting team who can arrange a suitable appointment.
Self-weigh and Go
Self-weigh is also available at our baby clinic venues, which can be used when there are no concerns and you just want to see how heavy your baby is. Clear guidance is provided on how to do this at the clinic venues. These are 'drop in' sessions.

Mums visit our health visiting clinic, at Wednesbury North Children's Centre.

Clinic Timetable

Clinic

Date/Time

Contact Details

Happy Faces Children's Centre, Windsor Road, Rowley Regis, B65 9HU

Mondays:
9.30am - 12.15pm

Appointment only by calling 0121 612 5021

Tipton Family Hub, 24 Ridgeacre Road, Tipton, DY4 0UB

Tuesdays: 9.30am - 12pm

Appointment only by calling 0121 612 5021

The Lyng Centre, Frank Fisher Way, West Bromwich, B70 7AW

Wednesdays: 9.30 - 11.30am

Appointment only by calling 0121 612 5021

Friar Park Children's Centre,
Priory Family Centre, Dorsett Road, Wednesbury, WS10 0JG

Thursdays: 9.30 - 11.30am

Appointment only by calling 0121 612 5021

Smethwick Family Hub, Corbett Street, Smethwick, B66 3PX

Thursdays: 9.30am - 3.30pm

Appointment only by calling 0121 612 5021

Hillside Community Centre, Connor Road, West Bromwich, B71 3DJ

Fridays (second and fouth day of the month): 9.30am - 12.15pm

Appointment only by calling 0121 612 5021

Oldbury Health Centre, Albert Street, Oldbury, B69 4DE

Fridays: 10 - 11.30am

Appointment only by calling 0121 612 5021

Help and Support

Useful Websites and Organisations

Black Country Women's Aid

The organisation supports survivors of domestic abuse and sexual violence. See below for contact details.

0121 553 0090 (9am-5pm) for advice or access to support services.

0121 552 6448 24 hour helpline for advice or seeking a refuge placement out of hours.
999 for anyone in immediate danger.

Children's Therapies

The Children's Therapy and Nurse Service is an integrated service consisting of Community Children's Nurses, Occupational Therapists, physiotherapists, and Speech and Language Therapists.

Weaning Advice

Current guidance recommends introducing solids to your baby from around six months of age, giving breast milk or first stage infant formula for the first six months. These will provide all the nutrients and energy your baby needs for the best start to life. When starting weaning at six months introduce a variety of vegetables, fruit, and protein rich food such as meat, fish, beans and cooked eggs. Starchy foods such as potatoes, bread, rice, pasta and pasteurised dairy products like full fat plain yoghurt and cheese. Please see meal plan ideas in the web links section, or visit http://www.nhs.uk/start4life/first-foods or the building blocks brochure.

More information can be found from First Steps Nutrition who have produced a good guide to what young babies and children should be eating and drinking. It also discusses portion sizes.

If you like see a structured weaning plan, the Dairy Council have devised the following meal plans that you can follow:

Older babies and their diet
As your baby gets older you can introduce more things to their diet. You can also gradually make the food less runny. The website discusses feeding children of other age ranges too.
Vitamins
If your baby is formula feeding at the age of 1 year, you can now give them full fat cow's milk to drink instead of formula. You would also need to give them vitamin D daily; your pharmacist can advise you which product is best for your child. If you are breast feeding continue to give vitamin D daily.
Looking after your child's teeth
As soon as your child's teeth start to come through, you can start brushing them. Use a baby toothbrush twice a day with a tiny smear of fluoride toothpaste. Try to protect their teeth by avoiding fruit juice and sugary and fizzy drinks. Water or milk are the best drinks for your child. Find out more here.

Contact Centre

The Health Visiting contact centre is your first port of call if you need to speak to the team.

Your call will be answered by a member of the administration team, who will take your details and a message. This will then be forwarded to your Health Visiting team, and a member of the team will return your call to help with your query.

Call the team at: 0121 612 5021.

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Health Visiting | Sandwell and West Birmingham NHS Trust

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You are here: On this page Health visitors are registered nurses/midwives who have additional training in community public health nursing. The Health Visiting Service is rated as Outstanding by the Care Quality Commission. In Sandwell, health visitors work from bases in each area of Sandwell.

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Log into Facebook to start sharing and connecting with your friends, family, and people you know.

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Supporting parents and tiny humans with the science of human milk

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A mothers story:

I knew I wanted to breastfeed my baby. I knew it was natural. So I was surprised when baby James and I could not seem to get the hang of it. I phoned a Breastfeeding Supporter. She gave us some good ideas about how I was sitting and holding James. But most of all it was good to have someone to talk to."

There are many reasons to breastfeed, but the simplest and most obvious one is "because you want to!" Your breasts have evolved to produce food for your baby, and if you want to use them for that purpose, you don't need any other explanation. However, breastmilk is amazing, and some of the other great reasons for breastfeeding are described below.

Breastfeeding supports bonding, parenting and your baby's development

Breastfeeding releases lots of a hormone called oxytocin (sometimes nicknamed "the love hormone") in your baby and you. This helps you to form a loving bond, feel calm, relaxed and happy. It also helps your baby's brain to grow and develop, which happens at an incredible pace in the first months of life. It is impossible to overfeed a breastfed baby, so breastfeeding can be used to sooth your baby, help them sleep, spend time together or rest whenever you want. Breastfeeding is a two-way relationship that supports both you and your baby emotionally.

You can learn more about this on these pages:

UNICEF leaflet: Building a happy baby, a guide for parents

UNICEF video: Breastfeeding and relationships in the early days

Parent-Infant Foundation: The first 1001 days

Health

Department of Health guidance states breastfeeding is the healthiest way to feed your baby. Exclusive breastfeeding (giving your baby breast milk only) is recommended for around the first six months (26 weeks) of your baby's life. After that, giving your baby breast milk alongside other food will help them continue to grow and develop. The World Health Organisation (WHO) and UNICEF recommend breastfeeding alongside other foods to age two and beyond.

Breastmilk contains all the nutrients your baby needs for the first six months. It is much more than just food: it is also a living fluid, full of antibodies and other bioactive factors that strengthen your baby's developing immune system, providing protection against infection, and other factors which help them digest nutrients. These living components are not found in infant formula.

You can read more about the many different components of breastmilk on this NHS page and also visit www.human-milk.com for lots more information.
Not breastfeeding increases various health risks for both mother and baby.
Babies who are not breastfed have an increased risk of:

infections, with more visits to hospital as a result

diarrhoea and vomiting, with more visits to hospital as a result

sudden infant death syndrome (SIDS)

obesity

cardiovascular disease in adulthood

Mothers who do not breastfeed have an increased risk of:

breast cancer

ovarian cancer

osteoporosis (weak bones)

cardiovascular disease

obesity

You can read more about how breastfeeding is linked to health on the NHS website.

Cost

You don't have to pay for breastmilk and breastfeeding does not usually need any special equipment. The cost of exclusively feeding infant formula for six months and continuing to provide it alongside other food until 12 months ranges from approximately £33 a month for the cheapest available powdered infant formula to around £80 a month for one of the most widely available brands ( First Steps Nutrition, data from November 2022. Note; all first infant formula sold in the UK is nutritionally equivalent. There is no need to purchase a more expensive brand). In addition, formula feeding requires bottles and teats which must be sterilised in between each use, and powdered infant formula must be mixed with boiled water that is at least 70 degrees C. Infant formula can also be purchased in pre-mixed cartons, which are more convenient, but these are much more expensive than powdered infant formula.

Breastfeeding mothers may choose to use a breast pump and bottles to feed expressed milk, to wear special breastfeeding clothes or to buy breastfeeding pillows or other accessories. These things can be helpful, but it is usually possible to breastfeed without them.

Convenience

Breastmilk is always available immediately, at the correct temperature, with no preparation required, at any time of day or night. It doesn't need to be mixed, heated or cooled, it doesn't go off in the breast and it won't be wasted if your baby decides they only want a small feed.  At night-time, you can breastfeed without getting out of bed!

Breastfeeding may feel challenging at first, and to begin with you may feel like you can only do it in a particular place, but once they get the hang of it, many mums find they can breastfeed almost anywhere, and whilst doing other activities.

Of course, breastfeeding means that you will be the only one who is able to breastfeed your baby, and this can sometimes feel overwhelming. However, even if you bottle-feed, UNICEF says that babies feel more secure if feeds are only given by the main caregivers, which helps them to bond. Once breastfeeding is established, some parents decide to introduce an occasional bottle, which can be expressed breastmilk, to give the mother more flexibility to be away from her baby for short periods of time. See our page on introducing a bottle for more information.

