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Some babies latch on and breastfeed well right from the start, but it doesn't always go so smoothly. Many moms and babies need time to learn how to breastfeed together. During the first week after your child is born, you may run into some struggles that can interfere with breastfeeding. But, even once breastfeeding is established and going well, issues can still pop up. Breastfeeding problems can be painful and distressing to a new mom, and they can cause a baby to become fussy, and frustrated. It can be scary to face a problem that you don't know how to deal with, so sometimes these unexpected issues lead to early weaning. But, by learning about and understanding these common breastfeeding problems, you will be more prepared to handle them and get through them successfully. From the newborn stage to weaning, here are some of the common breastfeeding problems you may experience along with the solutions to help you deal with them.

Sore Nipples

You can expect a little bit of nipple tenderness during the first few weeks of breastfeeding. That's normal. However, very sore, cracked, and bleeding nipples are not. They're a sign that something is not quite right. If your nipples are so sore that it's painful to breastfeed, that's a big problem. You'll want to try to prevent sore nipples as much as possible, but if they do develop, continue breastfeeding and treat them right away. Talk to your doctor or a lactation consultant for help if you need it.﻿﻿

Make sure your baby is latching on correctly.

Try a different breastfeeding position and change positions at each feeding.

Gently break the suction from the latch with your finger before removing the baby from the breast.

Offer short, frequent feedings.

Start breastfeeding on the breast that is the least sore.

Apply warm, moist compresses to the nipples.

Rub freshly expressed breast milk on your nipples to help them heal.

If your nipples do not show signs of improvement within a few days, notify your healthcare provider. Any opening in the skin can allow an infection to enter your body and that can make the situation even worse.

Breast Engorgement

When your breast milk fills your breasts by the end of the first week, your breasts can become swollen, and tight. Breast engorgement can be painful for you, and it can make it hard for your newborn to latch on to your large, hard breasts. This initial phase of engorgement usually lasts a few days or weeks as your milk supply adjusts to your baby's needs. While your body is adjusting, try to focus on relieving the pain and pressure.﻿﻿

Breastfeed very often, at least 8 - 12 times a day.

A good latch and correct positioning can help your child breastfeed more efficiently and remove more milk.

If your child isn't breastfeeding well or you still feel full after breastfeeding, use a breast pump or a hand-expression technique to remove more breast milk and relieve the pain and pressure.

Remove a little breast milk before you begin to breastfeed to soften the breast tissue and make it a little easier for your baby to latch on. The removal of breast milk also helps to release some of the pressure, so the flow of milk out of your breasts will not be too forceful for your baby.

Alternate warm and cold compresses to help relieve pain. You can also use clean, cold, cabbage leaves in place of a cold compress.

Gently massage the breasts.

Allow warm water to run over your breasts in the shower.

Plugged Milk Ducts

Plugged milk ducts are small, hard lumps in the breast. They form when breast milk clogs up and blocks the narrow milk ducts. The area around the plugged duct may be tender, swollen, and red. Plugged milk ducts will often go away on their own within a few days. Here's what you can do to help it along.﻿﻿

Make sure your baby is latching on correctly and removing the breast milk from your breasts efficiently.

Breastfeed very often to prevent your breast milk from building up and clogging the milk ducts.

Breastfeed on the side with the plugged duct first. Your baby's strong suck at the beginning of the feeding may help to unblock the duct.

Alternate breastfeeding positions to drain all the areas of your breast. Different holds can help target the area of your breast where the blocked duct is and dislodge it.

Apply warm compresses to the plug to encourage the breast milk to flow better in that spot.

Massage your breast while your breastfeeding to help relieve the plug.

Make sure to get enough rest and drink enough fluids.

Mastitis is swelling or inflammation of the breast tissue, and it's often called a breast infection. Other common issues such as breast engorgement, blocked milk ducts, fatigue, or illness can lead to mastitis.﻿﻿ You may suspect mastitis if you have redness or tenderness of the breast, flu-like symptoms, and fever.

