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Contact numbers for local support: telephone, whatsapp, in-person, and specialist feeding clinics

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Infant feeding in Richmond :: Central London Community Healthcare NHS Trust

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Our infant feeding support services provide mothers with evidence based information to support families to achieve their infant feeding goals. We provide information and support on breastfeeding and maximising breastmilk as well as also supporting parents who choose bottle feeding and/or using commercial infant formula by providing information on choosing milks, making up feeds and helping families to feed safely and responsively.

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Updated Approach to Nipple Pain (and thrush) - Breastfeeding Network

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Updated Approach to Nipple Pain (and thrush) - Breastfeeding Network

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An update on our information on, and approach to, persistent breast and nipple pain when breastfeeding - The Breastfeeding Network

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by the DiBM staff team and Emma Thomas You may have noticed recently that the Drugs in Breastmilk (DiBM) factsheets on thrush of the nipple or breast have been taken down. This is because our clinical pharmacy team have spent the last six months challenging the status quo when it comes to persistent nipple or breast […]

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Free WhatsApp Support: La Leche League Collective

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Free WhatsApp Support: La Leche League Collective

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"Do you need help right now? Or are you looking to join a meeting wherever you live? Check out our online support options- we've got you covered". A team of accredited breastfeeding counsellors are standing by to connect with families in need of support. Phone calls can also be arranged

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We're a growing team of La Leche League accredited breastfeeding counsellors throughout the UK, and we're here to support you. No question is ever too big or too small, too common or too rare. Reach out, and we will reply with warmth as soon as we can. We're also parents ourselves so often we're replying with children (large and small) underfoot!

And if you have specific accessibility needs we will do our best to meet them, please let us know how we can help you best.

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We're a growing team of La Leche League accredited breastfeeding counsellors throughout the UK, and we're here to support you. No question is ever too big or too small, too common or too rare. Reach out, and we will reply with warmth as soon as we can.

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The NICE Clinical Knowledge Summaries (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories.

CKS content is produced by Clarity Informatics Ltd (trading as Agilio Software | Primary Care). It is available to users outside the UK via subscription from the Agilio | Prodigy website.

If you believe you are seeing this page in error please contact us.

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The NICE Clinical Knowledge Summary (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories

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Telephone, text and webchat support from trained breastfeeding counsellors, available 24 hours a day

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National Breastfeeding Helpline - Helpline

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Local management pathway

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Kingston and Richmond NHS Foundation Trust

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Cow’s milk protein allergy in children :: Cow’s milk protein allergy in children :: Kingston and Richmond NHS Foundation Trust

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This guidance is for babies with symptoms of non-IgE cow’s milk protein allergy only.

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How Can I Tell Breastfeeding is Going Well? 

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How Can I Tell Breastfeeding is Going Well? 

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Adapted from the UNICEF Baby Friendly Checklist

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Recommendations for managing mastitis changed in 2022. Please read the following documents and infographics to understand why, and what management options are now recommended. Updated March 2025

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The NICE Clinical Knowledge Summaries (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories.

CKS content is produced by Clarity Informatics Ltd (trading as Agilio Software | Primary Care). It is available to users outside the UK via subscription from the Agilio | Prodigy website.

If you believe you are seeing this page in error please contact us.

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The NICE Clinical Knowledge Summary (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories

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Breastfeeding Network: Drugs in Breastmilk Factsheets

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Breastfeeding Network: Drugs in Breastmilk Factsheets

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Drugs in Breastmilk factsheets - The Breastfeeding Network

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These factsheets have been compiled by our Drugs in Breastmilk information service team of pharmacists. If you are unable to find the information you are looking for below, or you still have questions, you can contact the team by sending a private message via our Facebook page or via email. Please provide as much information as possible (age […]

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LLL: Mastitis, Blocked Ducts and Engorgement. 

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LLL: Mastitis, Blocked Ducts and Engorgement. 

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Advice for parents, based on the new mastitis recommendations

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Mastitis (breast inflammation), includes a wide range of symptoms, from a small, tender area (often called a blocked duct), through to severe infection.

If your breasts are inflamed or swollen, it's important to act quickly to relieve discomfort and stop it getting worse. You may also need to deal with any underlying causes.

LLL Leaders are here to help.

What do all these words mean? A quick guide

What are the signs of mastitis?

How can I prevent mastitis in the future?

Mastitis just means 'breast inflammation'. Recent research is changing how mastitis is viewed and treated. It's now understood as a wide spectrum, from a small, tender area - often called a blocked duct - to a severe infection.

Milk blisters/blebs look like tiny white or yellow dots on the tip of the nipple. They can cause no trouble, or they might be very painful (often described as 'stinging' pain). Sometimes they form in one or more 'milk pores', blocking milk from coming out of part of the breast. They are part of the mastitis spectrum of related conditions and the self-treatment measures suggested for mastitis may help. Milk blisters that don't block milk coming out, and don't hurt, can be safely left alone. They eventually disappear.

Engorgement is when the whole breast becomes swollen with extra fluid. It's common 2-5 days after birth, when milk production is increasing very fast. The mastitis self-treatment measures described below are helpful for engorged breasts, too. Treat engorgement promptly to avoid developing mastitis.

A breast abscess is a collection of pus (infection) within the breast. It is usually a complication of mastitis that was not adequately treated. An abscess needs urgent medical treatment: drainage and antibiotics.

One or more areas that are tender (sometimes called a blocked duct).

Your breast might feel warmer, harder, or lumpier than usual.

There may be a patch of skin on your breast that has changed colour (dark skin might look darker than usual, on light skin you might see a red patch).

You might have a fever and feel like you have the flu. Your body may respond to inflammation with an increase in temperature - it doesn't necessarily mean you have an infection. See below, "Do I need medical help?"

Could it be a breast abscess?

Most (though not all) people with an abscess feel very ill. If you have one or more lumps in your breast that don't get smaller as milk is removed, and don't respond to the treatments for mastitis suggested in this article, contact your GP or NHS 111. An abscess needs urgent medical treatment. It's usually possible - and may be preferable - to continue breastfeeding while an abscess is treated, if you want to. LLL Leaders can support you through it.

When breasts are too full of milk, or the breast is injured, your body may react with inflammation - a response to a threat. Blood flow to the area increases, and fluids and immune cells rush in to repair damage and fight off bacteria. As pressure within the breast increases, it feels tender or painful, and it may become difficult for the milk to flow easily.

Common causes of mastitis

Issues with positioning and attachment: Your baby is not removing milk efficiently.

Scheduling or limiting feeds: If breasts aren't relieved as often as they need to be, this can result in mastitis (and decreased milk production). The amount of milk breasts can hold - and how long they can comfortably hold it for - varies hugely between individuals, and changes over time.

Oversupply: Having a lot more milk than you need. Sometimes it's caused by 'overpumping'. Sometimes it just happens - this is more likely with second or subsequent babies. Your baby may get upset, gag, and splutter when your milk releases. They are probably growing very fast. Your breast/s may feel uncomfortably full a lot of the time. If you're struggling with oversupply, LLL Leaders can help.

Suddenly removing less milk than usual: For example, because your baby is ill, sleeping longer, or you are away from your baby.

Weaning: If you reduce the amount you breastfeed faster than your breasts can manage.

Breast injury, e.g. from a too-tight bra, bag or sling strap, breast pump, or seatbelt. Or even sleeping on your stomach.

Bacterial infection in the breast, possibly through an open nipple wound.

Less common causes of mastitis

Previous breast surgery, such as implants

Being under a lot more stress than usual, or extremely exhausted

Being anaemic or having other health conditions that make your immune system work less well

Gut health. Some experts think that imbalances in the 'microbiome' (the bacteria that live in your body) may make some people more likely to get mastitis. The breast has its own microbiome which is affected by many factors, including your diet, antibiotic use, and whether your baby feeds direct at the breast. It's a developing field of research.

Factors that may make mastitis more likely:

Causes of engorgement

your baby is unwell and feeding less than usual, or less than your breasts need

your baby starts sleeping for a longer stretch at night

you are away from your baby and don't express as often as your breasts need.

In the first few days after birth, you may have more engorgement if you were given extra fluids during labour and birth. But engorgement can happen at any stage of breastfeeding if there's more milk than your breast/s can comfortably hold. For example, if:

Take standard doses of an over-the-counter non-steroidal anti-inflammatory medication such as ibuprofen, if you can usually take it. Paracetamol may also be helpful if you're in pain, but ibuprofen is more useful for mastitis, because it also reduces inflammation. Both are safe to take while breastfeeding.

Experiment with cold or cool compresses on the affected area/s between feeds, to see what helps you feel most comfortable. Some cultures and communities advise new mothers to avoid cold in the early week after birth, and to use heat instead - if this is the case for you, see "things to avoid", below.

Remove milk as often as you need to, to keep the breast as comfortable as you can. Feed your baby whenever they want to be fed or continue expressing whenever you would usually express. Offer a feed or express some milk if your breast feels very full and uncomfortable.

Rest as much as you can. Inflammation is tiring for your whole body. Those who have had mastitis often say that they got it when they were under extra stress, or busier than usual - it may be a sign that you need to slow down. Rest is an important part of healing. Taking time off work, or having a partner or support person help you care for your baby can be useful for a few days.

Experiment with different feeding positions. This may help you be more comfortable and help to drain different areas of the breast.

Some experts recommend taking probiotics, or the food supplement lecithin. Check with your healthcare provider, a breastfeeding supporter, or LLL websites for current information.

Contact an LLL Leader or your local LLL group for more information and support.

Start treatment at the first signs of breast swelling or inflammation. It's often possible to deal with it at home without medical help.

Things to avoid

Rough massage of your breasts. This can increase inflammation - and really hurts! If you want to massage while feeding or expressing, use gentle touch, as if you were stroking a cat.

Applying a lot of heat, e.g. hot showers or compresses. Heat can increase inflammation. If a little warmth helps the milk to flow when you're feeding or expressing, or helps you feel more comfortable between feeds, use it for as short a time as possible. Don't direct a hot shower straight at your breast.

Trying to force milk out of the breast won't fix the inflammation and may make it worse.Electric toothbrushes, combs or other devices.

Trying to remove a lot more milk than usual. This can increase the amount of milk you're producing, increasing pressure in the breast. If you need to express more milk than your baby wants, aim to express just enough to be comfortable - not every available drop.

Some of the treatments that used to be recommended for mastitis don't help, and may even make things worse:

My breasts feel full but I can't get milk out - help!

Babies sometimes refuse to feed on a breast that has mastitis. The milk is safe for your baby but may taste different from usual. Your baby may also be objecting to a slower flow of milk - some people notice a temporary supply dip during mastitis. It usually goes back to normal when the breast has recovered. You will need to express milk from the affected breast until your baby is willing to feed on it again.

See Nursing Strikes for ideas to encourage your baby to feed.

Treat the inflammation by taking ibuprofen and perhaps applying a cold compress about 20-30 minutes before you feed or express.

If your baby is struggling to attach because the whole breast is engorged (full and tight), try expressing a little milk before offering the breast to your baby. Or try 'reverse pressure softening': press firmly around the nipple with fingertips or finger lengths for about one minute before feeding. This moves swelling away from the nipple.

Try gentle 'lymphatic drainage' massage (towards your armpit). See Further Reading.

What if your baby will feed, or you're trying to express, but little or no milk is coming out?

Don't panic! Engorgement or mastitis can act like a traffic jam in the breast . These tips can help you get the milk moving again:

Your symptoms are the same after 24 hours, or getting worse

You start to feel ill - shivery, shaky, like you have flu

You have a fever

A patch on your breast has changed colour and is getting larger, or you see streaks on your breast

You see signs of infection, such as a wound that looks crusty or oozes yellow, or your nipple is a different shape, size, or colour from normal.

If you're feeling okay in yourself (you don't have a fever or feel ill), you can try treating yourself at home for 24 hours. If by that time your symptoms are improving, you can continue for another 24 hours.

Get breastfeeding help if you need it. A breastfeeding supporter can help you get your baby deeply and comfortably attached at the breast.