Environment

Breastmilk is the ultimate sustainable food. Breastfeeding has a very small carbon footprint compared to formula feeding. Infant formula is made from cows milk which must be processed, packaged, transported, stored and fed using bottles. Breastfeeding doesn't generate any waste. You can read more about this here.

Culture

Breastfeeding is more common in some cultures and communities than others. You may want to breastfeed because it is the norm in your community or cultural setting. By contrast, some mums may choose not to breastfeed, or may find breastfeeding challenging, because it is not so common within their community. However, there are breastfeeding support groups in most places in the UK which let you socialise in a place where breastfeeding is normal. These groups can give you practical and emotional support to help you continue breastfeeding. Check out our local groups here or contact the National Breastfeeding Helpline to find a group local to you.

Speak to a registered Breastfeeding Supporter

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Why breastfeed? - The Breastfeeding Network

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A mothers story: I knew I wanted to breastfeed my baby. I knew it was natural. So I was surprised when baby James and I could not seem to get the hang of it. I phoned a Breastfeeding Supporter. She gave us some good ideas about how I was sitting and holding James.

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The image above lists the key ways in which the constituents of breastmilk or human milk work to protect infant health.
Key points

Even the basic nutritional constituents vary greatly between human milk and infant formula. Breastmilk contains many more live constituents that promote health.

Water: We are very lucky to have access to clean water in UK, but occasionally climate issues like floods, accidental over use of cleansing products, or fluorine can sometimes contain contaminants. Breastmilk water is filtered at source.

Protein: Protein in breastmilk is more whey based (60-80%) and easier to digest and the main protein, alpha lactalbumin, which makes up 20% of the total protein, has been associated with the destruction of over 40 types of cancer cells including bladder and brain. Protein in formula (cows' milk protein) has been associated with an increased risk of a baby developing juvenile onset diabetes.

Carbohydrates: Lactose is the primary carbohydrate in breastmilk and provides around 40% of the total calories. Lactose is also more prevalent in UK formula but you may also see sucrose, fructose and glucose in some soya or lactose free formula.

Fats are essential for brain development and absorption of fat soluble vitamins, and are a major calorie source. The long chain polyunsaturated fatty acids (LCPs) which naturally occur in breastmilk support the development of the entire nervous system including retinol development (improved eyesight) and there is some evidence of a link to improved IQ. Fats in formula tend to change depending on the market - currently they are mainly vegetable such as rapeseed oil, sunflower oil, coconut oil and algal oil, but some contain egg (egg phospholipid anhydrous milk fat) or fish oil.

Vitamins and minerals are essential for the health of our bodies from healing wounds and supporting bone growth to bolstering the immune system. In formula milk extra vitamins and minerals are added to the powder to ensure they are sustained for the entire shelf life (six months to a year), so amounts will vary accordingly.

Growth factors: Epidermal, insulin and transforming factors which promote gut growth. The epidermal growth factor is higher in the milk of mothers who have preterm babies, and it is linked to a reduction in Necrotising Enterocolitis (NEC) and other inflammatory responses. There is some evidence that growth factors also play a role in early life programming and so may be associated with a reduced risk of obesity and cancer in later life.

Transfer factors enable effective absorption of nutrients in the milk e.g. lactoferrin, which assists with the absorption of iron, and in so doing reduces the amount of free iron which attracts bacteria. Lactoferrin is also bactericidal e.g. it kills E.coli bacteria. There are also transfer factors that help with the absorption of fats and vitamins.

Stem cells: an internal repair system - these cells have the ability to develop into many different cell types. There is some evidence that these cells remain in the system long after breastfeeding has stopped. Scientists are looking at their potential for treating conditions such as leukaemia, diabetes, spinal injuries and Parkinson's.

Immunoglobulins: IgA, IgG, IgM and IgD, the most important is IgA, which provides a protective coating to the baby's gut; it covers the mucosal gut surface to prevent entry of pathogenic bacteria and enteroviruses (E Coli, Salmonella, Streptococci, Staph, pneumococci, rotavirus etc.), protecting against gastroenteritis, respiratory infections etc. Please see slide 11 for an explanation of how a mother provides up to date antibodies to her baby.

Leukocytes destroy harmful bacteria. One type, called macrophages, also produce lysozyme, an enzyme which destroys bacteria by disrupting the cell wall.

Oligosaccharides: More than 200 types of simple carbohydrates are found in breastmilk. These influence the development of the microflora by increasing the number of beneficial bacteria found in the baby's gut and in so doing they protect the baby against infections e.g. otitis media, respiratory, urine and gastrointestinal.

Milk lipids damage the outer surface of certain virus types, reducing infection rate in the baby.

Enzymes aid digestion and absorption and some destroy bacteria.

IL-7 is linked to the size of the thymus which is a central organ in the immune system. Breastfed babies have a much larger thymus than formula fed babies, which demonstrates a stronger immune system. IL-7 also has a role in stimulating antibody producing cells. It is also considered to play a part in reducing the risk of childhood leukaemia.

Cytokines: Another important constituent for boosting immune system.

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Baby Milk Constituents - Milton Keynes University Hospital

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The image above lists the key ways in which the constituents of breastmilk or human milk work to protect infant health. Key points Even the basic nutritional constituents vary greatly

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ABM are a group of trained volunteers dedicated to supporting breastfeeding mums and their families. We’ve been supporting mums and nurturing families for almost 40 years. We’d love you to join us. Become a member of the ABM and help us continue our work.

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Expressing your milk by hand is a useful skill to have. It may take a bit of time and practice, but once you've mastered it, you'll find it's very helpful.

And the great thing is you only need your hands and a container - rather than a shop-bought breast pump.

Hand expression can be useful in various situations, for example if your baby isn't feeding or latching on well, if you want to stimulate your milk production, or if your breasts become engorged (this is a good way to relieve them).

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Expressing breast milk by hand - Start for Life

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Watch our video and read our step-by-step guide to expressing breast milk by hand.

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

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

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

Further reading

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Infant formula and responsive bottle feeding - Baby Friendly Initiative

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

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Unicef UK Baby Friendly Initiative | Positioning and attachment

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Unicef UK Baby Friendly Initiative | Breastfeeding and Relationship Building

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Unicef UK Baby Friendly Initiative | Meeting baby for the first time

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1. Cradle hold

This is the probably the most popular breastfeeding position.

However, if you've had a caesarean, it may be uncomfortable because your baby lies across your tummy near the scar (try lying on your side or the rugby hold instead).

For the cradle hold, sit in a comfy chair with arm rests, or a bed with cushions or pillows around you.

1. Lie your baby across your lap, facing you.

2. Place your baby's head on your forearm - nose towards your nipple. Your hand should support the length of their body.

3. Place your baby's lower arm under yours.

4. Check to make sure your baby's ear, shoulder and hip are in a straight line.

Cradle hold tip

If you're sitting on a chair, rest your feet on a stool or small table - this will stop you from leaning forward which can make your back ache.

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Breastfeeding positions - Start for Life

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Find out about the different ways you can breastfeed with our step-by-step guide to breastfeeding positions.

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How do I know I’m holding my baby in the right position to breastfeed?

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5 ways to make feeding comfortable for you and your baby

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How to breastfeed comfortably | Infant Feeding Team

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There are several ways in which a baby's sleep affects their own health and that of their parents. The links in the left-hand navigation provide further information on these issues.

Sudden Infant Death Syndrome (SIDS, or cot death) is perhaps the most well known of these, but sleep related accidental deaths and injuries also happen, and non-accidental harm can occur to infants in sleep-related settings. Lack of sleep related to caring for a baby can also affect parents' health, particularly in the case of depression and accidents.

SIDS is the name given to the unexpected death of an infant for which there is no known cause. Such deaths commonly occur during sleep and can happen wherever babies sleep. No sleep environment is 100% risk-free, however there are well known ways to reduce a baby's risk of SIDS. This information used to be provided to all UK parents in the Department of Health leaflet 'Reduce the risk of cot death' which has now been discontinued. Many NHS Trusts now give parents the latest Safe Sleep Guidance from the Lullaby Trust, or the UNICEF Baby Friendly leaflet 'Caring for your baby at night', but some NHS trusts and local Safeguarding Boards issue their own recommendations.

Safe sleep guidance also covers keeping babies safe from sleep-related accidents. Accidents can occur wherever babies sleep, and parents need to be aware of their baby's sleep environment. See SIDS & Safety for more information.

Babies can also be at risk when tiredness and frustration spill over into anger in situations where carers are sleep-deprived and/or infants cry inconsolably. Many parents experience momentary feelings of helplessness and desperation, especially when trying to cope alone. We provide links to strategies for coping and sources of help and support. Please note, however, that we do not cover clinical issues and a qualified health practitioner should be consulted for guidance.

For more detailed information on all these topics, see the health practitioners section.