If you think you may have mastitis, call your doctor. You may need to take an antibiotic if you have an infection.

You may think that you can't breastfeed with mastitis, but you can and should continue to breastfeed often.

Try to get plenty of rest while you recover

Apply warm compresses to help ease

Thrush is a yeast infection that can appear on your nipples and in the baby's mouth. The symptoms of thrush can include breast pain, redness, and itchy nipples with or without a rash. It may also show up as white patches or areas of redness in your baby's mouth.﻿﻿

If you think you or your child have thrush, notify your doctor as soon as possible for an examination and the proper treatment. An antifungal medication may be necessary for you and the baby.

Clean and sterilize all pacifiers, bottles, toys, and breast pump parts that come in contact with your breasts or the baby's mouth.

Good hand washing is very important to prevent spreading the infection.

A Low Breast Milk Supply

A low breast milk supply can cause fear and frustration. It's scary for a new mom to believe that she isn't making enough breast milk for her child, and it can be frustrating for a baby if she isn't getting enough. The good news is that the common causes of a low breast milk supply are often easily corrected.﻿﻿

Check your baby's latch. Your newborn needs to take in all of your nipple plus part of the breast tissue surrounding your nipple to breastfeed well. Your body will increase milk production based on how much breast milk your child removes from your breasts.

Breastfeed your baby more often. Your newborn needs to breastfeed every 1 to 3 hours around the clock. The more you breastfeed, the more breast milk you'll make.

Keep your baby at the breast longer. Breastfeed at least 10 minutes on each side and try to keep your little one awake and actively sucking during each feeding.

Use a breast pump after and in-between feedings. The extra stimulation at the breast can help increase your milk supply.

Eat well, get enough rest, and drink plenty of fluids.

Too Much Breast Milk

An overabundant supply of breast milk can be a challenge. It could cause problems such as plugged milk ducts, breast engorgement, and mastitis. The pressure of having too much milk build up in the breasts can also cause a hyperactive let-down reflex and a fast flow of breast milk out of your breasts. A fast flow can make your baby may gag and choke while he's breastfeeding which can cause gassiness, fussiness, and spitting up.﻿﻿

Try offering only one breast at each feeding and offer the same breast if the baby wants to breastfeed again within an hour.

You can also try breastfeeding while laying back or reclining in a chair. Breastfeeding against gravity may help slow down the flow of milk.

Be sure to burp your baby frequently. Your baby is likely to swallow more air while trying to gulp down a large amount of fast flowing milk.

When to Get Help

Most of the common complaints that you may experience with breastfeeding will resolve in only a few days. However, if any of these issues continue beyond a few days or gets worse, seek help from your doctor or a lactation consultant. The earlier you can identify and correct a problem, the better it will be for you and your baby.

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Common Breastfeeding Problems and How to Deal With Them

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Some babies latch on and breastfeed well right from the start, but it doesn't always go so smoothly. Many moms and babies need time to learn how to breastfeed together. During the first week after your child is born, you may run into some struggles that can interfere with breastfeeding.

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Sterilising feeding equipment.

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When can I stop sterilising my baby's bottles?

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It's best to continue sterilising your baby's bottles until your little one is at least a year old. Babies are vulnerable to the germs that cause diarrhoea and vomiting. These germs can develop very easily in the nooks and crannies of bottle and teats.

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My details
Donna Cousins Nct BFC - 07388535801
Available: Mon - Fri 09:30 - 20:00
Sat - Sun 09:00 - 20:00
Donnamynardnct@gmail.com

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Fife breastfeeding baby cafe - Kirkcaldy

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Fife and Tayside LLL facebook group.

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Lothian Breastfeeding Buddies - Facebook

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Fife support with feeding.

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A wide range of breastfeeding support services are available in Fife. In the first instance, you will get general breastfeeding support and information from:

Your community midwife

Your health visitor or family nurse.