Keep your milk flowing. Avoid too much milk building up in your breasts: feed or express as much as your baby wants, and offer extra feeds or express some milk if your breasts become uncomfortable at other times. If you have a lot more milk than you need, a breastfeeding supporter can help.

Check your breast comfort. Make sure nothing is pressing on the breast (see above, "Why does it happen?")

Watch out for early signs of mastitis and start self-help measures right away.

Contact NHS 111 or your GP straight away if:

You may need antibiotics. The NHS guideline on mastitis says that you should usually be given a 10-14 day course (if you have a shorter course, the mastitis is more likely to come back). If you need antibiotics, it's important to keep up with the self-help treatments above, as well as taking the medication. Let your doctor know if you're still not feeling any better by the third day after starting antibiotics.

Mastitis can be horrible, and make you question whether you can carry on breastfeeding. It's important not to suddenly stop removing milk while you've got mastitis, as this can lead to complications. You need plenty of practical and emotional support, and good medical care if necessary, until you're feeling better.

Written by Jayne Joyce and Justice Reilly

Last updated June 2024

My Baby Won't Breastfeed When a Mother is Unwell
Mastitis
La Leche League International article on mastitis: https://llli.org/breastfeeding-info/mastitis/

References

Baeza, C. et al. 2022. Re: "Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022" by Mitchell et al. Breastfeed Med 2022 17(11):970-971.

Douglas P. Re-thinking benign inflammation of the lactating breast: A mechanobiological model. Women's Health. 2022;18. doi:10.1177/17455065221075907

Mitchell, K.B. et al.; Academy of Breastfeeding Medicine. 2022. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med 17(5):360- 376. Erratum in: Breastfeed Med 2022 17(11):977-978.
Engorgement
NICE Mastitis and Breast Abscess (Clinical Knowledge Summary)
Blebs
Last revised in December 2023 Wilson, E. et al. 2020. Incidence of and risk factors for lactational mastitis: a systematic review. 36(4):673-686.

Zakarija-Grkovic I, Stewart F. Treatments for breast engorgement during lactation. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD006946. DOI: 10.1002/14651858.CD006946.pub4.

Douglas P. Re-thinking lactation-related nipple pain and damage. Womens Health (Lond). 2022 Jan-Dec;18:17455057221087865.
Over-the-counter medication
Mitchell KB, Johnson HM. Breast Pathology That Contributes to Dysfunction of Human Lactation: a Spotlight on Nipple Blebs. J Mammary Gland Biol Neoplasia. 2020;25(2):79-83.

O'Hara, M. A. Bleb histology reveals inflammatory infiltrate that regresses with topical steroids: A case series. Breastfeeding Medicine. 2012

NHS Specialist Pharmacy Service - UK Drugs In Lactation Advisory Service

Using paracetamol during breastfeeding , published November 2023

Using NSAIDS during breastfeeding , published February 2024

Other websites

Academy of Breastfeeding Medicine Clinical Protocol #36:The Mastitis Spectrum, 2022. https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf

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

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

This information is available to buy as a printed booklet from our .

Copyright LLLGB 2024

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Mastitis, blocked ducts, and engorgement - La Leche League GB

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Avoiding and treating mastitis and breast infections

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A Physician's Guide to Breastfeeding: Mastitis, Engorgement & Breast Complications

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A Physician's Guide to Breastfeeding: Mastitis, Engorgement & Breast Complications

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Mastitis, Engorgement, and Breast Complications (with Images)

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Mastitis is a painful inflammation of breast tissue that often affects breastfeeding women. Symptoms can include pain, swelling, warmth, and redness in the affected breast that sometimes includes a breast infection that can also cause fever and chills.

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GP Infant Feeding Network: Online Learning Resources

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GP Infant Feeding Network: Online Learning Resources

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Below are listed online CPD modules which are useful to the GP wishing to learn more about infant feeding and postnatal care. Where educational resources and events are developed or sponsored by in…

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GPCPC is a network of GPs in the UK working together to improve perinatal care.

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This website provides information about the work of GPCPC and also includes resources intended as a guide to support healthcare professionals' clinical practice. The information included here is primarily aimed at practicing UK General Practitioners (GPs). Resources have been selected and included by GP members of GPCPC, from the wealth of reliable information available on perinatal healthcare, because we feel they are specifically relevant to General Practice.

This website uses the terms 'woman' or 'mother' throughout. These should be taken to include people who do not identify as women but are pregnant or have given birth. Similarly, where the term 'parents' is used, this should be taken to include anyone who has main responsibility for caring for a baby.

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GPCPC is a network of UK General Practitioners (GPs) working together to improve perinatal care in primary care.

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Our user friendly e-learning platform enables users to work at their own pace while gaining a strong foundation of knowledge around supporting infant feeding and parent-infant relationship building.

If you are already registered in the system, visit https://babyfriendly.litmos.com to login.
Please note: This e-learning package was reviewed in 2019 and a new e-learning platform is in use. Previous login details will be inactive; please contact the Baby Friendly office to discuss subscriptions.
The course is split into modules, allowing learners to pause and resume where they left off. The course provides CPD points for the GP.

Following completion, GPs should know:

How breastfeeding works

How to treat common breast conditions (e.g. mastitis, thrush)

How to access a reliable reference source for prescribing drugs for breastfeeding mothers

How to refer mothers to the most appropriate professional for breastfeeding help and support (particularly when a baby is failing to thrive).

For group subscriptions, you will be able to assign administrative level access as you require; these staff members will be able to track colleagues' progress with the package and manage users. You will also be given a self sign-up code to help users register directly. Upon completion of the training, GPs can print off a certificate for their portfolio.

Costs and booking

Order using the Baby Friendly digital resources order form, which you can download from our resources page.

The online training package is available to purchase for either individuals or groups.

Individual: £20 for one year's access

Groups of 10-49: £15 each for one year's access

Groups of 50 or above: contact the Baby Friendly office for a bespoke quote

Browse the images below to see parts of the package.

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E-learning for GPs - Baby Friendly Initiative

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Developed to provide GPs with all the information they require to support mothers and meet the requirements for Baby Friendly accreditation

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Published January 2025.

Recommendations for supporting breastfeeding, mixed feeding, returning to exclusive breastfeeding, continuing breastfeeding when returning to work or studies

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This guideline covers nutrition and weight management in pregnancy for anyone who may become pregnant, is planning to become pregnant or is already pregnant, and nutrition in children up to 5 years. Care of babies and children born preterm or with low birth weight is not covered. The guideline does not give detailed advice on what constitutes a healthy diet.

NICE has also produced guidelines on:

For information on other related topics, see our women's and reproductive health summary page.

Last reviewed: 15 January 2025

This guideline updates and replaces:

the NICE guideline on maternal and child nutrition (PH11, 2008)

the recommendations on weight management during pregnancy from NICE's guideline on weight management before, during and after pregnancy (PH27, 2010).

Next review: This guideline will be reviewed if there is new evidence that is likely to change the recommendations.
How we prioritise updating our guidance
Decisions about updating our guidance are made by NICE's prioritisation board. For more information on the principles and process, see NICE-wide topic prioritisation: the manual.

For information about individual topics, including any decisions affecting this guideline, see the summary table of prioritisation board decisions.

Recommendations

This guideline includes recommendations on:

Who is it for?

Healthcare professionals working in the NHS responsible for maternal and child nutrition from birth to 5 years, including midwives, obstetricians, health visitors, dietitians, public health nutritionists, primary healthcare professionals, general practitioners, community paediatricians, school and community nurses, specialist nurses, dentists and dental professionals, and pharmacists

Commissioners and providers of antenatal and postnatal care services, weight management and activity or exercise services, and primary care services

Providers of preschool education and care services and early years settings

Employers and staff in education settings

People planning a pregnancy or who are pregnant, and their families

Families, carers, partners, people who look after babies and children up to 5 years, and the public

Guideline development process
How we develop NICE guidelines
Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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Overview | Maternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 years | Guidance | NICE

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This guideline covers nutrition and weight management in pregnancy for anyone who may become pregnant, is planning to become pregnant or is already pregnant, and nutrition in children up to 5 years. Care of babies and children born preterm or with low birth weight is not covered. The guideline does not give detailed advice on what constitutes a healthy diet

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Step by step guidance in supporting suspected reflux in infants

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The NICE Clinical Knowledge Summary (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories

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NG75: Recognition and Management of Faltering Growth

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NG75: Recognition and Management of Faltering Growth

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Faltering growth: recognition and management of faltering growth in children | Guidance and guidelines | NICE

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Evidence-based recommendations on recognising, assessing and monitoring faltering growth in infants and children

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Accessible and Culturally Inclusive Infant Feeding Information & Support

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Accessible and Culturally Inclusive Infant Feeding Information & Support

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Breastfeeding Specialist Midwife, Shaheda Yasmeen-Khan, presents infant feeding topics in accessible formats, with cultural competence at the heart.

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Welcome back to Instagram. Sign in to check out what your friends, family & interests have been capturing & sharing around the world.

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The NICE Clinical Knowledge Summary (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories

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Academy of Breastfeeding Medicine: Patient Leaflet

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Academy of Breastfeeding Medicine: Patient Leaflet

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CMPA in Breastfed Babies (Association of Breastfeeding Mothers)

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CMPA in Breastfed Babies (Association of Breastfeeding Mothers)

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A guide to understanding the difference between Cow's Milk Allergy and Lactose Intolerance, written by a GP & IBCLC, Paediatrician, and Lactation Consultant

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In summary, GPs and other clinicians have a critical role to play in recognising and diagnosing CMPA and lactose intolerance in breastfed babies. Correct management includes appropriate referral (including to a dietician) and support to continue breastfeeding. The only exception to this is in cases of congenital lactose intolerance, which is incredibly rare. Families may find a dairy-free diet challenging, and reintroducing dairy to the maternal diet is an essential step to both confirm the diagnosis of non-IgE CMPA as well as preventing unnecessary dietary restriction.
Dr Naomi Dow (GP and IBCLC) naomi.dow@nhs.scot Emma Pickett (IBCLC and Association of Breastfeeding Mothers Breastfeeding Counsellor) Dr Vicky Thomas (Consultant Paediatrician with special interest in growth and nutrition)
Whilst we have used the terms 'mother', 'woman' and 'breastfeeding', we recognise that not all families use this terminology. We encourage clinicians to use the terminology preferred by each parent or family.
References

1. Venter C, Brown T, Meyer R, Walsh J, Shah N, Nowak-Węgrzyn A, Chen T, Fleischer DM, Heine RG, Levin M, Vieira MC, Fox AT. Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clinical and Translational Allergy. 2017;7:26.

2. Turnbull JL, Adams HN, Gorard DA. Review article: the diagnosis and management of food allergy and food intolerances. Alimentary Pharmacology and Therapeutics. 2015; 41(1):3-25.

3. Venter C, Pereira B, Voigt K, Grundy J, Clayton CB, Higgins B, Arshad SH, Dean T. Prevalence and cumulative incidence of food hypersensitivity in the first 3 years of life. Allergy. 2008;63(3):354-9.

4. Vandenplas Y, Brueton M, Dupont C, Hill D, Isolauri E, Koletzko S, Oranje AP, Staiano A. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Archives of Disease in Childhood.2007;92(10):902-908.

5. Järvinen KM, Mäkinen-Kiljunen S, Suomalainen H. Cow's milk challenge through human milk evokes immune responses in infants with cow's milk allergy. The Journal of Pediatrics. 1999. 135(4):506-12.

6. Venter C, Pereira B, Voigt K, Grundy J, Clayton CB, Gant C, Higgins B, Dean T. Comparison of open and double-blind placebo-controlled food challenges in diagnosis of food hypersensitivity amongst children. Journal of Human Nutrition and Dietetics. 2007;20(6):565-79.

7. Fox A, Brown T, Walsh J, Venter C, Meyer R, Nowak-Wegrzyn A, Levin M, Spawls H, Beatson J, Lovis M, Vieira MC, Fleischer D. An update to the Milk Allergy in Primary Care guideline. Clinical and Translational Allergy. 2019;9:40.