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There are several ways in which a baby's sleep affects their own health and that of their parents. The links in the left-hand navigation provide further information on these issues. Sudden Infant Death Syndrome (SIDS, or cot death) is perhaps the most well known of these, but sleep related accidental deaths and injuries also happen, and non-accidental harm can occur to infants in sleep-related settings.

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Breastfeeding at night is one of the most discussed topics at La Leche League meetings, both in person and online. This is often because breastfeeding at night, especially in the early days, can be so important to establishing a successful breastfeeding relationship. It is also because of its inextricable link with the topic of sleep, which can be one of the biggest changes many mothers and families experience when they have a new child.

There is no doubt that caring for a new baby can be exhausting, especially if you feel you are not getting enough sleep. Understanding why breastfeeding at night is so important can help. There is a huge amount of both reliable and rather less reliable information on the internet and in countless parenting books about what infant sleep 'ought' to be like, and therefore what infant night-time feeding 'ought' to be like. This article is designed to give mothers and parents the information and reassurance they need to inform their own night-time breastfeeding approach, including some helpful tips on how to get more rest when you can.

Breastfeeding at night in the early weeks and months is normal and important

Babies wake to feed at night in the early weeks and months (and often beyond) for a number of important reasons. Breastfeeding at night is a vital part of establishing and maintaining a good milk supply and ensuring that newborn babies get all the milk they need to grow and thrive. Breastmilk works on a supply and demand basis: the more milk that is removed, the more milk your breasts make. For the majority of mothers, this means milk needs to be removed roughly every 2-3 hours in the early weeks. Although some babies may sleep for slightly longer periods overnight, perhaps 3-4 hour stretches, newborn babies will typically wake several times a night to feed. This also helps to ensure that you don't get engorged breasts, which may lead to blocked ducts or mastitis.

Newborn babies often wake to feed because their bodies have signalled that they are hungry. However, newborns (and babies and children of all ages) also wake at night for many other reasons, including being scared or uncomfortable, being hot or cold, feeling the need for comfort and connection, and so on. As adults, we have developed ways of meeting these needs ourselves - adjusting a pillow, having a sip of water, cuddling our partner. As babies have no way of independently meeting these needs, they rely on their mother or parent to meet them. Breastfeeding at night offers mothers a way of easily and conveniently meeting the vast majority of these needs in one go.

Lots of research shows that night waking is the biological norm for babies. You can read more about it here as well as in Sweet Sleep, La Leche League International's exhaustive publication on nights and naps for breastfeeding families. Research also shows that, overall, breastfeeding mothers get more sleep than mixed- and formula-feeding mothers. This is for a number of reasons, including the impact of natural hormones and chemicals released for baby and mother when breastfeeding at night. There is also a perception that babies who have formula milk sleep longer than breastfed babies. Evidence shows this is not the case. "Despite the common perception that supplementing an infant's diet with formula milk or solid food will promote sleep, a recent study found that there was no difference in the frequency of night waking between breastfeeding and formula feeding infants aged 6-12 months old. Infants who received more milk or solid feeds during the day were less likely to feed at night but not less likely to wake."

Breastmilk at night

Research shows that breastmilk changes all the time, in response to all sorts of things, like the needs and health of your baby, temperature, and the time of day. For most mothers, breastmilk will gradually increase in fat content throughout the day. During the evening, young babies often cluster feed, taking in frequent feeds of this fattier milk, which tends to satisfy them enough to have their longest stretch of sleep. This cluster feeding in the early months may go on late into the evening when you were hoping you would be asleep, which can naturally feel exhausting.

Overnight, your prolactin levels - the hormone designed to support milk production - are at their highest. So, when your baby feeds frequently at night, the message to your body to boost milk supply is even stronger. Breastmilk at night is also high in the amino acid tryptophan, which in turn helps your baby to make melatonin, which is used by the body to develop its circadian rhythm (our internal system for recognising the difference between day and night) and to sleep better. Hormones produced while breastfeeding also help you to relax and fall more quickly back to sleep, which may be why you find yourself nodding off so easily while breastfeeding.

Given the fact that the hormones in night-time breastmilk help you and your baby to get back to sleep quickly, feeding babies to sleep is completely natural. A mother and baby's bodies are designed to work in tandem this way. Breastfeeding your baby to sleep helps baby feel calm, safe and secure. Over time, babies stop falling asleep at the breast so easily, and eventually all babies or children stop needing the breast to fall asleep. Sleep is not a taught development, and all children get there in their own time. So, while breastfeeding to sleep continues to work, many mothers find it a wonderful, loving and responsive way to help their children doze off.

Breast-sleeping / Co-sleeping

Safely sharing a bed with your baby, or having your baby sleep very close to you in a sidecar cot or similar, is one way of getting more sleep and rest. The majority of other mammals sleep with their young, and our own infants are hard-wired to expect this too. For many breastfeeding mothers, learning to feed lying down and being able to fall back asleep safely with baby is when things start to feel a lot more manageable at night. Some mothers may start out nursing their babies at night sat up in bed, but many soon find that mastering breastfeeding lying on their side can really help everyone to get more sleep, especially as baby gets a bit older and can latch on by themselves. Mums can feed from both breasts when lying on one side by simply tilting their body forwards more. The same principles for getting a comfortable, deep latch apply when side-lying as when feeding upright. It may take a little practice, but overall it's easier and less disruptive for both mother and baby at night. Research shows that breastfeeding tends to be more successful overall for mothers that co-sleep than those that keep their baby separated from them at night. You can read more about how to co-sleep or breast-sleep safely with your baby here

Breastfeeding at night after the early months

Many mothers go through patches where their baby may wish to breastfeed more or less at night, especially within the first year. This will be related to a whole host of reasons, including growth spurts, teething, illness, and learning new skills such as sitting, crawling and walking. Like so much else with babies and children, the frequency of breastfeeds at night is not a linear progression. Phases of increased night feedings are usually relatively short-lived and you may find that co-sleeping is a really valuable tool for managing those phases. Increased periods of waking and breastfeeding around four-six months are very common and are not a sign that your baby is hungry and needs formula and/or solids. You can read more about this in our article 'What happens at four months'

As your baby gets older and bigger, you may find that night feeding becomes much easier. While in the early days you may feel the need to switch on a light or sit up in bed in order to latch your baby comfortably onto your breast, as your baby gets stronger and learns to self-latch, feeding at night can be a simple matter of rolling over and putting the breast near your baby, who will manage the rest. Night feeds often become quicker too. Some mothers use breast compressions as a way of speeding up feeds. Being able to help their older baby back to sleep quickly with a breastfeed helps many mothers get the most sleep.

Coping with the challenges

Knowing that waking at night to breastfeed is positive for our supply and our baby, and that it is the biological norm, can often be reassuring for mothers and parents. Nevertheless, sleep deprivation can be really challenging for many families. It can feel especially hard if your baby is waking more than your friends' babies, or if they are an older baby still waking up more than you had expected.

New parents often get asked about their babies' sleep and their approach to feeding at night. These conversations can sometimes lead to (unwanted) comments about what is normal, what you 'should' be doing, and how to 'fix' things. And if you are feeling really tired or at a low point, you may be thinking that you do need to find a 'solution' and try some of those suggestions. The many unhelpful sources out there setting unrealistic expectations may be undermining your self-confidence as a mother. Perhaps you're wondering what a loving and respectful approach that suits both you and your baby would be?

First, it's important to say that you are not alone. At any point in time there are hundreds of thousands, if not millions, of mothers up and breastfeeding their babies - of varying ages - at night. A turning point for some of them is when they are able to relax their expectations of themselves and their babies a little. Some mothers also find that being constantly reminded of when they have been woken up is actually part of the problem, and they decide to ignore the clock and not to use their phones at night.

Being responsible for all the night-feeds can feel exhausting, or even unfair. Sometimes well-intentioned comments may suggest that a partner or other care-giver could feed the baby at night with a bottle. It can be useful to remember that the hormones in night-time milk make it easier for both you and your baby to get back to sleep quickly. And since the hormones in night-time milk are made at night-time, there is some evidence that giving your baby breastmilk expressed at other times does not always have quite the same effect. It is also sometimes easy to overlook the practicalities of another care-giver taking care of night-feeds. Mothers will often wake up when their baby does anyway, and may struggle to get back to sleep if they can hear their baby being upset while waiting for a bottle to be warmed up. Most mothers will also need to pump or hand express milk during the night to protect their supply and avoid engorgement, so they are often awake anyway during the time their baby is being fed by their partner.