Other sources of help and support available are:

Telephone and home visiting support from breastfeeding support workers

Specialist support for mums who may be experiencing more complex challenges

Mum-to-mum support in local groups

Help from voluntary organisations and the national breastfeeding helpline

All breastfeeding mothers should be given a copy of the breastfeeding support information leaflet before they leave the maternity unit. If you do not have a copy, or if you did not have your baby in the Victoria Hospital, you can find a copy in your Maternity Notes App. You can also get a copy from your midwife, health visitor or family nurse.

Breastfeeding support workers

Breastfeeding support workers work alongside midwives and health visitors to help support breastfeeding. They can give you additional help and encouragement and answer any questions you may have. This can be by telephone or by visiting you at home. They will try to telephone you to see how things are going. This should be shortly after you return home from hospital.

If you would like this type of breastfeeding support, ask your midwife or health visitor to refer you. You can also refer yourself by telephoning 01383 565331 or by sending an email.

Local breastfeeding support groups

These groups run throughout Fife. They can provide breastfeeding support in an informal environment. They provide mum-to-mum support and can help with breastfeeding difficulties, but you do not need to have a problem to come along. Most groups are facilitated by a health professional but some are run by voluntary organisations or by mums themselves.

You can also find details about breastfeeding groups in Fife (and other areas) on the parentclub.scot website.

NHS Fife breastfeeding helpline

This service is primarily for mothers with babies up to six weeks old.

Your call will be answered the infant feeding adviser when available, otherwise you will be given information on how to contact the maternity unit. You can also text 0781 063 7767 if your enquiry is not urgent and the infant feeding adviser will get back to you.

Specialist breastfeeding support (in hospital)

Specialist help with breastfeeding for mums with babies up to six weeks old is available from the infant feeding adviser within the Maternity Unit at the Victoria Hospital. Phone 07810 637767 to discuss your concerns or arrange an appointment.

Sometimes breastfeeding mums and babies need a longer assessment than your midwife can provide at home. In these circumstances you may be offered an appointment to see the infant feeding adviser at the Victoria Hospital.

If your baby is older than six weeks or you would prefer to be seen at home, contact the breastfeeding support workers on 01383 565331 or send an email.

- or -

Breastfeeding support coordinator

We are very lucky to have a dedicated breastfeeding coordinator who offers specialist breastfeeding support for mums with babies off any age. This support can be by telephone, email or at home.

Breastfeeding support coordinator
Tel: 01383 565331 Mobile: 07748704901
Email: gina.graham@nhs.scot

Breast pumps

Maternity services and the neonatal unit have a small number of pumps for short loan to enable lactation initiation.

The Health and Social Care Partnership also have a number of electric breast pumps available for loan. These units can be made available for longer term use.

Priority for pumps will be given to mums who:

need a breast pump to maintain their milk supply if they are separated from their baby

are temporarily unable to breastfeed for any reasons

need to increase their milk supply

need help to resolve other breastfeeding difficulties such as sore nipples

If you need help or support to overcome any of these breastfeeding challenges, or with expressing breast milk for your baby, you can contact a breastfeeding support worker.

Pumps are also available for social use, such as to helping to keep breastfeeding going when mums return to work.

Voluntary groups and other national support organisations

A number of voluntary organisations offer telephone helpline and breastfeeding counselling services.

National Helpline / Breastfeeding Network
0300 100 0212

The Parent Club
parentclub.scot

National Childbirth Trust
nct.org.uk
0300 330 0700

La Leche League
laleche.org.uk

Association of Breastfeeding Mothers
abm.me.uk
0300 330 5453

The Baby Friendly Initiative
unicef.org.uk/babyfriendly/

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Lothians support with feeding.

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Breastfeeding support groups are a great help for any mother giving her baby any breastmilk. A list of groups can be found here. Please check social media pages for last minute changes.

Breastfeeding and returning to work information can be found here.

The following associations have access to peer supporters who speak foreign languages. This means the peer supporters can phone a mum or video chat with a mum in their language.