8. National Institute for Health and Care Excellence [Internet]. Cow's milk allergy in children; [cited 2022 May 16]. Available from: https://cks.nice.org.uk/topics/cows-milk-allergy-in-children/

9. Meyer R, Lozinsky AC, Fleischer DM, Vieira MC, Du Toit G, Vandenplas Y, Dupont C, Knibb R, Uysal P, Cavkaytar O, Nowak-Wegrzyn A, Shah N, Venter C. Diagnosis and management of Non-IgE gastrointestinal allergies in breastfed infants-An EAACI Position Paper. Allergy. 2020;75(1)14-32.

10. Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, Mearin ML, Papadopoulou A, RuemmeleFM, Staiano A, Schäppi MG, Vandenplas Y. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Journal of Pediatric Gastroenterology and Nutrition. 2012;55(2):221-9.

11. Luyt D, Ball H, Makwana N, Green MR, Bravin K, Nasser SM, Clark AT. Executive summary of BSACI guideline for the diagnosis and management of cow's milk allergy. British Society for Allergy & Clinical Immunology (BSACI). Clinical and Experimental Allergy. 2014;44:642-672.

12. Picariello G, De Cicco M, Nocerino R, Paparo L, Mamone G, Addeo F, Canani RB. Excretion of Dietary Cow's Milk Derived Peptides Into Breast Milk. Frontiers in Nutrition. 2019;6:25.

13. The Academy of Breastfeeding Medicine. ABM Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant. Breastfeeding Medicine 2011;6:6.

14. Allen HI, Pendower U, Santer M, Groetch M, Cohen M, Murch SH, Williams HC, Munblit D, Katz Y, Gupta N, Adil S, Baines J, de Bont EGPM, Ridd M, Sibson VL, McFadden A, Koplin JJ, Munene J, Perkin MR, Sicherer SH, Boyle RJ. Detection and management of milk allergy: Delphi consensus study. Clinical & Experimental Allergy. 2022.52:848-858.

15. Schoemaker AA, Sprikkelman AB, Grimshaw KE, Roberts G, Grabenhenrich L, Rosenfeld L, Siegert S, Dubakiene R, Rudzeviciene O, Reche M, Fiandor A, Papadopoulos NG, Malamitsi-Puchner A, Fiocchi A, Dahdah L, Sigurdardottir ST, Clausen M, Stańczyk-Przyłuska A, Zeman K, Mills ENC, McBride D, Keil T, BeyerK. Incidence and natural history of challenge-proven cow's milk allergy in European children - EuroPrevall birth cohort. Allergy. 2015.70(8):963-72.

16. Heine RG, AlRefaee F, Bachina P, De Leon JC, Geng L, Gong S, Madrazo JA, Ngamphaiboon J, Ong C, Rogacion JM. Lactose intolerance and gastrointestinal cow's milk allergy in infants and children - common misconceptions revisited. World Allergy Organization Journal. 2017:12;10(1):41.

17. Torniainen S, Freddara R, Routi T, Gijsbers C, Catassi C, Höglund P, Savilahti E, Järvelä I. Four novel mutations in the lactase gene (LCT) underlying congenital lactase deficiency (CLD). BMC Gastroenterology. 2009:9:8.

18. Itan Y, Jones BL, Ingram CJE, Swallow DM, Thomas MG. A worldwide correlation of lactase persistence phenotype and genotypes. BMC Evolutionary Biology. 2010:10:36.

19. Gerbault P, Liebert A, Itan Y, Powell A, Currat M, Burger J, Swallow DM, Thomas DM. Evolution of lactase persistence: an example of human niche construction. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences. 2011. 27; 366(1566):863-877.

20. Douglas PS. Diagnosing gastro-oesophageal reflux disease or lactose intolerance in babies who cry a lot in the first few months overlooks feeding problems. Journal of Paediatrics and Child Health. 2013;49(4):E252-6.

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CMPA is an allergy to the beta-lactoglobulin protein in cow's milk. Learn about this and lactose intolerance in this article.

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Find out what to expect from breastfeeding in the first few days after birth, including what colostrum is, what happens when your milk ‘comes in’ and what the let-down reflex feels like.

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The new MAP guidelines were published in 2019 and are now hosted on GPIFN here.
Cows' Milk Allergy- Diagnosis and Management for the GP
Cows' Milk Allergy (CMA) is an allergy to cows' milk protein or to the carbohydrate (galactose-alpha-1-3-galactose). The prevalence of CMA has been reported as ranging from 1.9 - 4.9% in young children ¹ and it is the leading cause of food allergy in infants and children younger than 3 years ². In recent years the diagnosis and prescribing of specialist milk for CMA has increased in primary care. One of the suggested reasons for this is 'greater research focus on allergy, leading to greater, but sometimes misdiagnosed, identification of cows' milk allergy' ³. Milk allergy can present in exclusively breastfed infants but is much more rare than in formula fed infants (One study found the prevalence to be 0.5% amongst a cohort of 1974 patients which was just 9 infants) ⁴. Many of the symptoms of delayed allergy can represent normal physiology and it is important not to over diagnose CMA in a healthy infant due to the negative consequences of an unnecessary exclusion diet for mother and infant.

Up to 90% of children will grow out of their allergy by age 3 ¹. When this happens depends on various factors including how young they are when they develop the allergy, whether it is delayed or immediate, the severity of the symptoms and other allergies present.

CMA should not be confused with lactose intolerance, which is an intolerance to the sugar lactose, usually due to a temporary lack of the enzyme lactase which breaks down lactose. Lactase may be temporarily reduced due to changes in the gut lining after gastroenteritis. Lactose is present in both cows' milk and breastmilk, however lactose intolerance is due to an enzyme deficiency rather than an allergic reaction as with CMA.

There are two main types of CMA:

An IgE-mediated (immediate) allergy with symptoms starting within minutes to 2 hours of eating dairy. Symptoms might include urticaria, swollen eyes, lips, wheezing and/or vomiting.

A Non-IgE-mediated (delayed) allergy may cause eczema, respiratory symptoms, reflux, diarrhoea, cramps, constipation and sometimes blood in the stool.

Diagnosis of CMA
It is important to note that babies cry for many reasons and that some of the symptoms associated with a diagnosis of CMA may be caused by an alternative diagnosis, or may even fall within the range of normal infant behaviour.

The MAP guidelines & NICE CKS: Cows' Milk Protein Allergy in Children- Diagnosis includes detailed information on symptoms, taking an allergy focused history and examination. An allergy focused history is essential and will include asking about the presence of a family history of asthma, hayfever, eczema and food allergies, as well as the presence of the symptoms listed above.

It is physiologically normal for babies to posset regularly; reflux can be physiological and does not always require treatment, nor is it usually due to allergy. Parents may simply need reassurance. It is hard and exhausting caring for young babies, especially if they cry frequently. Parents may need more support with their baby. The website http://purplecrying.info/ is a great resource to signpost to parents to support those struggling with an infant that cries frequently.

Breastfed babies who have difficulties latching or other issues within the breastfeeding dyad may cry more, be unsettled and present with 'colic' symptoms. It is important therefore to ensure that as part of the clinical history and management, specialist support for breastfeeding including latch and tongue-tie assessment is addressed at an early stage.

If an infant is bottle fed breastmilk or formula, ensure that parents are practicing responsive bottle feeding. Babies made to 'finish the bottle' may be overfed and their vomiting may be due to excessive intake. The guidance on formula packs may not align with current best practice guidance on frequency and volume of feeds for babies at different stages⁵.

It is also important to be aware that the majority of infant eczema is not caused by CMA, although one should certainly consider it in eczema that is resistant to treatment.

Children with IgE-mediated allergy presentations should be referred to paediatrics and they may have specific IgE testing +/- skin prick testing.

Children with Non-IgE-mediated allergy can be diagnosed when all dairy products are removed from the diet of the baby and the breastfeeding mother for 2-4 weeks ⁶, ⁷ to see if the symptoms improve, followed by a trial of reintroduction of dairy, confirming the diagnosis if symptoms recur. This is an important step that should only be missed out in extreme cases.

Breastfeeding should continue for as long as the mother wishes and continuation of breastfeeding is particularly important for atopic children. The GP should aim to support the mother to continue breastfeeding by ensuring she has the guidance needed to commence a varied dairy free diet. If CMA is confirmed by the recurrence of symptoms following reintroduction of dairy, referral to a dietitian for advice for her diet as well as for the infant once complimentary foods are introduced. You may find the BDA Food Fact Sheet: Milk Allergy useful for dietary pointers.

In the case of non-IgE-mediated allergy, it can take 2-4 weeks on an exclusion diet to see an improvement but parents might notice a change after a few days. A symptom diary can help to objectively identify if there has been an improvement during the exclusion period.

If there is no improvement during the exclusion period, dairy can be reintroduced to the diet of mother and baby and an alternative diagnosis sought.

If an improvement is seen then it is important to reintroduce dairy while continuing the symptom diary. If symptoms return when back on dairy the diagnosis has been confirmed. Following this a referral to a paediatric dietitian should be made.

Studies estimate that over 10% of children with CMA will also be allergic to soya ⁸, ⁹. In cases of severe eczema or gut symptoms you may wish to discuss with a specialist with regards to also excluding soya +/- egg. Any reintroduction would need to include a gradual reintroduction of one item at a time to confirm the allergy. Excluding these three foods can significantly impact the diet of a breastfeeding mother or infant and must not be done lightly.

NICE CKS: Cows' Milk Protein Allergy in Children- Suspected Cows' Milk Protein Allergy Details the diagnostic procedure for immediate and delayed CMA.
After a Diagnosis of CMA
According to the NICE guidelines ¹⁰, non-IgE-mediated CMA can be managed in primary care if the GP feels competent but the mother and baby should be referred to a paediatric dietitian for guidance on introducing solid foods and to support breastfeeding mothers with their own dietary exclusions.

You should refer to a paediatric allergy clinic when:

The baby has faltering growth

There is a question about the diagnosis with ongoing symptoms

There has been an immediate (IgE-mediated) allergic reaction

There has been one or more severe delayed (non-IgE-mediated) reactions

There is more than one food allergy

If there is severe ongoing eczema where there is a risk of other allergies

If the baby has symptoms of CMA (especially IgE-mediated) then the parents need to ensure that all those looking after the child are aware of the allergy and check all food given to the child. If child-care is used they should ask to see the child-care setting's policy on food allergies especially regarding avoidance of cross-contamination from other children's plates and training in the management of allergy.

If the child has an IgE-mediated CMA, parents should be given guidance on managing anaphylaxis and immediate allergy (which will be supported by the paediatric allergy clinic). If the child has a history of a severe IgE allergy or mild plus a history of asthma s/he should be prescribed an adrenaline pen . Parents should be given an Allergy Action Plan, to be used in childcare and school settings.
Ongoing Cows' Milk Exclusion for the Infant
Breastfeeding a Baby with CMA Information to support breastfeeding mothers with a dairy exclusion diet.

Formula Feeding a Baby with CMA Information to support the appropriate use of hydrolysed or amino acid formula if a baby with CMA is formula fed.
Introducing Solids (Family Foods) when Dairy Free
WHO guidance is for babies to be exclusively breastfed until 6 months. Complementary solid foods can be introduced from 6 months and there is significant evidence for benefits to mother and baby from continued breastfeeding until at least 2 years of age ¹¹.

When the family see the paediatric dietitian they will get more ideas on being dairy free and help with ideas for when it's time to introduce solid food for the baby. The baby will need high calorie snacks to replace the fat and calories that they would get from dairy products normally. Homemade dairy free flapjacks, sugar free carrot muffins, pieces of chicken, houmous and cucumber, peanut butter oat balls, rice pudding with coconut cream are all ideas.

High sugar options should be avoided.

Once solids are introduced, dairy free milks can be used in food preparation:

Milks fortified with at least 120mg/100ml of calcium should be used.

These may include soya (if soya is tolerated) eg. Alpro Soya Junior 1+, oat milk and almond milk.

Rice milk should not be used until 4.5 years of age due to high levels of naturally occurring arsenic ¹².

When making meals for the baby they can make porridge/rice pudding with dairy free milks and creams (expressed breast milk; alternative milks including: oat, soya (if tolerated), coconut, almond, dairy free formula etc.).