Even though breastfeeding at night may be the responsibility of the mother alone, there are lots of ways to get supported so that things feel easier. For example, sometimes dads and partners get up with the baby first thing in the morning to give mums some extra time in bed, which can make a big difference to how tired they feel. Good communication is really helpful - ask for help with other things where you can and be clear about the kind of support you need. It's OK not to enjoy breastfeeding every second, and it's OK to complain about being tired: that doesn't mean you don't want to do it, so you can explain that asking 'Why don't you just stop?' is not helpful and that you'd rather be asked 'How can I help you find time to rest today?'

If you are really struggling with tiredness, you may want to think of ways to adapt your own routines for a short while to help you get more rest - perhaps sleeping more during the day, or going to bed earlier when your baby has her first 'longer' stretch of sleep. It can also be a great time to join an LLL group meeting with other breastfeeding mothers, as hearing that they are experiencing the same challenges can be really reassuring. Mothers often get bombarded with unrealistic expectations of infant sleep, and it's precisely this misalignment of expectation and reality that can cause stress.

Another challenge that mothers may experience (usually once their baby is a bit older) is a feeling of nursing aversion or irritability, particularly during night-time feeds. These feelings can be very normal and are often linked to tiredness or feeling 'touched out'. You may experience them more when your baby is waking or feeding a lot more frequently, for example when teething or feeling ill. You may also experience these feelings when there is a change in your own hormones, for example, during ovulation or your period. There is some anecdotal evidence that taking magnesium supplements can be helpful. Many mothers describe these feelings as irrational and usually short-lived; they can be a sign that you need to give yourself a little 'self-care' - perhaps asking for some more help during the day so that you can rest or focus on yourself.

Nursing aversion can sometimes lead to feelings of guilt about not enjoying breastfeeding, and make you wonder whether it is a sign you need to stop. There are some helpful information groups on social media where mothers share their nursing aversion experiences, as well as tips and tricks that helped them overcome those feelings. Like anything in life, you may not enjoy breastfeeding every moment of every day; that's OK. Take things one day at a time, listen to your body and your baby.

Stopping breastfeeding at night

Breastfeeding at night meets a baby's needs in a variety of ways. For many mothers, it's the easiest way to settle their baby back to sleep when they wake at night, and they continue to use it for as long as it continues to work. It is not a bad habit and all babies eventually fall asleep and stay asleep without the breast. You may decide that you are happy with breastfeeding back to sleep, but you are feeling pressured by others' expectations about what your baby 'should' be doing.

Some books suggest that after six months babies no longer need night feeds. Not only is this an arbitrary figure, taking little account of the different circumstances of different babies and families, but it also has no evidence to back it up. Sometimes, mothers worry that breastfeeding at night is what is causing their baby to wake up several times. This is not the case. Babies wake for lots of reasons and it is better to think of breastfeeding as a tool that meets the vast majority of those needs. Some sources claim that babies after a certain age don't 'need' breastmilk at night any longer, but breastfeeding goes on meeting a baby's needs for a long time. Many babies will continue to need the calories from night-time breastmilk, as well as all the other comforts that it brings, for some time after six months, and sometimes well beyond.

Some families may feel that their baby is ready to cut some breastfeeds at night or stop breastfeeding at night altogether. Generally speaking, the evidence seems to suggest that night-weaning is best left until after around 18 months. Many mothers find that gently cutting down feeds at this point is much easier, as the baby is learning to talk and the mother can help to explain any changes. There is helpful information about approaches to cutting down night feeds here. Any changes are best approached gradually and respectfully, so that you can preserve the important close connection to the baby at night-time. As your baby gets older, you will discover ways of being responsive to their needs at night that might not include offering your breast every time. For example, you may find that you are able to try other things like rocking, patting and shushing before offering the breast. These may not work initially, but over time, as your baby develops, you may find that in some cases these soothe him back to sleep. As always, you are the expert on your baby and you'll be able to assess whether your child is ready to stop breastfeeding at night, or whether it would be easier to try night weaning later on.

Conclusion

Having a baby, and eventually a toddler, can of course be exhausting. Since responding to your baby's intense needs at night can feel overwhelming, being able to access reliable information about infant sleep and night-time feeding behaviour can help you adjust your expectations. You may be happy breastfeeding your baby back to sleep as often as needed, yet you may feel pressured by well-meaning comments from friends and family about what your baby's sleep 'should' be like. Sometimes spending time with others who understand what you're going through, and who are supportive or your choices, can help you feel confident to make the decisions that work for you. Chatting with other mothers at a La Leche League meeting, in person or online, about what they found helpful, and exchanging ideas for getting more sleep may help you decide what's right for you and your baby. Never forget that you know your baby best!

Written by Rhiannon Butterfield, LLL Cambridge. February 2021

Endnotes:

i Baby Sleep Info Source (BASIS) - Durham University

ii Brown A, Harries V. Infant Sleep and Night Feeding Patterns During Later Infancy: Association with Breastfeeding Frequency, Daytime Complementary Food Intake, and Infant Weight. Breastfeeding Medicine. 2015;10(5):246-252.

iii https://gpifn.org.uk/sleep-and-safe-sleeping/

Further reading:
Safer Sleep and the Breastfed Baby
I need some sleep!
LLLI: Safe Sleep Seven
The reasons why nightwaking is the biological norm
Letting babies cry: the science behind the studies
Sweet Sleep available in our LLLGB Shop

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Breastfeeding at night - La Leche League GB

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Breastfeeding at night is one of the most discussed topics at La Leche League meetings, both in person and online. This is often because breastfeeding at night, especially in the early days, can be so important to establishing a successful breastfeeding relationship. It is also because of its inextricable link with the topic of sleep, [...]

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Some babies sleep much more than others. Some sleep for long periods, others in short bursts. Some soon sleep through the night, while some don't for a long time.
Your baby will have their own pattern of waking and sleeping, and it's unlikely to be the same as other babies you know.

It's also unlikely to fit in with your need for sleep. Try to sleep when your baby sleeps.

If you're breastfeeding, in the early weeks your baby is likely to doze off for short periods during a feed. Carry on feeding until you think your baby has finished or until they're fully asleep. This is a good opportunity to try to get a bit of rest yourself.

If you're not sleeping at the same time as your baby, don't worry about keeping the house silent while they sleep. It's good to get your baby used to sleeping through a certain amount of noise.

How can I get my baby used to night and day?

It's a good idea to teach your baby that night-time is different from daytime from the start. During the day, open curtains, play games and don't worry too much about everyday noises when they sleep.

At night, you might find it helpful to:

keep the lights down low

not talk much and keep your voice quiet

put your baby down as soon as they've been fed and changed

not change your baby unless they need it

not play with your baby

Your baby will gradually learn that night-time is for sleeping.

Where should my baby sleep?

For the first 6 months your baby should be in the same room as you when they're asleep, both day and night. This can reduce the risk of SIDS (sudden infant death syndrome).

Particularly in the early weeks, you may find your baby only falls asleep in your or your partner's arms, or when you're standing by the cot.

You can start getting your baby used to going to sleep without you comforting them by putting them down before they fall asleep or when they've just finished a feed. It may be easier to do this once your baby starts to stay alert more frequently or for longer.

If you use a baby sling to carry your baby, make sure you use it safely. The Lullaby Trust has information about swaddling your baby and using slings safely.

Establishing a baby bedtime routine

You may feel ready to introduce a bedtime routine when your baby is around 3 months old. Getting them into a simple, soothing bedtime routine can be a great opportunity to have 1-to-1 time with your baby.

The routine could consist of:

having a bath

changing into night clothes and a fresh nappy

putting them to bed

reading a bedtime story (see more in Baby and toddler play ideas)

dimming the lights in the room to create a calm atmosphere

giving a goodnight kiss and cuddle

singing a lullaby or having a wind-up musical mobile you can turn on when you've put your baby to bed

brushing their teeth (if they have any)

As your child gets older, it can be helpful to keep to a similar bedtime routine. Too much excitement and stimulation just before bedtime can wake your child up again. Spend some time winding down and doing some calmer activities, like reading.

How much sleep does your baby need?

Just as with adults, babies' and children's sleep patterns vary. From birth, some babies need more or less sleep than others. The list below shows the average amount of sleep babies and children need during a 24-hour period, including daytime naps.

Newborn sleep needs

Most newborn babies are asleep more than they are awake. Their total daily sleep varies, but can be from 8 hours up to 16 or 18 hours. Babies will wake during the night because they need to be fed. Being too hot or too cold can also disturb their sleep.

Sleep requirements at 3 to 6 months old

As your baby grows, they'll need fewer night feeds and will be able to sleep for longer. Some babies will sleep for 8 hours or longer at night, but not all. By 4 months, they may be spending around twice as long sleeping at night as they do during the day.

Baby sleep at 6 to 12 months

For babies aged 6 months to a year, night feeds may no longer be necessary and some babies will sleep for up to 12 hours at night. Teething discomfort or hunger may wake some babies during the night.