National Childbirth Trust
(08:00am until Midnight​) Tel: 0300 330 0771​

Have access to the following languages -

Catalan, Dutch, French, German, Polish, Spanish Chinese Gujarati, Hindi, Punjabi, Urdu and Korean

Lothian.Peers@nct.org.uk

Breastfeeding Network

(9:30 am to 09:30 pm) ​Tel: 0300 100 0210​

Have access to the following languages - Italian, Hungarian and Lithuanian

La Leche League
midlothian@breastfeedingnetwork.org.uk

(Open 24 hours)​ Tel: 0845 120 2918​

Have access to the following languages-

Afrikaans, Bemba, British sign language, Croatian, French, German, Gujarati, Hebrew, Hungarian, Italian, Polish, Portuguese, Spanish, Swahili, and Welsh

For written resources, LLL International at www.llli.org

The LLL website is available in a number of languages.

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Breastfeeding support groups are a great help for any mother giving her baby any breastmilk. A list of groups can be found here. Please check social media pages for last minute changes. Breastfeeding and returning to work information can be found here. The following associations have access to peer supporters who speak foreign languages.

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Further help & support, and local Nct classes.

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With as many as one in three women reporting some level of anxiety or depression during or after pregnancy, the need for support, reliable information and services is vital.

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Your emotions after birth.

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It's hard to describe to anyone how much having a baby flips your life - and your mind - upside down. Your emotions are likely to be all over the place after you give birth and leap between utter joy and complete despair in the space of two minutes. A whopping 81% of women said they'd experienced a maternal mental health problem after giving birth (RCOG, 2017).

As with all things mental health related, it's great to share your feelings, though that can be daunting. Here's how you could make a start on working through things...

How to lessen the load

Try talking to your partner, friends and family or to other new parents who might be going through the same thing.

Try to open up to your health visitor as well about things and see your GP if you need to. Your six-week postnatal check is a chance to talk about how you are feeling as well as talking about your baby.

The good thing is that treatment does help, with 82% of women treated for mental health problems after their babies were born saying treatment had helped (NCT, 2017). So don't delay asking for help.

Emotions you might be experiencing

The baby blues

No matter how much you love or are grateful for your baby, the baby blues can affect you. The baby blues usually arrive in the first week after you give birth (NHS, 2018a).

A lot of new mums find themselves feeling weepy and irritable and not knowing why. But if it happens to you, don't worry, most new mums go through it (NICE, 2014). The baby blues is not an illness and you should see the back of it without any medical treatment. This'll probably happen by the time your baby is around 10 days old (MIND, 2018).

If you're still feeling low after this, speak to your GP or midwife as it might be something more serious. Read more about the baby blues here.

Postnatal depression (PND)

Depression can affect both mums and dads in the weeks and months after birth, so it's something to be aware of and look out for (NHS, 2018a).

No single answer tells us why some new parents are affected and not others (NHS, 2018a). However, emotional and stressful events can bring on depression, and having a baby can definitely be both of those things.

If you are concerned that you or your partner may have PND, speak to your GP or health visitor. The recovery from PND is gradual but with help and support you can get better (NHS, 2018a). Read more about PND here.

Postpartum or puerperal psychosis

Postpartum psychosis (also known as puerperal psychosis) is a serious mental illness that will require psychiatric treatment and a stay in hospital. This condition is rare, affecting only one or two mums in every 1,000. It most commonly occurs in the first month after having a baby (NICE, 2014).

The main symptoms of puerperal psychosis are delusions, hallucinations, confused thoughts and a lack of self-awareness (NHS, 2017). In very severe cases, a woman may try to harm her baby and/or herself. If you are, or know someone who may be, suffering from puerperal psychosis, you should get medical help from your GP, midwife or health visitor immediately.

How to help someone who is low or depressed

You might find living with your partner or seeing your family member who's depressed hard, sad and frustrating (MIND, 2018). Try to never blame them or be judgemental though: instead, try to support them and listen. That way you understand a bit more what they're going through.