Be mindful that cows' milk allergy can co-exist with soya allergy (see above) and starting soya may also cause symptoms.
Dairy Free Milk Drinks Beyond Infancy
Breastfeeding is recommended until 2 years of age and beyond ¹¹. If the infant receives formula feeds s/he can be switched from dairy free formula under the guidance of a paediatric dietitian at 1 year of age if:

A varied diet is followed,

The baby can tolerate soya and

The baby is growing well.

At this stage the baby can have non-dairy calcium fortified milk eg. Alpro Soya Junior 1+ (This is found in the UHT aisle in the supermarket and is different to normal soya milk as it is specially designed for children over 12 months).

If the baby cannot tolerate soya the dietitian might recommend a dairy free milk or may recommend to continue on a dairy free formula depending on the above factors. This is usually only recommended by a paediatrician or paediatric dietitian rather than being started by the GP.

Once the child is 2 years old s/he can move to a dairy free milk ¹² that is fortified with at least 120mg/100ml of calcium eg. Oat milk. Before the age of 2 these milks are considered too low in protein and fat compared to dairy free formula or soya.
Reintroduction of Cows' Milk
The dietitian will discuss when it is safe to reintroduce cows' milk. In the case of non-IgE-mediated cows' milk allergy they will discuss the ' Milk Ladder' so this can be done slowly and safely step by step. NICE recommends implementing a strict cows' milk elimination diet until the child is 9-12 months old and for at least 6 months after confirmation of diagnosis ⁷. Please see the full for resources to support the family when reintroducing cows' milk.

Individuals should be reassessed at 6-12 monthly intervals from 12 months of age to assess for suitability of re-introduction ⁸.
Further Information
NICE CKS: Cows' Milk Protein Allergy in Children Revised June 2015

NICE Guideline CG116: Food allergy in under 19s: assessment and diagnosis February 2011

Local Infant Feeding Information Board (LIFIB): Cows' Milk Protein Allergy in Infants- For Parents and Carers Parent information leaflet

Local Infant Feeding Information Board (LIFIB) Multidisciplinary group of healthcare professionals based in the northwest of England who critically appraise information and research on infant feeding issues, producing factual evidence-based summaries for healthcare professionals.

First Steps Nutrition Trust: Specialised Infant Milks in the UK- Infants 0-6 Months Information for Health Professionals September 2019- scroll down to the purple report. See sections 3.12 and 3.13 which cover extensively hydrolysed peptide-based infant milks suitable from birth and amino-acid based infant milks for non-metabolic disorders, suitable from birth.

Surrey CCGs Prescribing Advisory Database (PAD). Your own CCG / health board may have their own prescribing preferences. If they do not, the following guideline might be useful.
CMA Resources for Parents
British Dietetic Association (BDA) Food Fact Sheet: Milk Allergy Lists foods to avoid if dairy free.
British Dietetic Association (BDA) Food Fact Sheet: Milks for Children with Cows' Milk Allergy
First Steps Nutrition Trust Independent evidence based guidance on eating healthily including leaflets on special diets and guidance on recipes and portion sizes.

First Steps Nutrition Trust: Eating Well- Vegan Infants and Under 5s Recipes are suitable for a dairy-free diet. Scroll down the page to reach this guide.

The NHS Website: Children's Teeth Guidance on dental health for children, particularly important for those given dairy free formula.

The NHS Website: Vitamin D Guidance on vitamin D supplements for babies and children.

Food Maestro Website and smart phone App. You can enter your allergies then scan products to check if they are safe (Co-developed by Guys and St Thomas' Hospital).

Dilan and Me: Has useful tips on thriving as a breastfeeding mother or an infant with CMA including a handy list of dairy and soya free treats.
References

1. Venter C, Broen T, Shah N, Walsh J, Fox A. Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy - a UK primary care practical guide. Clinical and Translational Allergy. 2013;3(1):23

2. Koletzko S, Niggemann B, Arato A, Dias J, Heuschkel R, Husby S et al. Diagnostic Approach and Management of Cow's-Milk Protein Allergy in Infants and Children: ESPGHAN GI Committee Practical Guidelines. Journal of Pediatric Gastroenterology and Nutrition. 2012;55(2):221-229

3. First Steps Nutrition Trust: Specialised Infant Milks in the UK (Infants 0-6 months) Information for Health Professionals September 2019. Scroll down to the purple report.

4. Host A, Husby S, Osterballe O. A prospective study of cow's milk allergy in exclusively breast-fed infants. Incidence, pathogenetic role of early inadvertent exposure to cow's milk formula, and characterization of bovine milk protein in human milk. Acta Paediatr Scand. 1988;77(5):663-70.

5. First Steps Nutrition Trust: Infant Milks in the UK- A Practical Guide for Healthcare Professionals June 2019. Scroll to the green report.

6. Surrey CCGs Prescribing Advisory Database (PAD)

7. NICE CKS: Cows' Milk Protein Allergy in Children Revised June 2015

8. Luyt D, Ball H, Makwana N, Green M, Bravin K, Nasser S et al. BSACI guideline for the diagnosis and management of cow's milk allergy. Clinical & Experimental Allergy. 2014;4:642-672

9. Kattan J, Cocco R, Järvinen K. Milk and Soy Allergy. Pediatric Clinics of North America. 2011;58(2):407-426.

10. NICE Guideline CG116: Food allergy in under 19s: assessment and diagnosis February 2011

11. WHO: Infant and Young Child Feeding Factsheet Updated February 2018

12. British Dietetic Association (BDA) Food Fact Sheet: Milks for Children with Cows' Milk Allergy

Published April 2017, Updated October 8th 2019

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by Dr Marie-Therese (Terri) Lovis, General Practitioner The new MAP guidelines were published in 2019 and are now hosted on GPIFN here. Cows' Milk Allergy- Diagnosis and Management for the GP Cows' Milk Allergy (CMA) is an allergy to cows' milk protein or to the carbohydrate (galactose-alpha-1-3-galactose).

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Example Local Flowchart for Diagnosing Suspected CMPA

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Example Local Flowchart for Diagnosing Suspected CMPA

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This is an example of a local flow chart illustrating the steps to follow in exploring a possible diagnosis of CMPA. Please note that pathways and prescribing guidance will vary between localities.

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BSACI Primary Care Guidelines Milk Allergy

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BSACI Primary Care Guidelines Milk Allergy

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The specialist UKDILAS service from SPS provides evidence-based information and advice to healthcare-professionals on the use of medicines during breastfeeding

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University Hospitals of Leicester NHS Trust
Leicester Royal Infirmary
Victoria Building
Oliver Ward
Leicester
Leicestershire
LE1 5WW

Telephone: 0116 258 6491
Email: ukdilas.enquiries@nhs.net

Where we can and can't help

Help us to help you

Before contacting us, ensure you have gathered information on both the mother and the infant, so that we can help you with your enquiry.

Questions we can answer

Types of enquiry our specialist team can help with:

Medicines in breast milk for preterm and health compromised infants.

Effects of medicines on milk production, including enhancement and suppression of lactation.

Advising on appropriate medicines in breastfeeding for specific conditions.

Management of breastfeeding-related conditions, e.g. nipple/breast infections.

Advising on medicines in breast milk after maternal overdose.

Questions we can't answer

We are not formally trained as breastfeeding supporters and therefore cannot offer specific advice on breastfeeding itself.

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The specialist UKDILAS service from SPS provides evidence-based information and advice to healthcare-professionals on the use of medicines during breastfeeding

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Breastfeeding Network: Drugs in Breastmilk Factsheets

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Breastfeeding Network: Drugs in Breastmilk Factsheets

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These factsheets are maintained by the BFN Drugs in Breastmilk information service team of pharmacists. If you are unable to find the information you are looking for, or you still have questions, you can contact the team by sending a private message via their Facebook page or via email.

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Drugs in Breastmilk factsheets - The Breastfeeding Network

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These factsheets have been compiled by our Drugs in Breastmilk information service team of pharmacists. If you are unable to find the information you are looking for below, or you still have questions, you can contact the team by sending a private message via our Facebook page or via email. Please provide as much information as possible (age […]

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The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data are derived from the scientific literature and fully referenced. A peer review panel reviews the data to assure scientific validity and currency.

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The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate.

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A review of the evidence supporting the use of domperidone for low milk supply

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SPS Evidence Review on Use of Domperidone for Low Milk Supply

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SPS Evidence Review on Use of Domperidone for Low Milk Supply

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Recommendation

Complete a full assessment to understand the underlying cause of the low milk supply and correct any known problems before considering domperidone.

Domperidone is the medicine of choice if medical treatment is required for low milk supply.

Use 10mg three times daily, initially for 7 days then review.

Limited evidence shows negligible amounts of domperidone pass into breast milk.

How lactation works

Lactation is complex, involving hormonal, physical, and emotional factors.

Several hormones (including prolactin, insulin and hydrocortisone) are needed for colostrum production, and for the onset of copious milk supply. For breasts to continue producing milk, the following are needed:

a rise in prolactin levels, usually caused by nipple stimulation

oxytocin release to allow milk ejection, caused by nipple stimulation

regular removal of milk

Milk production is based on supply and demand. If milk isn't removed, supply will reduce and eventually stop.

Signs of normal milk supply

Colostrum, in small volumes, is produced during the first 24 to 48 hours after birth. Larger volumes of breast milk are produced by the fifth day.

After the first two weeks of life, the best indicator of adequate milk supply is the baby gaining weight, and wetting nappies and passing stools as expected.

Diagnosing low milk supply

Up to half of breastfeeding women worry their milk supply is low. A true low milk supply is uncommon, affecting only about 15% of mothers.

There is often an underlying cause which can be resolved. A proper assessment of breastfeeding technique and other maternal and infant factors to identify any potential cause, will lead to the most successful outcome, potentially without the need for medication.

Assessment tools are available and should be used by a suitable qualified person with skills in lactation support.

Some medicines may affect milk production. If you are concerned, check the Safety in Breastfeeding information, or contact the UK Drugs in Lactation Advisory Service (UKDILAS).

Medicines used to increase milk supply

Substances to increase milk supply are known as galactagogues.

No medicines are licensed in the UK for the treatment of low milk supply, and are therefore used off-licence. Follow the GMC's guidance on unlicensed and off-licence prescribing.

Most galactagogues work by increasing prolactin levels. However, a higher prolactin level does not mean more milk. It is unknown if all women with a low milk supply also have low prolactin levels, and therefore if increasing prolactin levels further would help. A sudden increase in prolactin levels (usually triggered by nipple stimulation) seems to be important, not the maximum level produced. The frequent removal of milk via feeding also increases prolactin levels.

Evidence for the efficacy of galactagogues is limited, but they probably do increase milk volume initially. Prolactin levels also increase. We do not know if they help maintain breastfeeding long-term or increase infant weight gain.

Choice

If a galactagogue is required, domperidone is first choice due to most evidence for use and efficacy, better side-effect profile, and negligible passage into breast milk.

Other galactagogues include metoclopramide, sulpiride, and some herbal products. However, there is less evidence of efficacy, and these have other safety considerations.

Domperidone

Most evidence is in pre-term infants, which shows a moderate short-term effect on expressed breast milk volume, increasing by around 86 to 245mL per day. There is less evidence evaluating domperidone in mothers feeding term infants.

When to start

In studies, domperidone was started between days 1 and 33 post-delivery. It may be effective after this point, but there is no good evidence to support this.

Dose

Domperidone should be prescribed at a dose of 10mg three times daily. Doses higher than this should not be used.

Most studies used domperidone 10mg three times daily. Some small studies used higher doses. Only two small studies compared domperidone 10mg and 20mg three times daily. The 20mg groups produced on average slightly more milk, but it is uncertain whether this was a real difference or due to chance.

Domperidone does not always work. One study used domperidone 10mg and 20mg three times daily found a third of mothers did not have an increased milk supply at either dose. The study suggested that if there was no response to 10mg, increasing to 20mg was unlikely to work.

Duration of treatment

Domperidone should be prescribed for 7 days and then reviewed.