Sleep requirements from 12 months

Babies will sleep for around 12 to 15 hours in total after their first birthday.

2-year-old sleep needs

Most 2 year olds will sleep for 11 to 12 hours at night, with 1 or 2 naps in the daytime.

Sleep requirements for 3 to 4 year olds

Most children aged 3 or 4 will need about 12 hours sleep, but this can range from 8 hours up to 14. Some young children will still need a nap during the day.

Coping with disturbed nights

Newborn babies invariably wake up repeatedly in the night for the first few months, and disturbed nights can be very hard to cope with.

If you have a partner, ask them to help. If you're formula feeding, encourage your partner to share the feeds. If you're breastfeeding, ask your partner to take over the early morning changing and dressing so you can go back to sleep.

Once you're into a good breastfeeding routine, your partner could occasionally give a bottle of expressed breast milk during the night. If you're on your own, you could ask a friend or relative to stay for a few days so you can get some sleep.

Dealing with baby sleep pattern changes

All babies change their sleep patterns. Just when you think you have it sorted and you've all had a good night's sleep, the next night you might be up every 2 hours.

Be prepared to change routines as your baby grows and enters different stages. And remember, growth spurts, teething and illnesses can all affect how your baby sleeps.

If your baby is having problems sleeping or you need more advice about getting into a routine, speak to your health visitor.

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Read tips on how to help your baby sleep, including what to expect, establishing a routine, and safe sleeping.

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Family Services, Support and Help | Sandwell Family Hubs

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Sandwell Family Hubs are at hand to offer services and support for all families in Sandwell with children aged 0 - 19 (or 25 with SEND). Learn more here.

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Some evidence suggests that mums who give birth by caesarean can find it more difficult to establish breastfeeding and are more likely to stop breastfeeding earlier. But other research has found that the type of birth has very little effect on the numbers of mums still breastfeeding when their babies are six months old (Prior et al, 2012; Hobbs et al, 2016).

We discuss why a caesarean birth might make breastfeeding more difficult. And here are some helpful suggestions for breastfeeding your baby after a caesarean birth, including how some positions can make it easier.

How to get breastfeeding off to a good start after a caesarean birth

Skin-to-skin contact between mum and baby are recommended immediately after birth (NICE, 2021; UNICEF, no date). This means your baby is placed naked onto your bare chest. This helps babies adjust to the world, begin bonding and start breastfeeding.

Babies in skin-to-skin contact with their mums soon after birth are more likely to have a successful first feed and are more likely to be breastfeeding at four months (Moore et al, 2016). Mums who give birth by caesarean are more likely to stop breastfeeding earlier than those who give birth vaginally (Hobbs et al, 2016). Yet there is no difference in breastfeeding rates with different types of birth in babies who have early skin-to-skin contact (Lau et al, 2018).

Skin-to-skin contact within the first hour after a caesarean birth is more challenging, but mums who request this - and who are supported by health professionals to achieve this - are more likely to have a positive outcome (Stevens et al, 2018). Guidelines on caesarean birth recommend that women who want to breastfeed should be supported to have skin-to-skin contact with their babies as soon as possible after birth (NICE, 2021).

The many benefits for you and your baby of holding them skin-to-skin include:

(Stevens et al, 2019)

If a baby can't have skin-to-skin contact with their mum, skin-to-skin with the other parent is also beneficial (UNICEF, 2019b).

Tips: how to get the breastfeeding support you need after a caesearean

After a caesarean birth, early skin-to-skin contact should be encouraged and extra support offered (Beake et al, 2017; NICE, 2021). Extra support could include the following...

You can ask your midwife to help you to find positions that are comfortable for breastfeeding (NICE, 2021).

Your midwife or someone on the infant feeding team should support you with keeping your baby as close to you as possible. They should also support you to help your baby to have as much skin-to-skin contact and access to your breasts as possible (NICE, 2021).

They can check whether your baby is latching effectively, especially if they're drowsy from medication. They'll also help to make sure your baby feeds frequently and will continue to support you with breastfeeding your newborn.

If your baby is unable to breastfeed directly, they should show you how to express your milk. This is so that your baby can have your milk and your milk supply will be maintained (UNICEF, 2014).

Women do experience pain after a caesarean birth, which can have a negative effect on establishing breastfeeding. It is usually necessary to take pain relief. It's fine to take paracetamol and ibuprofen to help with the pain but aspirin and codeine are not recommended when breastfeeding (Karlström et al, 2007; NICE, 2021).

Babies born by caesarean absorb some of the IV fluids given to the mum during surgery, increasing the baby's weight at birth. These babies urinate more in the first 24 hours, which restores their weight to normal. That means it's more accurate for babies born by caesarean to have their birth weight recorded at 24 hours and for this to be used as a baseline to compare their progress with (UNICEF, 2019).

Do give yourself and your baby time to adjust, you've just been through an amazing but huge change in your life and your baby needs time to get used to life outside the womb. Plus, it takes time for you and your baby to recover physically from the caesarean birth and from any medications you had (NICE, 2019).

Do accept all offers of help and certainly don't be afraid to ask for it - you've just had an operation and a baby after all. Help isn't just good for you, it's good for your baby too. Research says that mums who 'look after themselves' by asking for more help are more likely to breastfeed for longer (Tully and Ball, 2014).

Breastfeeding positions

It's important to find a breastfeeding position that's comfortable for both you and your baby. This helps your baby to latch well and helps you to maintain the position for as long as your baby is feeding.

Some mums like to cover their caesarean scar to protect it, others prefer positions that keep their baby away from it. Some mums find the position of the cannula in their hand or arm from the caesarean can affect how easy it is to find a comfortable breastfeeding position. So it might be worth discussing this with midwives or breastfeeding supporters.

When your baby is breastfeeding, they should come to your breast chin first, nipple pointing up the nose, body in a straight line, nipple aimed towards the roof of their mouth and their body very close to you. Read our article How to help your baby attach and breastfeed for more information.

Here are some positions you could try...

Lying down on your side

Laid-back breastfeeding

Rugby-ball or underarm position

Why a caesarean birth might make breastfeeding more difficult

Frequent, effective removal of milk from a mum's breasts ensures she produces the amount of milk her baby needs. That's because the more milk your baby takes, the higher your levels of breastfeeding hormones (prolactin and oxytocin) will be and the more milk you'll make. We also know that the earlier breastfeeding starts, the more likely it is to continue. A caesarean birth could affect this in a variety of ways...

Pain - from the scar and from the baby not latching well at the breast because the mum finds it harder to get comfortable (Tully and Bull, 2014). This could cause her not to feed as often or for as long.

Loss of mobility - can make it harder to get into a comfortable position to feed and to pick the baby up when they want feeding (Tully and Bull, 2014).

Not going through labour - if a mum has an elective caesarean birth before labour starts, she will not have produced labour hormones. This might lead to lower levels of breastfeeding hormones in the mother and babies being less prepared for feeding (Prior et al, 2012; Zanardo et al, 2013; Hobbs et al, 2016).

Long and stressful labour - an emergency caesarean birth can leave women feeling tired and anxious for themselves and their baby. This stress can lead to lower levels of breastfeeding hormones (Hobbs et al, 2016).

Exhaustion - in both mum and baby can lead to the baby feeding less often and less effectively.

Medication - can lead to a mum feeling drowsy or unwell, which can make early breastfeeding less likely. Medication can also affect the baby, making them drowsy and less able to breastfeed effectively (Brown and Jordan, 2013; UNICEF, 2019).

Separation - if mum and baby are separated, this can mean less chances for early breastfeeds.

Less opportunities for early skin-to-skin and a delayed first breastfeed - caesarean births might mean less opportunities for skin-to-skin contact. Skin-to-skin contact and the baby having their first breastfeed as soon as possible after birth help breastfeeding to become established (Moore et al, 2016).

Effects of a caesarean on the baby - babies born by caesarean are more likely to have mucous in their lungs, which can affect how interested they are in feeding (Tully and Ball, 2014). The IV fluids during labour can also boost a baby's birth weight, which can lead to worries that they've lost too much weight and to early formula supplementation and less breastfeeding (Noel-Weiss, 2011; Chantry et al, 2014).

Loss of confidence - mums might be less likely to believe their bodies can nurture and feed their baby and that breastfeeding is going well. Well-meaning family members might also be more likely to suggest a mum gives her baby formula (this makes breastfeeding more difficult) so she can rest after her caesarean. Early formula supplementation reduces a mother's milk production and confidence in her ability to feed her baby (Tully and Ball, 2014).

Night feeds - feeding at night can be particularly difficult after a caesarean birth if family members or supporters are not available to help with picking the baby up. Some mums say they feel asking midwives for help is a sign of failure.