Perhaps the most important thing to recognise is that someone suffering from depression may need encouragement to seek help, and support to get it (MIND, 2018). You can also reassure them that they will feel better, in time.

Helping yourself feel better

Share your feelings with people you trust. It's important to feel understood and supported so speak to a friend or family member, or a counsellor or health visitor, who you know will listen and won't judge.

Talking to other mums and dads can be super reassuring and make you feel a lot less alone and isolated.

Try and get help with the childcare and grab a bit of you time, even if it's just an hour here or there.

It's a cliché but a true one: exercise really does help, so head out for a brisk walk with the baby in the pram or go for a swim. You'll notice a mood improvement when the endorphins kick in.

Try as much as you can not to grab cake as a short-term fix: eating badly or skipping meals can make you feel tired and irritable, so try to eat simple and nutritious meals. Foods rich in omega 3 oils (oily fish, seeds and nuts) might help with depression. Though we're not ruling out the occasional chocolate brownie.

Learn to say yes to all offers of help and support. Whether offers involve whizzing a vacuum around, walking your dog or arriving with a home-cooked pie (never say no to pie) - just say yes please.

Give yourself time to adjust. Parenthood is a huge change in your life so go easy on yourself and be patient while you go through the transition.

Further information

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

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

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

You might also like to try one of our NCT Yoga for Pregnancy classes, which aim to help improve your physical and emotional wellbeing, as well as feel more confident and positive.

Mind, a leading mental health charity, provides information on a range of mental health topics including postnatal depression and has an infoline for support: 0300 123 3393.

#PNDHour is an online peer support group that runs every Wednesday at 8pm via the Twitter account @PNDandMe. Anyone can join in to discuss topics about antenatal and postnatal depression, such as self-care, medication and seeking help. It's run by a mum called Rosey who also blogs about her own experiences with antenatal and postnatal depression, as well as raising awareness of perinatal mental illness, at PND and me.

We are grateful to Dr Andrew Mayers, a psychologist specialising in child and family mental health (particularly perinatal mental illness) and sleep (especially children), for his help in reviewing the information on this page.

The Association for Postnatal Illness is a charity that provides support to mothers suffering from postnatal illness and increases public awareness of the illness.

NHS Choices has information on postnatal depression.

The Royal College of Psychiatrists has information on postnatal depression.

Effective psychotherapeutic treatments may be found in your area. Check out the British Association for Counselling & Psychotherapy, the United Kingdom Council for Psychotherapy (UKCP) and the British Psychoanalytic Council (BPC) for a list of recommended therapists. Well Scotland or Niamh (in Northern Ireland), leading providers of mental health information in their regions, for further information on PND.

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Postnatal depression, baby blues and emotions after giving birth

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It's hard to describe to anyone how much having a baby flips your life - and your mind - upside down. Your emotions are likely to be all over the place after you give birth and leap between utter joy and complete despair in the space of two minutes.

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How partners can support mum with breastfeeding.

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Tongue tie - information and guidance.

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Read more for support for parents on tongue-tie

Many babies have a piece of membrane under their tongue (the frenulum) which does not usually cause problems. Tongue-tie (ankyloglossia) occurs when the frenulum is abnormally short, stopping the tip of the tongue from protruding beyond the lower gum. This may cause problems with feeding as a result of the inability to move the tongue in a normal way and therefore attach and suck effectively. The frenulum may reach the tip of the tongue and be easily seen, and may be either thin and stretchy or thicker/tighter. A posterior frenulum, which is at the back of the tongue, can be less easy to see and in some cases may only be felt. If you and/or your baby are experiencing feeding difficulties, an assessment of your baby's tongue function and a feeding assessment by a specially trained professional will determine whether a division of the membrane ( frenulotomy) could help.

Many tongue-ties are asymptomatic and do not require treatment, and some may resolve spontaneously over time. In some instances, support to improve attachment is all that is needed. However, if the condition is causing problems with feeding, surgical division of the lingual frenulum can be recommended and carried out as early as possible. This may enable the mother to continue breastfeeding rather than having to switch to artificial feeding.
NICE has approved the division of tongue-tie.