This is in line with the maximum treatment duration for the licensed indication (nausea and vomiting), due to the increased risk of cardiac events (particularly in certain populations), and potential for psychiatric withdrawal effects.

There is limited evidence regarding how long to use domperidone to increase milk supply. Some evidence shows the maximum effect is usually achieved within 7 to 14 days. Therefore, continuing treatment is unlikely to make a difference.

Whether to continue domperidone for longer than 7 days is a clinical decision after considering the evidence and potential increased risks.

Stopping treatment

Maintaining milk supply

It is not known whether stopping treatment with a galactagogue suddenly or gradually is better for maintaining milk supply. The American Academy of Breastfeeding Medicine recommends considering gradual discontinuation.

If milk supply reduces after stopping domperidone and improves on restarting again, gradually decrease to the lowest effective dose, and attempt discontinuation again.

Gradual withdrawal may also help reduce concerns about discontinuation.

Withdrawal symptoms

A small number of case reports suggest withdrawal symptoms occur when domperidone is discontinued either suddenly or gradually. In all cases, either prolonged use (up to 10 months) or higher than recommended doses (up to 160mg daily) were used.

Symptoms of withdrawal include insomnia, anxiety, headaches, palpitations, gastro-intestinal disturbances and depression. Re-emergence of previous mental health conditions has been reported.

If suspected withdrawal symptoms occur, increase the dose of domperidone back to a level that does not produce symptoms, and restart withdrawal more slowly.

A Canadian Safety Review on this issue is available.

Risk of cardiac events

Domperidone can cause a small increased risk of serious cardiac events, including certain types of arrhythmias, especially when used in high doses, for longer periods, or when additional risk factors are present. Patients at higher risk include those with cardiac disease, severe liver problems, electrolyte imbalances, or taking medicines affecting the QT interval or which interact with domperidone.

Maternal risk

Most breastfeeding women are relatively young and healthy and their baseline risk of cardiac events is very low.

A large cohort study involving over 1 million post-partum patients found domperidone increased the baseline ventricular tachycardia rate from 0.20 to 0.74 per 10,000 person years. It is not possible to prove whether the increase was due to chance or not. No sudden cardiac deaths in the domperidone group were reported, and the rate of all-cause mortality was decreased.

An increased incidence of arrhythmia in women with no arrhythmia history, taking domperidone to increase milk supply, has generally not been seen in studies.

Domperidone can be considered if a woman has no additional cardiac or medical risk factors, and is not taking medication that interacts with domperidone or affect the QT interval. Further information on drug-induced QT interval prolongation is available.

However, if risk factors are present, then ECG monitoring may be required, or an alternative considered. Contact UKDILAS for alternative galactagogue use.

Infant risk

Cardiac events in the infant have not been reported after domperidone exposure via breast milk.

In one study in premature infants, five babies had a prolonged QT interval, although none had symptoms or needed intervention. This was more likely due to infant prematurity than domperidone exposure.

If the infant has cardiac disease, severe liver disease or is receiving medicines which may be a problem, then domperidone use in the mother is best avoided. Contact UKDILAS for alternative galactagogue use.

Domperidone levels in breast milk

Very limited information shows domperidone passes into breast milk in negligible amounts (less than 0.5% of the maternal weight-adjusted dose), even with high dose, long term therapy.

In addition, there is a very low risk of accumulation in the infant and its low oral bioavailability will limit the amount absorbed from the breast milk.

Monitoring the infant
No serious side-effects have been reported in infants exposed to domperidone via breast milk.
As a precaution, monitor for gastro-intestinal disturbances, or signs of dry mouth, such as difficulty feeding.

Since there is no evidence that domperidone via breast milk can cause significant ECG changes in the infant, infant ECG monitoring is not routinely required. If there are additional risk factors, contact UKDILAS.

Ongoing support

Ongoing lactation support will be necessary during treatment with domperidone. Regular review is needed if domperidone is used beyond 7 days.

Induced or restarting lactation

Inducing lactation in a person who has not given birth, or restarting after a period of non-lactation, is beyond the scope of this article.

Get in touch with the UK Drugs In Lactation Advisory Service if:

you need further advice

you are considering a different medicine for low milk supply

multiple medicines are being taken

Acknowledgement

Thanks to Dr Louise Santhanam, General Practitioner, and Leicester Mammas CIC for their expert review.

Bibliography

A referenced version is available on request.

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Domperidone can be used to treat low milk supply. However, this is only after thorough assessment and once non-medical interventions have been tried.

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A 7 part discussion: "It's Not Thrush"

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Naomi Dow on Instagram: "It's Not Thrush - Part 1
Candida is a normal part of us.

Candida is a type of fungus. It is naturally present in the human mouth, gut and vagina. It is also sometimes present on the skin in low numbers.

Candida is a commensal - this means it is part of our microbiome: a complex community of microbes that live in and on us. It is supposed to be there!

Candida numbers can sometimes grow rapidly, allowing the numbers of candida to be far higher than found in the commensal state. When this happens, it is called candidiasis, or 'thrush'.

BUT, thrush can only happen when there is a change in the environment. For example, vaginal thrush can develop when the number of lactobacilli (another commensal) drop, allowing candida numbers to swell.

Most of the time, for most people, Candida is just a normal part of us - not causing any harm. So let's take the fear out of Candida!

Interested in reading more? 'On Commensalism of Candida', by Jesus Romo and Carol Kumamoto, in The Journal of Fungi (2020) is an excellent overview.

#candida #thrush #itsnotthrush #microbiome #normalisingnormal"

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81 likes, 6 comments - dr_naomidow_ibclc on October 19, 2024: "It's Not Thrush - Part 1
Candida is a normal part of us.

Candida is a type of fungus. It is naturally present in the human mouth, gut and vagina. It is also sometimes present on the skin in low numbers.

Candida is a commensal - this means it is part of our microbiome: a complex community of microbes that live in and on us. It is supposed to be there!

Candida numbers can sometimes grow rapidly, allowing the numbers of candida to be far higher than found in the commensal state. When this happens, it is called candidiasis, or 'thrush'.

BUT, thrush can only happen when there is a change in the environment. For example, vaginal thrush can develop when the number of lactobacilli (another commensal) drop, allowing candida numbers to swell.

Most of the time, for most people, Candida is just a normal part of us - not causing any harm. So let's take the fear out of Candida!

Interested in reading more? 'On Commensalism of Candida', by Jesus Romo and Carol Kumamoto, in The Journal of Fungi (2020) is an excellent overview.

#candida #thrush #itsnotthrush #microbiome #normalisingnormal". 

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A Physician's Guide to Breastfeeding: Nipples

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A Physician's Guide to Breastfeeding: Nipples

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Nipple Topics - Physician Guide to Breastfeeding

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A variety of topics relating to nipples and nipple care and breastfeeding. Proper nipple care is essential for healing wounds from postpartum engorgement and latch struggles, as well as resolving other trauma from causes such as pumping or infant biting.

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Feedback here! Suggestions for content, or feedback on current material. 

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Feedback here! Suggestions for content, or feedback on current material. 

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Easily create surveys and polls to collect customer feedback, measure employee satisfaction, and organize team events.

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Expression and Safe Storage of Breast Milk

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Expression and Safe Storage of Breast Milk

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Expressing milk means squeezing milk out of your breast so you can store it and feed it to your baby later.

You might want to express milk if:

How to express breast milk

You can express milk by hand or with a breast pump. How often you express your milk, and how much you express, will depend on why you're doing it.

Sometimes it takes a little while for your milk to start flowing. Try to choose a time when you feel relaxed. Having your baby (or a photo of them) nearby may help your milk to flow.

You may find it easier to express if you cover your breasts with a warm towel first, or after you have a shower or bath.

Expressing breast milk by hand

Some find it easier to express milk by hand, especially in the first few days or weeks. It also means you can express without needing a pump, or an electricity supply.

Hand expressing allows you to encourage milk to flow from a particular part of the breast. This may be useful, for example, if one of the milk ducts in your breast becomes blocked.

Hold a sterilised feeding bottle or container below your breast to catch the milk as it flows.

These tips may help:

Before you start, wash your hands with soap and warm water.

Have something clean ready to collect the milk in.

Some find gently massaging their breasts before expressing helps their milk to let down.

Cup your breast with one hand then, with your other hand, form a "C" shape with your forefinger and thumb.

Squeeze gently, keeping your finger and thumb a few centimetres away from your nipple, just outside the darker area around it (areola). Do not squeeze the nipple itself as you could make it sore. This should not hurt.

Release the pressure, then repeat, building up a rhythm. Try not to slide your fingers over the skin.

Drops should start to appear, and then your milk usually starts to flow.

If no drops appear, try moving your finger and thumb slightly, but still avoid squeezing the darker area near your nipple.

When the flow slows down, move your fingers round to a different section of your breast, and repeat.

When the flow from one breast has slowed, swap to the other breast. Keep changing breasts until your milk drips very slowly or stops altogether.

Watch a video about expressing milk by hand on the UNICEF website

Expressing milk with a breast pump

There are 2 different types of breast pump: manual (hand-operated) and electric.

Manual pumps are cheaper but may not be as quick as an electric pump.

You may be able to hire an electric pump. Your midwife, health visitor or a local breastfeeding supporter can give you details of pump hire services near you.

The suction strength can be altered on some electric pumps. Build up slowly. Setting the strength to high straight away may be painful or damage your nipple.

You may also be able to get different funnel (the part that goes over your nipple) sizes to fit your nipples. The pump should never cause bruising or catch your nipple as it's sucked into the funnel.

Always make sure that the pump and container are clean and sterilised before you use them.

Find out how to sterilise baby bottles

Storing breast milk

You can store breast milk in a sterilised container or in special breast milk storage bags:

in the fridge for up to 8 days at 4C or lower (you can buy fridge thermometers online) - if you're not sure of the temperature of your fridge, or it is higher than 4C, use it within 3 days

for 2 weeks in the ice compartment of a fridge

for up to 6 months in a freezer, if it's -18C or lower

Breast milk that's been cooled in the fridge can be carried in a cool bag with ice packs for up to 24 hours.

Storing breast milk in small quantities will help avoid waste. If you're freezing it, make sure you label and date it first.

Defrosting frozen breast milk

It's best to defrost frozen breast milk slowly in the fridge before giving it to your baby. If you need to use it straight away, you can defrost it by putting it in a jug of warm water or holding it under running warm water.

Once it's defrosted, give it a gentle shake if it has separated. Use it straight away. Do not re-freeze milk that's been defrosted.

Once your baby has drunk from a bottle of breast milk it should be used within 1 hour and anything left over should be thrown away.

Warming breast milk

You can feed expressed milk straight from the fridge if your baby is happy to drink it cold. Or you can warm the milk to body temperature by putting the bottle in a jug of warm water or holding it under running warm water.

Do not use a microwave to heat up or defrost breast milk. This can cause hot spots, which can burn your baby's mouth.

Storing breast milk if your baby is in hospital

If you're expressing breast milk because your baby is premature or sick, ask the hospital staff caring for your baby for advice on how to store it.

Read more about breastfeeding a premature or sick baby

If you're having difficulty expressing breast milk

If you're finding it difficult or uncomfortable to express your breast milk:

Ask your midwife, health visitor or breastfeeding supporter for help. They can also tell you about other breastfeeding support available near you.

Search online for breastfeeding support in your area.

Call the National Breastfeeding Helpline on 0300 100 0212 (9.30am to 9.30pm daily).

The Bliss website also has advice about expressing milk for a premature or sick baby

Community content from HealthUnlocked

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Everything you need to know about expressing and storing your breast milk, including tips on hand expressing and electric breast pumps, and how to freeze, defrost and warm breast milk.

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Team Baby! A Free Online Course to prepare for breastfeeding (ABM)

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Team Baby! A Free Online Course to prepare for breastfeeding (ABM)

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It doesn't just take the parent who has the breasts to make breastfeeding work, it takes a team and you can make all the difference! It's about knowing how breastfeeding happens, knowing how newborns behave, accessing qualified support when things are challenging, providing encouragement and emotional support - and practical support around the home too.