Take a look at our articles for more about the practicalities of recovering from a caesarean birth and for tips to help you recover more quickly.
This page was last reviewed in December 2021.
Further information

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

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

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

Beake S, Bick D, Narracott C, Chang YS. (2017) Interventions for women who have a caesarean birth to increase uptake and duration of breastfeeding: A systematic review. Matern Child Nutr. 13:e12390. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27882659 [Accessed 30th December 2021]

Chantry C, Dewey K, Peerson J, Wagner E, Nommsen-Rivers L. (2014) In-hospital formula use increases early breastfeeding cessation among first-time mums intending to exclusively breastfeed. J Pediatr. 164:1339-1345. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120190/ [Accessed 30th December 2021]

Hobbs A, Mannion C, McDonald S, Brockway M, Tough S. (2016) The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy and Childbirth. 16:90. Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s1288... [Accessed 30th December 2021]

Karlström A, Engström-Olofsson R, Norbergh K-G, Sjöling M, Hildingsson I. (2007) Postoperative pain after cesarean birth affects breastfeeding and infant care. JOGNN. 36: 430-440. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17880313 [Accessed 30th December 2021]

Lau Y, Tha PH, Ho-Lim SST, Wong LY, Peng IL, Nurfarah BZMC, et al. (2018) An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation. Matern Child Nutr. 14(1):e12492. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6866048/ [Accessed 30th December 2021]

Moore E, Bergman N, Anderson G, Medley N. (2016) Early skin-to-skin contact for mums and their healthy newborn infants'. Cochrane Database of Systematic Reviews. (11):CD003519. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003519.pub4/full [Accessed 30th December 2021]

NICE. (2021) NG192 Caesarean birth. Available at https://www.nice.org.uk/guidance/ng192/chapter/Recommendations#care-of-... [Accessed 30th December 2021]

Noel-Weiss J, Woodend AK, Peterson WE, Gib W, Groll DL. (2011) An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss. Int Breastfeed J. 6:9. Available at: http://www.internationalbreastfeedingjournal.com/content/6/1/9 [Accessed 30th December 2021]

O'Brien M, Buikstra E, Fallon T, Hegney D. (2009) Strategies for success: a toolbox of coping strategies used by breastfeeding women. J Clin Nurs. 18:1574-1582. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19220615 [Accessed 30th December 2021]

Prior E, Santhakumaran S, Gale C, Philipps L, Modi N, Hyde M. (2012) Breastfeeding after caesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 95(5):1113-1135. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22456657 [Accessed 30th December 2021]

Stevens J, Schmied V, Burns E, Dahlen HG. (2018) Who owns the baby? A video ethnography of skin-to-skin contact after a caesarean section. Women Birth. 31(6):453-462. Available at: https://pubmed.ncbi.nlm.nih.gov/29496385/ [Accessed 30th December 2021]

Stevens J, Schmied V, Burns E, Dahlen H. (2019) Skin-to-skin contact and what women want in the ﬁrst hours after a caesarean section. Midwifery. 74:140-146. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30954633 [Accessed 30th December 2021]

Tully K, Ball H. (2014) Maternal accounts of their breast-feeding intent and early challenges after caesarean childbirth. Midwifery. 30:712-719. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451198/ [Accessed 30th December 2021]

UNICEF. (no date) Skin-to-skin contact. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implemen... [Accessed 30th December 2021]

UNICEF (2014) The Baby Friendly Initiative - The ten steps to successful breastfeeding. Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2014/... [accessed 30th December 2021]

UNICEF. (2019) Research on skin-to-skin contact. Available at: https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/research-supporting-breastfeeding/skin-to-skin-contact/ [Accessed 30th December 2021]

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Breastfeeding after a caesarean birth | Baby & toddler, Feeding articles & support | NCT

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A caesarean birth can affect breastfeeding at first so here are some helpful tips on how to get breastfeeding off to the best start.

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The thought of breastfeeding your baby when out and about might be daunting at first, but that's true of lots of things about being a new parent. A little planning and preparation can help you to feel more confident. Remember that most people never even notice a mum is breastfeeding, and everyone prefers a happy, quiet baby feeding than a hungry, crying one. Although we all understand that babies cry sometimes too.

If you are bottle feeding your baby, then the most important thing to think about is how you will make up milk safely outside the home. Advice on safe bottle feeding can be found in the 'Guide to bottle feeding' by Start4life.

If you are breastfeeding:

Your baby has the right to eat when you are outside the home by law. Everywhere you and your baby can be, you can feed. Almost everyone who breastfeeds their baby never receives anything but warm smiles and the occasional free drink. Media reports that mums are sometimes made to feel uncomfortable make the news precisely because they are rare. We know from surveys that our society supports mums feeding outside the home. Every day, there are babies and mums nursing in cafes, shops, parks, on buses and trains happily and peacefully.

When and where to feed is a decision for you and your baby. You don't have to ask for permission. You don't even have to look around. And with practice, feeding outside the home gets easier every time. You might be in an environment where you'd like to find a quieter space. Many facilities can offer you that, but it's fine to feed as part of your normal day wherever you need to be. When you breastfeed out and about, you're helping to make it 'the norm' in society.

If you feel unsure, you can start by practising at home. Have a go in front of a mirror or ask someone to take a video. How much can someone opposite see? You might be surprised how you look like someone just holding a baby. Most people, even quite close by, wouldn't know you were feeding a baby. In time, most mums become confident about feeding in public and don't even have to pause to think about what they're doing, as you'll see in these lovely photos of mums feeding all over the UK from our #FeedOn Campaign.

The first time you feed outside the home, it can be helpful to have your partner or a friend with you. They might help you get organised or get you something to eat and drink, but often it's just nice to know someone else is there. You might want to practise feeding away from home by visiting a breastfeeding group, and exploring different positions that you can use in different chairs. You might like to go to a familiar place like a local café. The positions you use may not be exactly the same as at home, but that's OK. You might support your arm and your baby's head with a rolled-up jacket or a blanket. Or you might lean back so your baby's weight is supported by your body. It doesn't have to be exactly the same as if you were on the sofa at home. It can be a good idea to practise using a position where you have a hand free so you can eat and drink too.

Layering your clothing might be helpful. Two light, loose tops with trousers or skirt is often easier for feeding than a one-piece top or dress. Some clothes are specially designed for breastfeeding with zips, slits or pieces that lift up. Not everyone finds them helpful, so experiment at home. You could pop your baby under a loose-fitting top, but you might also have a front-opening top or jacket around the side of your body.

* You do not need to 'cover up' unless you want to. Some mums carry a scarf so that if they feel a little unsure of themselves when feeding, the scarf can be draped over their shoulder and across their baby. This will look more like normal clothing than using a muslin cloth (which may not be very big) or a baby blanket that can make baby uncomfortably warm. Some mums also feed their baby when they are in a sling. Clips or clothes pegs can be useful to secure clothing out of the way so it doesn't fall into baby's face and to keep scarves on shoulders.

Breastfeeding helps your baby to feel safe and secure and when they are feeling tired and overwhelmed, it is valued even more. Getting the hang of nursing in public can be really useful for a mum, since if your baby is happily feeding away, you can focus on your own tea, cake and conversation. When you feed your baby outside the home, you are helping the next person to do the same thing. Let's make this country a great place for mums and babies to feel welcome, however they feed their little ones.

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Breastfeeding outside the home nibbles at the mind of many new mums. Mothers are not allowed to be discriminated against on the grounds of breastfeeding.

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Breastfeeding videos, latching, Attachment, milk making and more

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Breastfeeding videos, latching, Attachment, milk making and more

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Breastfeeding Videos - Global Health Media Project

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

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Introducing a bottle - The Breastfeeding Network

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At the beginning babies have a strong sucking reflex which means they usually suck on a teat easily. After a few weeks this reflex fades and introducing a bottle can take a while for your baby to get used to sucking on a teat, even if they have had bottles before. Sometimes just getting used […]

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Why Do So Many Babies Sleep Alone?

In many Western countries, it's common for babies to sleep in their own space - often in a separate room from their parents. But this hasn't always been the case.

Starting in the 1920s and 1930s, parenting advice began to shift. Influenced by behaviourist theories that promoted self-reliance and emotional restraint, parents were encouraged to avoid showing too much affection and to discourage dependence (Hardyment, 1983). As part of this philosophy, solitary infant sleep became a goal - a sign of a baby's growing independence and a marker of 'successful' parenting.

At the same time, more families began living in homes with extra rooms. Having a separate nursery became a symbol of progress and middle-class status. Within just one generation, putting babies in their own room had become the norm for night-time care in the UK, US, and parts of Europe (Liamputtong, 2007).