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Many babies have a piece of membrane under their tongue (the frenulum) which does not usually cause problems. Tongue-tie (ankyloglossia) occurs when the frenulum is abnormally short, stopping the tip of the tongue from protruding beyond the lower gum.

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Sore damaged nipples.

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Tongue tie - private specialist Edinburgh.

https://www.tongue-tie.org.uk/find-a-practitioner/

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Flat or inverted nipples.

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Inverted or Flat Nipples

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

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

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

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

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

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

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

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

To help evert the nipple:

Pull back on breast tissue so nipple will protrude more.

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

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

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

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

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

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

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

If Nipple Soreness Occurs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

( Revised February 2022)

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Inverted and Flat Nipples - La Leche League International

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

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Thrush and breastfeeding.

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Breast and nipple pain in breastfeeding women is sometimes caused by a thrush (candida) infection in the breast. Breastfed babies can also develop thrush in their mouths.

Thrush infections sometimes happen when your nipples become cracked or damaged. This means the candida fungus that causes thrush can get into your nipple or breast.

Thrush infections can also happen after you or your baby has had a course of antibiotics. Antibiotics may reduce the number of helpful bacteria in the body and allow the candida fungus that causes thrush to flourish.

Signs of thrush in breastfeeding women

You may have a thrush infection in your breasts if:

you start to feel pain in both nipples or breasts after feeds, having previously had no pain after feeding

the pain is quite severe and lasts for up to an hour after every feed

It's not likely to be thrush if:

you have always experienced pain while breastfeeding

the pain only affects 1 nipple or breast

you have a fever

there is a warm, red patch on 1 of your breasts

Symptoms of oral thrush in breastfed babies

Signs to look for include:

creamy white spots or patches on the tongue, gums, roof of the mouth or insides of the cheeks - if you gently wipe these patches with a clean cloth, they won't come off

your baby being unsettled when feeding

a white film on the lips

in some babies, nappy rash that won't clear up

If you suspect you or your baby has a thrush infection, see your health visitor or GP. They can arrange for swabs to be taken from your nipples and your baby's mouth to see if thrush is present. It's important other causes of breast pain are ruled out before you start treatment for thrush.

If no thrush is present, the pain may be caused by something else, such as poor positioning and attachment. It's important for your midwife, health visitor or a breastfeeding specialist to watch you do a full breastfeed and give advice if needed.

Read more about other possible causes of breast pain.

If either you or your baby does have thrush, you'll need to be treated at the same time as the infection can easily spread between you. It can also spread to other members of the family.

Washing your hands carefully after nappy changes and using separate towels will help prevent the infection spreading. You'll also need to wash and sterilise any dummies, teats or toys your baby puts in their mouth.

You'll need to wash any breastfeeding bras at a high temperature and change your breast pads frequently while you're both being treated.

If you express any breast milk while you have thrush, you'll need to give the milk to your baby while you're still having treatment. Freezing it and using it may mean the thrush comes back at a later date.

Treating thrush when you're breastfeeding

You can carry on breastfeeding while you and your baby are treated for thrush.

Oral thrush in babies is usually treated with an anti-fungal gel or liquid. This is safe for your baby to have. It's important to wash your hands carefully after treating your baby.

See more about treating oral thrush in babies.

Thrush in breastfeeding women is usually treated with a cream that you sparingly spread on and around your nipples after feeds. You'll need to wash your hands thoroughly after treating yourself. Some women may need to take anti-fungal tablets to clear the infection.

Once you and your baby start treatment, your symptoms should improve within 2 to 3 days. It will take a little longer for the infection to clear completely.

If you don't see any improvement within 7 days, speak to your health visitor or GP.

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Breast and nipple pain in breastfeeding women is sometimes caused by a thrush (candida) infection in the breast. Breastfed babies can also develop thrush in their mouths. Thrush infections sometimes happen when your nipples become cracked or damaged. This means the candida fungus that causes thrush can get into your nipple or breast.