This FREE course is aimed at,

Expectant couples

grannies and grandads

sisters and the brothers

aunties and the uncles

friends and supporters

The course is broken down in to 5 sections which include articles and videos to empower you to become informed and confident.

1. The decision to breastfeed

2. How breastfeeding works

3. How newborns behave

4. What challenges can arise

5. Where to get help

At the end of each section, you'll also find a 'partner challenge' - an activity you can do with your partner. It can take a few minutes in the car on the way to the supermarket, or however long you like. You can do them at any point in the course or afterwards!

Please note this course is compatible only on Edge, Chrome and Safari Browsers.

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A free online short course to empower you to become informed and confident around the topic of breastfeeding

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A free online support group run by Dr Helen, a GP with a special interest in allergy

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

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The NICE Clinical Knowledge Summaries (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories.

CKS content is produced by Clarity Informatics Ltd (trading as Agilio Software | Primary Care). It is available to users outside the UK via subscription from the Agilio | Prodigy website.

If you believe you are seeing this page in error please contact us.

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The NICE Clinical Knowledge Summary (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories

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The NICE Clinical Knowledge Summaries (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories.

CKS content is produced by Clarity Informatics Ltd (trading as Agilio Software | Primary Care). It is available to users outside the UK via subscription from the Agilio | Prodigy website.

If you believe you are seeing this page in error please contact us.

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The NICE Clinical Knowledge Summary (CKS) site is only available to users in the UK, Crown Dependencies and British Overseas Territories

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The Association of Breastfeeding Mothers: Online Courses

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The Association of Breastfeeding Mothers: Online Courses

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The ABM offers a range of training options, from a short course for partners and families, to in-depth courses for mothers and professionals.

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"With a substantial development of research and findings for breastfeeding over the past three decades, we are now able to expand on the health benefits for both women and children across the globe. The two papers in this Series will describe past and current global trends of breastfeeding, its short and long-term health consequences for the mother and child, the impact of investment in breastfeeding, and the determinants of breastfeeding and the effectiveness of promotion interventions."

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With a substantial development of research and findings for breastfeeding over the past three decades, we are now able to expand on the health benefits for both women and children across the globe.

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This three-paper Series outlines the multifaceted and highly effective strategies used by commercial formula manufacturers to target parents, health-care professionals, and policy-makers. The industry’s dubious marketing practices—in breach of the breastfeeding Code—are compounded by lobbying of governments, often covertly via trade associations and front groups, against strengthening breastfeeding protection laws and challenging food standard regulations.

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Basis information sheets are provided for you to download and print as required, free of charge.

Download and/or print our latest A5 flyer - ideal for introducing Basis to parents or colleagues.

Our Info Sheets on 'Where Babies Sleep' and 'Bedsharing & Safety' have been endorsed by NICE as suitable resources for health practitioners to use in implementing the new NICE cosleeping and SIDS recommendations in UK. See NICE Guidance NG194 for the revised guidance, and resources for the link from NICE to the endorsed resources.

Information sheet 1: Normal Infant Sleep

Information sheet 2: Where babies sleep

Information sheet 3: Bed-sharing & safety

Information sheet 4: Daytime sleep and slings

Information sheet 5: Sleep aids: Dummies, swaddling and sleep bags

Information sheet 6: Sleep training

Information sheet 7: Twin infant sleep

Information sheet 8: Supporting new parents

You can now download and print Italian translations of all our information sheets:

Normal infant sleep - Il sonno normale dei bambini

Where babies sleep - Dove dormono i bambini

Bed-sharing & safety - Condivisione del letto e sicurezza

Day-time sleep & slings - Usare una fascia portabebe per il sonno diurno dei vostri bambini

Sleep aids - Succhiotti, fasce e sacchi nanna

Sleep training - Insegnare a dormire

Twin infant sleep - Il sonno dei neonati gemelli

You can now download and print Spanish translations of all our information sheets:

Normal infant sleep - El Sueño Normal del Bebé

Normal infant sleep - El Sueño Normal del Bebé

Where babies sleep - Dónde duermen los bebés

Bed-sharing & safety - Colecho y Seguridad

Day-time sleep & slings - El uso del Portabebés para el sueño diurno

Sleep aids - Chupetes, empañadura y sacos de dormir para bebés

Sleep training - Métodos para Enseñar a Dormir

You can now download and print Dutch translations of all our information sheets:

Normal infant sleep - Normaal slaapgedrag van baby's en jonge kinderen

Where babies sleep - Waar baby's slapen

Bed-sharing & safety - Bedding-in en veiligheid

Day-time sleep & slings - Het gebruik van een draagdoek voor slapen overdag

Sleep aids - Fopspenen, inbakeren en babyslaapzakken

Sleep training - Slaaptraining

Twin infant sleep - Slaapgedrag van tweelingbaby's

Japanese translations of all our information sheets are now available for you to download and print

Normal infant sleep - 赤ちゃんの通常の睡眠

Where babies sleep - 赤ちゃんが眠る場所

Bed-sharing & safety - ベッドに一緒に寝ること (ベッドの共有)と安全性

Day-time sleep & slings - 日中の睡眠(昼寝)でのスリングの 使用

Sleep aids - おしゃぶり、スワドリング(布で赤ちゃんを しっかり巻くこと)、赤ちゃん用寝袋(スリーパー)

Sleep training - ねんねトレーニング(ネントレ)、 睡眠トレーニンク ゙

Twin infant sleep - 双子の赤ちゃんの睡眠

You can now download and print French translations of all our information sheets:

Normal infant sleep - Le sommeil normal de l'enfant

Where babies sleep - Ou dorment les bébés

Bed-sharing & safety - Couchage partagé et sécurité

Day-time sleep & slings - Utiliser une écharpe pour le sommeil en journée

Sleep aids - Tétines, emmaillotement et turbulettes

Sleep training - S'entrainer à dormir

Twin infant sleep - Le sommeil des jumeaux

You can now download and print Romanian translations of all our information sheets:

Normal infant sleep - Somnul normal al sugarului

Where babies sleep - Unde dorm bebeluşii

Bed-sharing & safety - Dormitul cu bebeluşul şi Siguranţa acestuia

Day-time sleep & slings - Utilizarea unui port-bebe pentru somnul de zi

Sleep aids - Suzete, înfășarea şi saci de dormit pentru bebeluşi

Sleep training - „Antrenamentul"somnului

Twin infant sleep - Somnul gemenilor

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First Steps Nutrition: Infant Milks & the WHO Code

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First Steps Nutrition: Infant Milks & the WHO Code

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First Steps Nutrition is an expert-led non-commercial organisation which provides unbiased and influence-free advice on infant nutrition and infant milks.

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Our partner site

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. On this website we provide information about the types of infant milks on the UK market and provide compositional information for infant formula, follow-on formula and infant milks marketed as foods for special medical purposes that are available for sale over the counter.

First Steps Nutrition Trust provides a one stop shop for information on infant milks marketed in the UK. We provide information on the composition of infant milks, the claims made and the usefulness and safety of ingredients. We gather together all the information needed to support families who use these products to feed their infants.

The International Code of marketing of breastmilk substitutes and all the subsequent World Health Assembly resolutions are global agreements designed toprotect all babies from unscrupulous marketing and claims about alternatives to breastmilk. Some but not all of the Code and resolutions are written into regulation in the UK, which means that advertising of follow on formula, and advertising to health professionals is permissible.

Everyone working in Unicef UK Baby Friendly Initiative accredited settings however pledges to work within the Code and resolutions, and we are pleased to work in partnership with them to support health professionals in this.

In this section we summarise the history of infant milks, how infant milk composition is regulated, and the current infant feeding patterns in the UK. The UK and international markets for infant milks are also summarised in this section.

It is important that infant milks are made up safely. Powdered infant formula is not sterile and needs to be made up a temperature which will kill any potential bacteria present. All equipment needs to be sterilised, and it is important to know how to make up and store milk safely. Here you can link to useful information on making up milks safely, how to use vaccum flasks safely when making up milk on the move and the safety of electrical milk preparation machines (such as Tommy Tippee Perfect Prep™).

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Infant milks for health workers - First Steps Nutrition Trust

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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. On this website we provide information about the types of infant milks on the UK market and provide compositional information for infant formula, follow-on formula and infant milks marketed as foods for special medical purposes that are available for sale over the counter.

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Many families may need to or choose to use bottles to feed their babies. This may be expressed milk, donor milk, or formula milk. This article discusses "responsive", or "paced" bottle feeding, which is a useful technique to discuss with families mixed feeding or exclusively bottle feeding. These techniques may improve symptoms of possetting and/or reflux.

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Feeding on demand - Bottle feeding - Start for Life

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Feeding on demand, or responsive feeding is when you feed your baby when they show you they’re hungry, rather than a strict schedule.

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Good hygiene is very important when making up a formula feed.
Your baby's immune system is not as strong as an adult's. That's why bottles, teats and any other feeding equipment need to be washed and sterilised before each feed.

This will reduce the chance of your baby getting an infection, in particular diarrhoea and vomiting.
Find out more about sterilising baby bottles

Product recall: Elecare Similac and Alimentum Similac powdered formula

Some batches of Elecare Similac and Alimentum Similac powdered formula, made by Abbott, have been recalled as a precaution because they may contain bacteria. If you have bought or been prescribed either of these types of formula, return them to where you got them from and do not give them to a baby.
Find out more from the Food Standards Agency

Step-by-step guide to preparing a formula feed

Step 1: Fill the kettle with at least 1 litre of fresh tap water (do not use water that has been boiled before).

Step 2: Boil the water. Then leave the water to cool for no more than 30 minutes, so that it remains at a temperature of at least 70C.

Step 3: Clean and disinfect the surface you are going to use.

Step 4: It's important that you wash your hands.

Step 5: If you are using a cold-water steriliser, shake off any excess solution from the bottle and the teat, or rinse them with cooled boiled water from the kettle (not tap water).

Step 6: Stand the bottle on the cleaned, disinfected surface.

Step 7: Follow the manufacturer's instructions and pour the amount of water you need into the bottle. Double check that the water level is correct. Always put the water in the bottle first, while it is still hot, before adding the powdered formula.

Step 8: Loosely fill the scoop with formula powder, according to the manufacturer's instructions, then level it using either the flat edge of a clean, dry knife or the leveller provided. Different formulas come with different scoops. Make sure you only use the scoop that comes with the formula.

Step 9: Holding the edge of the teat, put it into the retaining ring, check it is secure, then screw the ring tightly onto the bottle. Make sure the ring is attached firmly.

Step 10: Cover the teat with the cap and shake the bottle until the powder is dissolved.

Step 11: It's important to cool the formula so it's not too hot to drink. Do this by holding the bottle (with the lid on) under cold running water.

Step 12: Test the temperature of the formula on the inside of your wrist before giving it to your baby. It should be body temperature, which means it should feel warm or cool, but not hot.

Step 13: If there is any made-up formula left in the bottle after a feed, throw it away.

Dos and don'ts of making up formula feeds

Do follow the manufacturer's instructions very carefully, as they vary as to how much water and powder to use.

Do not add extra formula powder when making up a feed. This can make your baby constipated or dehydrated.

Do not add extra water when making up a feed. Too little powder may not give your baby enough nourishment.

Do not add sugar or cereals to your baby's formula.

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

Reducing the risk of infection

Even when tins and packets of powdered infant formula are sealed, they can sometimes contain bacteria.

Bacteria multiply very fast at room temperature. Even when a feed is kept in a fridge, bacteria can still survive and multiply, although more slowly.

To reduce the risk of infection, it's best to make up feeds 1 at a time, as your baby needs them.

Use freshly boiled drinking water from the tap to make up a feed. Do not use artificially softened water or water that has been boiled before.

Leave the water to cool in the kettle for no more than 30 minutes. Then it will stay at a temperature of at least 70C. Water at this temperature will kill any harmful bacteria.

Remember to let the feed cool before you give it to your baby. Or you can hold the bottle (with the lid on) under cold water from the tap.

Do not use bottled water to make up formula feeds

Bottled water is not recommended for making up feeds, as it's not sterile and may contain too much salt (sodium) or sulphate.