Today, this practice is still framed as a developmental milestone. Many parents believe that helping babies learn to sleep alone promotes independence - and that the moment of birth marks the beginning of a baby's autonomy (Ball, 2025).

Modern Tools & Practical Reasons

Cultural messages aren't the only influence. Baby monitors and electronic tracking devices have made separate sleep more acceptable by giving parents the sense that they can safely keep an eye (or ear) on their baby from another room. However, it's important to know that no current research confirms that these devices reduce the risk of SIDS (Ball and Keegan, 2022).

Some families also choose separate sleep because of space constraints - for example, if there isn't room in the parents' bedroom for a crib or side-car cot. Others find that night-time disruptions from a noisy or restless baby affect their sleep too much - especially if one or both parents have to work or care for others during the day (Ball, 2003; Kendall-Tackett et al., 2007).

Every Family is Different

There's no one-size-fits-all approach to infant sleep. Families make decisions based on their living situation, work schedules, personal beliefs, and cultural expectations. What matters most is that parents have accurate, evidence-based information to help them create a sleep setup that works for their baby - and for them.

Room Share At Night

For at least the first 6 months your baby should be in the same room as you when they're asleep, both day and night. It should be noted that the presence of a caretaker is protective, not necessarily the location they sleep in (Blair et al., 1999).

Read more about safe sleep guidance here.

Implications of Infants Sleeping Separately
Given the novelty of solitary infant sleeping arrangements, it is unsurprising that they are now shown to be detrimental to the health of babies.
Not only has an increased risk of SIDS been strongly associated with solitary infant sleep, but we now also know there are other consequences for babies who are left in rooms alone to 'sleep'. For instance Hayes and colleagues (1996) found that infants and children who were solitary sleepers had a much stronger attachment to a security object and were more likely to be disturbed by that object's absence than infants who did not sleep alone. Tollenaar and co-authors (2012) examined the stress reactivity of 2 month old infants who slept alone or in proximity to their parents. Infants with a solitary sleeping arrangement in their first month of life showed a heightened cortisol response to a mild physical stressor (a bathing session) at 5 weeks. The authors suggest that solitary sleeping in the first month of life is associated with heightened sensitivity of the HPA-axis to a mild stressor, possibly due to less nocturnal parental availability as external stress regulator.

Options Besides Separate Rooming

If there is no room for the baby's cot in your room, could you fit a single bed in the baby's room where a parent could sleep near to the baby?

If the baby is disturbing one parent who needs to be alert for work, could that parent sleep in a separate room for a few months instead of the baby?

Newborn babies wake frequently and need feeding and attention at night for several months. If a baby is in a separate room it can be difficult to know when it wakes or needs attention. Scroll through this page to learn about the different places that babies sleep so you can make an informed choice.

Day-Time Sleep

Often-times babies are put in a separate room to sleep during the daytime, which is also associated with greater risk of SIDS (Carlin et al., 2017). Keep your baby in the presence of an adult caregiver when they are sleeping, day and night. It may be helpful to have a portable sleep space downstairs, and a cot in the bedroom. Remember that babies should lie flat to sleep - car seats and other baby seats are not suitable for prolonged sleep periods because they promote a slumped sleeping position that can affect a baby's ability to get air into their lungs (Mannen, 2025). Learn more about day-time sleep in slings here.

Ball, H.L. (2002) 'Reasons to bed-share: Why parents sleep with their infants', Journal of Reproductive and Infant Psychology, 20(4), pp. 207-221. Available at: https://doi.org/10.1080/0264683021000033147.
Ball, H.L. (2003) 'Breastfeeding, Bed-Sharing, and Infant Sleep', Birth, 30(3), pp. 181-188. Available at: https://doi.org/10.1046/j.1523-536X.2003.00243.x.
Ball, H.L. (2006) 'Bed sharing on the postnatal ward: Breastfeeding and infant sleep safety', Paediatrics & Child Health, 11(suppl_A), pp. 43A-46A. Available at: https://doi.org/10.1093/pch/11.suppl_A.43A.
Ball, H.L. (2008) 'Evolutionary Paediatrics: a case study in applying Darwinian Medicine'. Available at: https://durham-repository.worktribe.com/output/1688377 (Accessed: 11 June 2025).
Ball, Helen L et al. (2011) 'Randomised trial of sidecar crib use on breastfeeding duration (NECOT)', Archives of Disease in Childhood, 96(7), p. 630. Available at: https://doi.org/10.1136/adc.2010.205344.
Ball, Helen L. et al. (2011) 'Randomised trial of sidecar crib use on breastfeeding duration (NECOT)', Archives of Disease in Childhood, 96(7), pp. 630-634. Available at: https://doi.org/10.1136/adc.2010.205344.
Ball, H.L. et al. (2012) 'Bed- and Sofa-Sharing Practices in a UK Biethnic Population', Pediatrics, 129(3), pp. e673-e681. Available at: https://doi.org/10.1542/peds.2011-1964.
Ball, H.L. and Keegan, A.-A. (2022) 'Digital health tools to support parents with parent-infant sleep and mental well-being', NPJ Digital Medicine, 5, p. 185. Available at: https://doi.org/10.1038/s41746-022-00732-4.
Ball, H.L. and Taylor, C.E. (2020) 'Baby-box schemes in England: parent and practitioner experiences, and recommendations', BMC Pediatrics, 20(1), p. 154. Available at: https://doi.org/10.1186/s12887-020-02064-2.
Blair, P.S. et al. (1999) 'Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. CESDI SUDI research group', BMJ (Clinical research ed.), 319(7223), pp. 1457-1461. Available at: https://doi.org/10.1136/bmj.319.7223.1457.
Blair, P.S. et al. (2006) 'Sudden Infant Death Syndrome and the time of death: factors associated with night-time and day-time deaths', International Journal of Epidemiology, 35(6), pp. 1563-1569. Available at: https://doi.org/10.1093/ije/dyl212.
Blair, P.S. et al. (2009) 'Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England', BMJ (Clinical research ed.), 339, p. b3666. Available at: https://doi.org/10.1136/bmj.b3666.
Blair, P.S. et al. (2014) 'Bed-Sharing in the Absence of Hazardous Circumstances: Is There a Risk of Sudden Infant Death Syndrome? An Analysis from Two Case-Control Studies Conducted in the UK', PLoS ONE, 9(9), p. e107799. Available at: https://doi.org/10.1371/journal.pone.0107799.
Carlin, R.F. and Moon, R.Y. (2017) 'Risk Factors, Protective Factors, and Current Recommendations to Reduce Sudden Infant Death Syndrome: A Review', JAMA Pediatrics, 171(2), pp. 175-180. Available at: https://doi.org/10.1001/jamapediatrics.2016.3345.
Feldman-Winter, L. et al. (2016) 'Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns', Pediatrics, p. e20161889. Available at: https://doi.org/10.1542/peds.2016-1889.
Hardyment, C. (1983) Dream Babies: Child Care from Locke to Spock. Jonathan Cape.
Hayes, M.J., Roberts, S.M. and Stowe, R. (1996) 'Early childhood co-sleeping: Parent-child and parent-infant nighttime interactions', Infant Mental Health Journal: Infancy and Early Childhood, 17(4), pp. 348-357. Available at: https://doi.org/10.1002/(SICI)1097-0355(199624)17:4<348::AID-IMHJ6>3.0.CO;2-I.
Keefe, M.R. (1987) 'Comparison of neonatal nighttime sleep-wake patterns in nursery versus rooming-in environments', Nursing Research, 36(3), pp. 140-144.
Kendall-Tackett, K. (2007) 'A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health', International Breastfeeding Journal, 2(1), p. 6. Available at: https://doi.org/10.1186/1746-4358-2-6.
Kendall-tackett, K., Cong, Z. and Hale, T.W. (2010) 'Mother-Infant Sleep Locations and Nighttime Feeding Behavior: U.S. Data from the Survey of Mothers' Sleep and Fatigue', Clinical Lactation, 1(1), pp. 27-31. Available at: https://doi.org/10.1891/215805310807011837.
KLINGAMAN, K. (2009) Breastfeeding after a caesarean section: Mother-infant health trade-offs. Doctoral. Durham University. Available at: https://etheses.dur.ac.uk/102/ (Accessed: 22 June 2025).
Liamputtong, P. (2007) Childrearing and Infant Care Issues: A Cross-cultural Perspective. Nova Publishers.
Mannen, E.M. (2025) 'Infant Biomechanics and Implications for Safe Sleep', in R.Y. Moon (ed.) Infant Safe Sleep: A Pocket Guide for Clinicians. Cham: Springer Nature Switzerland, pp. 75-92. Available at: https://doi.org/10.1007/978-3-031-84294-8_4.
McGarvey, C. et al. (2006) 'An 8 year study of risk factors for SIDS: bed-sharing versus non-bed-sharing', Archives of Disease in Childhood, 91(4), pp. 318-323. Available at: https://doi.org/10.1136/adc.2005.074674.
Moon, R.Y. et al. (2022) 'Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment', Pediatrics, 150(1), p. e2022057990. Available at: https://doi.org/10.1542/peds.2022-057990.
Rechtman, L.R. et al. (2014) 'Sofas and infant mortality', Pediatrics, 134(5), pp. e1293-1300. Available at: https://doi.org/10.1542/peds.2014-1543.
Santos, I.S. et al. (2009) 'Bed-sharing at 3 months and breast-feeding at 1 year in southern Brazil', The Journal of Pediatrics, 155(4), pp. 505-509. Available at: https://doi.org/10.1016/j.jpeds.2009.04.037.
Skea, Z. et al. (2022) 'The Baby Box scheme in Scotland: A study of public attitudes and social value', Health Expectations : An International Journal of Public Participation in Health Care and Health Policy, 25(6), pp. 3307-3314. Available at: https://doi.org/10.1111/hex.13639.
Tappin, D., Ecob, R. and Brooke, H. (2005) 'Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study', The Journal of Pediatrics, 147(1), pp. 32-37. Available at: https://doi.org/10.1016/j.jpeds.2005.01.035.
Thompson, J.M.D. et al. (2017) 'Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-analysis', Pediatrics, 140(5), p. e20171324. Available at: https://doi.org/10.1542/peds.2017-1324.
Tollenaar, M.S. et al. (2012) 'Solitary sleeping in young infants is associated with heightened cortisol reactivity to a bathing session but not to a vaccination', Psychoneuroendocrinology, 37(2), pp. 167-177. Available at: https://doi.org/10.1016/j.psyneuen.2011.03.017.
Tully, K.P. and Ball, H.L. (2012) 'Postnatal Unit Bassinet Types When Rooming-In After Cesarean Birth: Implications for Breastfeeding and Infant Safety', Journal of human lactation : official journal of International Lactation Consultant Association, 28(4), pp. 495-505. Available at: https://doi.org/10.1177/0890334412452932.
Tully, K.P. and Ball, H.L. (2014) 'Maternal accounts of their breast-feeding intent and early challenges after caesarean childbirth', Midwifery, 30(6), pp. 712-719. Available at: https://doi.org/10.1016/j.midw.2013.10.014.
Yamauchi, Y. and Yamanouchi, I. (1990) 'The relationship between rooming-in/not rooming-in and breast-feeding variables', Acta Paediatrica Scandinavica, 79(11), pp. 1017-1022. Available at: https://doi.org/10.1111/j.1651-2227.1990.tb11377.x.