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Engorgement

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Engorged breasts are painful. They feel heavy, hard, warm and sensitive -as if they are ready to burst! As well as being painful, engorgement can lead to other breastfeeding problems if not treated. Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

Most mothers experience some engorgement in the first weeks after birth. With changing hormone levels, your breasts swell and enlarge as milk production increases. It may seem as though they are filling up with milk, but engorgement is more than milk storage. Your body directs extra blood and fluids to your breasts to boost milk production. This causes congestion and swelling which will decrease as your body adjusts.

Minimizing early engorgement
Treat engorgement to...
When to treat engorgement
After the first few weeks
Causes of engorgement
Treating engorgment
Be sure your baby is sucking effectively
Reverse pressure softening
Keep comfortable
Watch out for signs of mastitis

Minimizing early engorgement

New mothers vary in how engorged their breasts become in the weeks after birth; some experience little engorgement, others describe their breasts as feeling like watermelons!

Try these suggestions

Breastfeed your baby frequently from birth: at least 8-12 times in 24 hours. Keeping your baby close makes it easier to nurse every hour or two.

If your baby is sleepy, perhaps from a medicated birth, you may need to wake him and encourage him to nurse.

Aim to be comfortable while breastfeeding, and learn how to get your baby latched on well.

If your newborn is unable to breastfeed, electric hand express frequently until your milk 'comes in', then combine with using a hospital-grade help establish your milk production and relieve engorgement. Your milk breastpump to can be given to your baby until he is able to nurse.

Treat engorgement to...

Make breastfeeding easier
Even if you feel as though you have lots of milk, engorgement can make it harder for your baby to latch on to your breast and feed well. A poor latch-on can give you sore nipples. Your baby may also have trouble coping with the flow of milk from engorged breasts.

Protect milk production
When milk isn't removed from your breasts, you will produce less milk. Treating engorgement gives your baby more milk now and helps protect milk production for when your baby is older.

Avoid blocked ducts or mastitis
Engorgement can result in blocked ducts leading to mastitis.

When to treat

Take action to relieve engorgement if your breasts feel firm, hard, shiny or lumpy. When milk is removed, blood circulation improves and swelling reduces. Use the suggestions below to reduce swelling and keep your milk flowing. Many mothers have a slight temperature when their breasts are engorged. Temperatures under 38.4ºC are not usually associated with infection. Keep your baby close and continue breastfeeding.

Engorgement after the first weeks

Treat as outlined below while working out the cause so you can prevent it happening again.

Common causes of engorgement are:

A missed feed or expressing session.
This can easily happen during holidays and festivities or when visitors arrive. Encourage your baby to feed more often, or express more frequently if you're apart from your baby.

Feeding a baby on a schedule
Recent research has revealed that mothers vary in how much milk their breasts can store without becoming uncomfortable. Mothers following routines often suffer from engorgement, mastitis and low milk production because their breasts are not drained often enough.

Expressing milk.
Some books advise expressing to keep milk production one step ahead of a baby's needs. However, making more milk than your baby needs can increase your risk of engorgement and mastitis, especially if you go for several hours without feeding or expressing.

A baby who is unable or unwilling to nurse well for any reason
Expressing milk frequently until your baby can nurse well will help you maintain milk production and avoid blocked ducts or mastitis.

Weaning from the breast too quickly
If you experience engorgement duringweaning, you may need to slow down the process. This will give your breasts time to adjust to the reduced demand for milk. If breastfeeding more often is not an option, try expressing just enough milk to relieve the fullness by hand or pump.

Treating engorgement
Reduce swelling and keep milk flowing:

Aim to breastfeed every 1½ to 2 hours during the day, and at night every 2-3 hours from the start of one feed to the start of the next. Let your baby finish on the first breast before switching to the second

Avoid using bottles or dummies. If a supplement is needed try using a spoon, flexible feeding cup or syringe.