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How to make up formula milk feeds for your baby correctly and safely.

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Why Express Milk?

Expressing Milk

Storing Milk

Why express milk?

There are several reasons why you might need or want to express milk for your baby. These include:

when a baby can't breastfeed

to make more milk

a return to paid work

separation

choice

When a baby can't breastfeed

Babies and parents have many instincts for breastfeeding, but it is still a learned skill that can take time and practice. When babies won't breastfeed, it is usually because they can't. This could be for many reasons, for example:

they are preterm

they are unwell

they have a tongue tie

they are sleepy as a result of birth medications

they had a difficult birth

it is taking time to learn how to breastfeed

Expressing milk when your baby cannot nurse - or nurse effectively - protects your milk supply and provides milk to feed them. Breastmilk is especially important for babies who are unwell and/or preterm as it helps protect against illness and infections, and is ideal for a baby's sensitive and immature digestive system.

Expressing milk is often a short-term solution. However, some mothers may find themselves exclusively expressing breast milk (' exclusively pumping ') long-term when their baby is ill or has medical difficulties.

A return to paid work

There are many ways to combine working and breastfeeding. It is not always necessary to express milk when returning to work. It may depend on:

the age of your baby

the length of time you are apart

your willingness - and ability - to express; pumping is not effective for everyone, although there are ways to improve this.

your baby's willingness to take your milk when you aren't there

Many mothers express initially for reassurance and comfort, and to avoid blocked ducts and mastitis. However, you may find that your body quickly adjusts to a new breastfeeding pattern and you no longer need or want to express.

You and your baby may need to be apart. This may be for illness or health reasons, an appointment or event, or a night away.

Your baby has an intense need for your presence as well as your milk, and separation can be hard for both of you. It may be possible to take your baby with you - young babies are very portable and often enjoy being out and about.

Some mothers choose to express milk some or all of the time. You might want - or feel pressured - to let a partner or other family member feed your baby. Some parents choose to exclusively pump because they don't enjoy breastfeeding, but want their baby to have the benefits of their milk.

Expressing Milk

What kind of pump do I need?

Pumps are available to hire and to buy. The pump you use depends on your reason(s) for expressing and your personal preference. We all respond differently to pumps and have different needs.

Single electric pumps and manual pumps are best suited to occasional expressing, for example, short term separation or a return to work. They can also be used to express 'to comfort' any time your breast feels very full and your baby doesn't want to feed.

Double electric pumps express milk from both breasts at once, which often saves time. It is also said that they tend to stimulate more milk production. They are available as personal use pumps and 'hospital grade' pumps.

Hospital grade pumps are very powerful and are intended to be used by more than one person multiple times a day. They are usually hired. Hospital grade pumps are recommended when you are exclusively expressing, expressing very frequently, or trying to increase your supply. Parents might start with a hospital grade and then switch to a personal use pump once their supply is established and if they need to keep expressing.

Silicone pumps tend to be best suited to occasional use. Some mothers have found them helpful to relieve blocked ducts. (Note: When attached to the breast, a silicone pump is not just a device for collecting dripping milk - it creates a vacuum stimulating a 'letdown'. If this is not your planned use, it can create supply issues.)

Hands-free pumps come as single or double electric pumps. They can be handy for mums who want to pump on the go, or pump and multitask. Hands-free pumps have small motors and are possibly best suited to occasional pumping. You can buy or make a hands-free bra for a pump to fit in to.
Types of Pump (image above)
A. Manual breast pump
B. Single electric pump
C. Double electric pump

It is also possible to express without any equipment. Hand expressing is a great skill to learn for all ages and stages! It can take a little practice, but it can quickly become second nature:

It is free and can be done any time, anywhere!

It is the perfect choice for the early days when you are producing colostrum (you can collect - or 'harvest' - colostrum before your baby is born).

You can practise antenatally and become familiar with your breasts before your baby arrives.

Getting 'hands-on' during a pumping session can increase milk output. See Expressing Tips.

What else do I need to know about pumps?

Pumps are often sold in a standard size, however pump parts come in different sizes. The funnel-shaped piece that touches your breast is usually called a flange . The tubed-shaped bit that the nipple goes into is sometimes called the nipple tunnel

If pumping is comfortable with good milk flow, you probably have a good fit. However, if pumping is painful or causing swelling and/or rubbing, you may need a bigger or smaller flange. Sometimes a different flange size is needed for each breast. A poor fit can also reduce milk flow. ¹

The nipple should have enough room to slide in and out during pumping, without rubbing. The areola (darker area around the nipples) may move slightly with it, but it shouldn't be drawn into the nipple tunnel. After pumping, the nipple will almost certainly be bigger, but shouldn't seem darker or swollen. ²
Pump Flange Sizes (image above)
A. Milk expression
B. Flange is too big
C. Flange fits
D. Flange is too small
Suction strength and cycle speed
Electric pumps often come with a range of settings. There will be settings for suction strength and settings for cycle speed.

A pump is trying to mimic a breastfeeding baby. When a baby nurses, they do a fast, light suck to trigger a letdown. Once the milk lets down, the sucking slows and they swallow more.

You might begin by using a low suction, high speed setting and once your milk starts flowing, switching to a higher suction, lower speed setting.

Exactly how high or low depends on how it feels and if it is removing milk well. Expressing should be comfortable, and a pump provides most milk when it is set at the upper end of fully comfortable. ³

Painful pumping may impact milk flow, damage your nipples, and is unlikely to make you feel like doing it!

How often and when should I express?

If your baby can't breastfeed yet, aim to express 8-10 times in a 24-hour period, including at least once at night. These do not need to be at regular time intervals, but avoid stretches longer than 5 or 6 hours. Once your supply is well established, you may find that you can get by with fewer sessions.⁴

If you are trying to make more milk, express after or between feeds. How often depends on how much more milk your baby needs and how feeding at the breast is going.

If you are returning to paid work, how often you express will depend on a number of things. Some parents look at how often they feed on average in a 24-hour period and work out how many feeds they will typically have when they are with their child, so express the same number of times when separated to maintain this daily average.

If you are stockpiling milk for short-term separation or in the run up to a return to work, express once or twice a day after or between feeds. If your baby typically feeds from one breast, you could express from the other side while they feed. The amounts may seem small, but they quickly build up!

Some mothers try 'power pumping' as a short-term strategy to increase their milk supply, or when they are struggling to fit pumping into their daytime routine. This approach involves expressing very frequently for short periods, stopping and starting as many times as possible - it is said to mimic cluster feeding.

How long should I express for?

Just like breastfeeding, expressing milk is not a 'one-size-fits-all'. Observe your milk flow, notice how your breasts feel and find what works for you.

If you are using a single pump, this usually takes about 20-30 minutes for both breasts. You might try switching sides when the milk flow slows, usually every 5-7 minutes.⁵

Double pumps save time. A double-pumping session that replaces what would have been nursing will probably last no more than 15 minutes. However, it is more important to pay attention to your breasts than the clock.⁶

How much milk will I express?

How much we can express at any one time depends on lots of different things. If you've never used a pump before, it might be helpful to think of the first pumping sessions as practice. ⁷

Expect small amounts in the early days. This will be drops for some and as much as a teaspoon for others. Many parents think of it as 'putting in their order' for more milk later.⁸

If you are breastfeeding full-time, expect to express around 15-60ml (0.5-2 fl oz) in total from both breasts per pumping session.⁹

If you are exclusively pumping, consider the overall volume in 24 hours. Full milk production is about 750-900 ml (25-30 fl oz) per baby. Milk production reaches its peak at about five weeks and stays relatively stable until around six months.¹⁰

Once milk production peaks, a typical feed is about 60-120ml (2-4 fl oz).¹¹

We all respond differently to pumps. How much you can express is not always a reliable or accurate sign of how much milk is there. It's important to remember that a baby who is nursing effectively will get more milk than a pump.

Expressing tips

Before expressing:

Wash your hands and get comfortable

Put something warm on your breasts, such as a warm flannel

Gently massage your breasts

Use any objects or techniques that help you to feel calm and relaxed. This might be a photo of your baby, an item of their clothing, a favourite warm drink or snack, music or visualisations.

While expressing:

Try 'hands-on pumping'. This is said to produce better results than relying on a pump alone¹²

Use breast compression to increase milk flow

Take a break midway and gently massage the breasts to help increase the amount of milk.¹³

Hand express from both breasts after you have finished pumping.

Try nursing your baby on one side and expressing on the other, or expressing from both sides at the same time, to encourage more letdowns

After expressing:

Hand-express for a minute or two to help increase output and supply.

Cleaning pump parts

There is not complete agreement about cleaning pumping equipment. Some public/advisory bodies (including NHS England) recommend sterilising equipment after every feed.

Others recommend washing pump parts thoroughly after every feed and sterilising once a day.

Some advisory bodies and breastfeeding organisations state that pump parts do not need to be sterilised, and that washing in hot soapy water is enough if your baby is healthy and full term.

Day-to-day milk handling

There is very little research on the day-to-day problems of milk handling, so guidelines often err on the side of caution.

Fresh human milk kills almost all bacteria, viruses and fungi that it comes in contact with.¹⁴

Mothers who are exclusively expressing, or expressing frequently, sometimes put the whole pumping kit (flanges attached) in a clean container in the fridge until the next expressing session and clean everything at the end of the day.

Breastmilk can be safely stored at room temperature for up to 4 hours (see below). Some parents apply the same timeframe to their pump and pump parts, and express multiple times within a 4 hour period before cleaning everything.

One quick method of sterilising is to use a sterilising fluid that you change every 24 hours. Submerge pump parts in the solution after washing them each time.¹⁵

Washing and drying

Ensure hands and pump area are clean.

You may like to use a separate basin and separate utensils for cleaning pump parts and equipment rather than the sink.

Clean with hot soapy water and rinse separately with clean water.

Some pump equipment is also dishwasher-safe.

Air dry or dry with paper towels.

Clean pump dials and switches with a disinfectant spray or wipe.

Store dry pump equipment in a clean container.

If you are expressing milk for a sick or premature baby, good hygiene is vital and sterilising is essential.

Storing Milk

How long can I store milk for?

There isn't complete agreement about milk storage.

Wherever you are storing milk, the fresher it is, the better.

Good hygiene is important - clean hands, clean pump parts, clean storage.

For healthy, full term babies ¹⁶:
Room temperature

Ideally, use within 4 hours.

Depending on room temperature and how clean storage conditions are, up to 6-8 hours may be safe.

Frozen milk that has thawed and kept at room temperature should be used within 4 hours.

Fridge

Ideally, use within 4 days.

When conditions are very clean, 5-8 days may be acceptable.

Store milk in the back of the fridge rather than in the door.

Frozen milk that has thawed in the fridge should be used within 24 hours.

Freezer

Ideally, use within 6 months.

Can be stored for up to 12 months.

Store at the back of the freezer, away from the door where temperatures may fluctuate.

Insulated bag
Milk left over after a feed should be used within 1-2 hours as it mixes with a baby's saliva, although it may be safe to put it in a fridge for up to 4 hours. ¹⁷

For premature or sick babies, consult with hospital staff and follow hospital guidelines.

Combining expressed milk

When combining milk expressed at different times, mix cold with cold:

Chill newly expressed milk before adding it to an existing container.

You can add refrigerated milk to frozen as long as there is less refrigerated milk than frozen.

Use within the time limit of the oldest expressed milk.

What can I store milk in?

You can store milk in any clean container, such as a hard (BPA-free) plastic or glass container with a tight-fitting lid, or a disposable milk storage bag.

Milk expands in the freezer, so leave space in the bag or bottle if you plan to freeze it.

Put the date on the container.

How much milk should I store?

Store milk in small quantities to avoid waste. Small amounts also defrost more quickly.

For babies older than one month, a feed is approximately 60-120ml. You could also store some smaller amounts in case you need to offer more.

How do I prepare stored milk?

You don't have to warm milk - some babies like it cold!

If you do warm milk, run the container under a warm tap or place it in a pan of warm water.

Never use a microwave or heat milk directly.

Swirl milk to combine rather than shaking it.

If defrosting milk, thaw it overnight in a fridge or hold it under warm running water.