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Informed Choices: Where Babies Sleep Across cultures and throughout history, babies have slept close to their mothers - day and night. In the early months of life, this arrangement provides everything a baby needs: warmth, protection, comfort, and nourishment. Before modern technologies, survival without this closeness was nearly impossible.

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Expressing and storing breastmilk - The Breastfeeding Network

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

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If you are leaving your child with a carer for an evening out, when working, or at college, or if you are separated from your baby for any other reason.

To feed a premature or hospitalized baby.

To increase or protect your supply.

If your child isn't attaching at the breast.

To donate to a milk bank (www.ukamb.org).

A breastfeeding counsellor will be able to discuss your particular situation with you.
Can I hire a pump?
Only hospital-grade electric pumps are available for hire. They can be hired from pump agents around the country or can be dispatched quickly online, often arriving the next working day. If your baby is in special care, then you may be able to obtain a pump from the hospital.
Should I sterilise the equipment?
When storing and expressing breastmilk, everything coming into contact with the milk should be sterilised before first use. If you're storing milk for your own healthy baby, you might choose to sterilise the equipment each time for extra protection, but research suggests a wash with hot soapy water is sufficient. Some pumps parts can be washed in a dishwasher.

We know breast milk can be stored at room temperature for several hours, and in the fridge for several days, so some mums who are pumping frequently do choose to reuse the pump without washing, and then wash it carefully after several sessions. This isn't an area where there is a lot of research and you can discuss your options with a breastfeeding counsellor or lactation consultant.
How should I express?
You can express by hand or use a manual or electric breast pump. There's a first time for everyone when it comes to expressing, so don't feel upset or put off if only a few drops come out at first.

Begin by washing your hands and relaxing. Relaxing will help the milk ejection reflex (also known as the 'letdown' reflex).

You may warm your breasts, wrapping a warm towel around, or express after a shower or bath.

By hand:
Massage your breast in a circular manner. You can roll the nipple to optimize oxytocin release (the hormone needed for milk flow to start). Have something clean ready to collect your milk in. Something with a wide opening, such as a bowl or jug, can make it easier to catch every drop.

Find where you need to put your fingers to express most effectively. This is usually a few centimetres back from the nipple, but everyone is different. Cup the breast and make a 'C' shape with your thumb on one side and some fingers on the other. Compress the breast tissue. It may help to think: "press back, bring together, press forward". Release and repeat. Then rotate the fingers around the areola to express a new area when the milk flow subsides. There are lots of online videos on hand expression that might help you get started. Instructions may be different if you are expressing colostrum in the very early days so speak with your midwife or breastfeeding supporter.
By pump:
Pumps create a vacuum to remove milk. Make sure the funnel isn't too small, nor too large, as this could damage the nipple and reduce your milk flow. Some manufacturers can provide alternative sizes. Pumping shouldn't be painful nor leave a mark on your breast.

lf you're expressing to increase your supply; shorter more frequent pumping sessions are more likely to increase supply than a few long sessions. 'Hands on pumping' can help to increase output by nearly 50%. You can start with breast massage, continue to massage and compress your breasts while you use the pump, and finish with some hand expression. Some people use an adapted bra or crop top to hold the pump in place.

Electric pumps can lose effectiveness over time and may need servicing after heavy use. Many personal grade pumps are not suitable to be shared with someone else as milk can enter the mechanism of the pump and not all pumps are designed to be used more than once or twice a day.
Using Expressed Breastmilk (EBM)
Depending on age and health, your baby may be fed EBM in several ways: by cup, spoon, beaker, syringe or tube.

If you are using a bottle, consider using 'paced' feeding which may reduce confusion for the baby around the different skills needed to breast and bottle feed, and help prevent overfeeding. You may also see it called 'responsive bottle feeding'. Babies can overfeed from a bottle even when only breastmilk is used.
Any other tips?

Express as often as your baby would normally feed, if possible. If your young baby is not feeding at the breast, it's usually recommended to pump at least 8 times in 24 hours.

You could try expressing from one breast when your baby is feeding from the other. This takes advantage of the natural milk ejection reflex. There are some pumps which attach to your breast with suction and catch the letdown without you needing to touch the pump further.

Try not to focus on the amount as you pump. Remember that a large volume of milk may be high in water content but not necessarily high in fat content. A smaller amount may be more valuable.

Some mums find it helpful to use breathing exercises or to focus on their baby by looking at a picture or using a piece of clothing. Others listen to music or watch TV. Find what works best for you.

Pumping can send messages to your milk supply which may not always match your baby's needs.

It's often recommended not to pump too much in the early days or earlier than you need to.

Remember, don't use your pumping output as a reliable judge for what is going on with your milk supply. Pumping is a skill and, even when mastered, it is not the same process as a baby feeding.

How can I store breast milk?
These storage guidelines are suitable for a healthy term born baby.
Different storage times may be needed for sick infants or donated milk.

Room temperature (77°F/25°C)for up to 6 hours

In main part of fridge (below 4°C)for up to 5 days (up to 8 days according to some sources)

Warmer fridge (5°C-10°C) for 3 days

Fridge thermometers can be bought from kitchen shops.

Freezer (approx. -18°C)for 6 months

Previously frozen/thawed milk12 - 24 hours in fridge

When transporting frozen EBM in a cold box, check the cool blocks are newly frozen and refrozen regularly.
Refrigerate your milk in a sealed container as soon as possible. Store in small quantities so there is less waste and it's quicker to thaw or warm. It's possible to collect together milk from a number of expressing sessions but allow each batch to cool before adding it to the sealed container.
How do I defrost breastmilk?
It is possible to defrost milk in a number of different ways, either slowly in a fridge or with the container in contact with warm water. It is not recommended to defrost breastmilk in a microwave.

Gently shake the milk before use as the fats may have separated. It is a myth that you will damage the proteins in the milk with vigorous shaking, but you may cause air bubbles to form in the milk.

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

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Cows milk protein allergy (CMPA) & lactose intolerance in breastfed babies - The Breastfeeding Network

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You can read our factsheets about the symptoms and managment of cows milk protein allergy and lactose intolerance in breastfed babies.

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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.