Thawed milk should not be kept at room temperature. It should either be fed immediately or put in the fridge.

Smelly milk

Sometimes milk smells or tastes soapy after a short time in the fridge or freezer. This is because of an enzyme (lipase) that breaks down fats in milk. The milk is completely safe and most babies will drink it. However, if they refuse to, heat freshly-expressed milk to scalding (bubbling around the edges, but not boiling) and then quickly cool and freeze it. Scalding reduces some of the immune factors, but may be the only option for some families. You can also experiment with the length of storage time needed for the milk to acquire the smell.

Feeding your baby your milk

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

Further Reading

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

Online Information

Hand expressing:

Maximizing milk production when expressing:

Books

La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010.
Marasco, L & West, DMaking More Milk, McGraw Hill, New York: 2019.
Mohrbacher, N.,Breastfeeding Answers, Nancy Mohrbacher Solutions, Illinois: 2020.
Ruddle, L.,Relactation: A Guide to Rebuilding Your Milk Supply, Praeclarus Press, Texas: 2020.

References

1. La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010; 298.

2. As above, p304.

3. As above, p489.

4. La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010; 300.

5. As above, p500.

6. Bonyata, K. I'm not pumping enough milk. What can I do? Accessed: 28 March 2023.

7. La Leche League International, The Womanly Art of Breastfeeding, Pinter and Martin, London: 2010; 307.

8. As above, p301.

9. As above, p300.

10. As above, p309.

11. As above, p515.

Copyright LLLGB 2023

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Expressing & Storing Milk - La Leche League GB

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Why Express Milk? When a baby can't breastfeed Making more milk A return to paid work Separation Choice Expressing Milk What kind of pump do I need? What else do I need to know about pumps? How often and when should I express? How long should I express for?

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Hand expression may be a useful technique to use in some circumstances

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Physician's Guide to Breastfeeding: Online Resources

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Physician's Guide to Breastfeeding: Online Resources

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Skip to content

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Physician Guide to Breastfeeding for Parents, Physicians, Lactation Consultants, & Doulas

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Skip to content We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking "Accept", you consent to the use of ALL the cookies.

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An online community for doctors who themselves are providing, or have provided, human milk for their infants

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

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Many families may need to or choose to use bottles to feed their babies. This may be expressed milk, donor milk, or formula milk. This article discusses "responsive", or "paced" bottle feeding, which is a useful technique to discuss with families mixed feeding or exclusively bottle feeding. These techniques may improve symptoms of possetting and/or reflux.

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Feeding on demand - Bottle feeding - Start for Life

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Feeding on demand, or responsive feeding is when you feed your baby when they show you they’re hungry, rather than a strict schedule.

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Breastfeeding Beyond Infancy: A Guide for GPs

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Breastfeeding Beyond Infancy: A Guide for GPs

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Breastfeeding until at least 2 years old is recommended by the World Health Organization because of the benefits for both child and mother. This includes developed countries such as the UK. Although there are estimates that less than 1% of UK children are still breastfed by their first birthday, the exact figure is unknown. For those families who do continue to breastfeed, it has a significant value that goes beyond nutritional or health benefits. Children allowed to continue breastfeeding will typically self-wean between the ages of 2 and 7 (natural term). A breastfed child eats normal solid foods alongside breastmilk, and they do not require any other mammalian milk (e.g. cow's milk). There is no evidence of harm to children or mothers who breastfeed to natural term. Breastfeeding beyond infancy is biologically normal: it should be celebrated and encouraged in mothers who wish to do so. It has health, economic and environmental benefits for the individuals involved as well as wider society; yet British culture is not generally supportive of natural term breastfeeding. Few GPs receive high quality lactation education, and thus may be inadequately informed to support families achieve longer term breastfeeding. This guide summarises the evidence available and how GPs can help. Effects on maternal and child health
Most GPs are aware of the vast array of benefits of breastfeeding babies (1), but may mistakenly believe that these benefits are time-limited. Breastmilk remains rich in vitamins, minerals and fats through toddlerhood and beyond (2,3), and immune components unique to human milk actually increase as the child ages (4). Children who are breastfed beyond 1 year have a reduced risk of acute otitis media (5), type 2 diabetes (6) and obesity (7). Breastfeeding beyond infancy may have psychological benefits for the child (8) and is an important source of comfort for young children. Many mothers find breastfeeding an invaluable parenting tool, by soothing a tired, injured or frustrated toddler and helping to promote sleep. Continued breastfeeding can prevent dehydration and malnourishment in unwell or hospitalised children, and is an ideal source of nutrition for 'fussy eaters'; parental attempts to increase solid foods in these situations can lead to displacement of nutrient-rich breastmilk (9). Breastmilk is particularly important for children with cow's milk protein allergy, as ready-made soya, oat, coconut or other milk substitutes are unsuitable under 2 years of age (10). There are also numerous benefits for mothers, but it should be noted that few (if any) mothers continue to breastfeed beyond 12 months solely for their own benefit. Benefits include a reduction in the risk of breast cancer (11), endometrial cancer (12) ovarian cancer (13), cardiovascular disease (14) and type 2 diabetes (15). Indeed, the UK government estimates savings of over £31 million for each annual cohort of new mothers through reduction of maternal breast cancer, if more women breastfed and did so for longer (16). There is no evidence in the literature of harm to either mother or child from natural term breastfeeding, including tooth decay (17). Production of toddler 'follow-on milks', which in ordinary circumstances are not proven to be necessary (18), undermine the International Code of Marketing of Breast-milk Substitutes and contribute to environmental impact (19).
Considerations for GPs

Mothers who breastfeed any age of child(ren) do not require any specific dietary adjustment or supplement apart from 10mcg Vitamin D daily (20).

It is very rarely necessary for a mother to stop breastfeeding in order to take medication (21). Many mothers will opt to delay treatment if a breastfeeding compatible medication is not prioritised. The BNF alone is an inadequate reference for safety in lactation, and GPs should check additional sources for more comprehensive information (22): we recommend UK Drugs In Lactation Advisory Service (NHS service) or The Breastfeeding Network.

Lactational Amenorrhoea Method of contraception is only suitable for use if the baby is under 6 months and has several strict criteria, as detailed by FSRH (23). Beyond 6 weeks of age, all hormonal forms of contraception (including COCP) are categorised as UKMEC 1 or 2 (24), however this is a complex area. Breastfeeding professionals frequently see mothers reporting a decrease in milk supply with all types of hormonal contraception, and GPs should be prepared to counsel women fully, including a discussion of the risks (25).

Women breastfeeding a baby or child of any age may develop sore nipples, engorgement, blocked ducts, mastitis or thrush and should be supported appropriately - see GP Infant Feeding Network for detailed information (26).

Supporting Breastfeeding
Breastfeeding is not always easy, and families who have reached 12 months may have overcome many challenges (27). Whilst many mothers report they receive good breastfeeding support in the early months, this reduces as their baby gets older (28). Lactation-specific education is scarce in UK medical schools and postgraduate training programmes, leaving many GPs ill-prepared to support natural term breastfeeding. Unsolicited advice to wean, unsupportive personal opinions or inaccurate information are all unhelpful to families who trust their GP, and may damage the doctor-patient relationship (29). US research has shown that even a very brief educational programme can improve doctors' attitude and knowledge towards breastfeeding beyond infancy (30). A doctor's personal experience of breastfeeding can affect their breastfeeding advocacy (31). Therefore, GPs who have had a negative personal experience of breastfeeding should ensure that any advice they give is evidence-based rather than anecdotal. Mothers who fear ridicule may choose to hide the fact that they breastfeed (32). But breastfeeding in public in the UK is protected by law, and there is no upper age limit to this (33). Mothers returning to work can successfully continue breastfeeding with appropriate support, and there is no need to wean unless she or the child wish to (34).

Nursing aversion (intense unpleasant emotions experienced whilst breastfeeding) may affect mothers, particularly of older children (35). Some mothers persevere for the benefit of their child; others may wish to wean. In either case, mothers benefit from their GP asking them about their wishes and then providing appropriate signposting to achieve this. Weaning from the breast may be mother-led or child-led (or a combination): natural child-led weaning is a gradual and gentle process and all children will eventually wean (36). Families should avoid abrupt weaning due to the risk of breast engorgement, mastitis and emotional distress for both mother and child. Some mothers fall pregnant whilst breastfeeding, and may continue to breastfeed their older child throughout their pregnancy and once their baby is born (tandem nursing). There is no evidence that breastfeeding during a normal pregnancy causes miscarriage or premature labour (37).

Mothers seeking breastfeeding support can contact the National Breastfeeding Helpline on 0300 100 0212, or can seek face to face support from Peer/Mother Supporters, Breastfeeding Counsellors or International Board Certified Lactation Consultants. IBCLCs are recognised as the gold standard in breastfeeding support and are available throughout the UK (38). GPs who wish to learn more about breastfeeding can do so via Unicef's e-learning package (39) or RCGP's e-learning course (40), which is free to College members. The ABM also offers their Breastfeeding Support Training Foundation Module (41), an online course suitable for healthcare professionals. Finally an online book for doctors has recently been published and is free to access (42).
Conclusions
In summary, GPs have an important role to play in helping to normalise and support breastfeeding beyond infancy. Breastfeeding mothers have a right to ongoing high standards of evidence-based healthcare for as long as they choose to continue. Breastfeeding beyond infancy benefits mothers, children and the NHS and thus should be actively supported by all GPs.
Dr Naomi Dow (GP) naomi.dow@nhs.scot Emma Pickett (International Board Certified Lactation Consultant, Chair of Association of Breastfeeding Mothers) Dr Vicky Thomas (Consultant Paediatrician with special interest in growth and nutrition)
Whilst we have used the terms 'mother', 'woman' and 'breastfeeding', we recognise that not all families use this terminology. We encourage GPs to use the terminology preferred by each parent or family.

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Breastfeeding Beyond Infancy a GP Guide - ABM

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Breastfeeding until at least 2 years old is recommended by the World Health Organization because of the benefits for both child and mother. This includes developed countries such as the UK. Although there are estimates that less than 1% of UK children are still breastfed by their first birthday, the exact figure is unknown.

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"Babies sometimes need more milk than they can take at the breast.  This may be because they were born early or small, and don’t yet have enough energy to do all the work of breastfeeding.  Sometimes, mothers don’t have as much milk as their baby needs.  It is important that babies get enough milk to be healthy and to grow normally."

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"Autism is a neurodevelopmental difference which may cause differences in how an autistic person will experience the world and communicate. An autistic person may be described as neurodivergent.

Autism presents differently across the spectrum and many autistic people’s abilities and challenges will change depending on the situation they are in. Many autistic women will choose to have children and breastfeed, and some breastfed children are autistic.

Many autistic women and parents will choose to breastfeed. There may be additional challenges and strengths for both the autistic parent, and for the parent breastfeeding an autistic child."

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An online community supporting the needs of families nursing Autistic children (Facebook)

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

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Por La Paz en Ucrania. NO a la guerra.

La guerra se asocia a disminución de la prevalencia y duración de la lactancia materna y aumento de uso de fórmula infantil, lo que implica graves riesgos para la salud infantil.

Las consecuencias de una guerra son especialmente graves para los niños y las mujeres...

OMS 2004, principio 3: Se debe controlar estrictamente la cantidad, distribución y uso de sucedáneos de la leche materna en los entornos de emergencia.
La guerra y la lactancia en e-lactancia.org

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Por La Paz en Ucrania. NO a la guerra. La guerra se asocia a disminución de la prevalencia y duración de la lactancia materna y aumento de uso de fórmula infantil, lo que implica graves riesgos para la salud infantil. Las consecuencias de una guerra son especialmente graves para los niños y las mujeres...

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Academy of Breastfeeding Medicine: Mastitis Protocol

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Academy of Breastfeeding Medicine: Mastitis Protocol

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West Middlesex Hospital Multilingual Resource Padlet

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West Middlesex Hospital Multilingual Resource Padlet

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

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

Breastfeeding guidance: English (for reference)

Bottle feeding guidance: English (for reference)

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Foreign language resources - Baby Friendly Initiative

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