Between feeds, apply ice for 15-20 minutes at a time between feeds to reduce swelling. Use an ice pack, crushed ice in plastic bags or bags of frozen vegetables (that can be refrozen several times before being thrown away). Wrap them in a lightweight towel to protect your skin.

Just before feeding, apply moist warmth to your breasts for up to two minutes to help milk flow. Try a warm wet towel, warm shower or immersing breasts in a bowl of warm water. Then, express to comfort if your baby isn't ready to feed.

Use gentle massage from the chest wall toward thenipple area in a circular motion.

Be sure your baby is sucking effectively:

Position your baby with his chest and tummy in full contact with your body. With his cheek in close contact with your breast, your baby can easily tip back his head to latch on. This way he'll take a large mouthful of breast. Listen for swallowing as he feeds.

If your baby is finding it hard to latch on - when your baby bobs his head and licks the nipple, he naturally makes it easier to latch on.

For more information on getting your baby positioned and attached comfortably see here.

Reverse pressure softening

works by moving fluid away from the nipple area.

Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola.

You can also press with the sides of fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby's lips will be.

If this isn't enough, gently hand express a little milk before feeding to soften the areola. If you choose to use a breastpump, set it to minimum suction.

Keep comfortable:

Ask your midwife or GP to recommend an over-the-counter, anti-inflammatory medication suitable for breastfeeding mothers to relieve pain and swelling.

A well-fitting, supportive bra may help. Avoid bras (and underwires) that are tight or put pressure on specific areas of the breast.

Cold, raw cabbage leaves worn inside a bra can be soothing. Change when they become wilted or after about 2 hours. Use only until swelling goes down as long-term use may reduce milk supply. Stop use if a skin rash or other signs of allergy appear.

Watch out for symptoms of mastitis:

Inflamed, hot, red or darkened localised areas of your breast, depending on your skin tone. Changes in breast appearance may be harder to spot in darker skin. You may still have engorged breasts without a noticeable red or darkened area.

Temperature over 38.4ºC or flu-like symptoms.

Weaning can make a breast infection worse so continue to breastfeed frequently especially on the affected side and treat as for engorgement. Rest and drink fluids. If fever persists, continue breastfeeding and check with your GP as you may need antibiotics. More information on mastitis.

Engorgement should improve within a day or two. If not, contact an LLL Leader for further suggestions. You may need to improve your baby's breastfeeding technique or find ways to reduce your milk supply. These are not difficult problems to solve, especially if treated promptly.

Written by Karen Butler, Sue Upstone & mothers of La Leche League Great Britain

Further Reading

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

Beginning Breastfeeding
Comfortable Breastfeeding
Dummies and Breastfeeding
Hand Expression of Breastmilk
Mastitis
My Baby Won't Breastfeed
Nipple Pain - why and what to do
Positioning and Attachment
Sleepy Baby - why and what to do

This information is available to buy in printed format from our shop

Copyright LLLGB 2016

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Engorged Breasts - avoiding and treating - La Leche League GB

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Engorged breasts are painful. They feel heavy, hard, warm and sensitive -as if they are ready to burst! As well as being painful, engorgement can lead to other breastfeeding problems if not treated. Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

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Mastitis

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Mastitis symptoms usually develop quickly with signs of inflammation normally appearing in one breast, often alongside feeling like you have flu. It's most common in women who are breastfeeding.

What is mastitis?

Mastitis causes a woman's breast to become painful, inflamed and often red. It usually occurs within the first three months after giving birth (NHS Choices, 2016a).

Mastitis symptoms

Mastitis symptoms usually develop quickly and might include:

a red lump or area on the breast that is sore and hard; it might feel hot and painful to touch

a burning pain that might be continuous or happen while you're breastfeeding

nipple discharge that is white or contains traces of blood

flu-like symptoms, for example feeling tired and achy, and having a fever and chills.

(The Breastmilk It's Amazing, 2009; La Leche League GB, 2016; NHS Choices, 2016a)

What causes mastitis?

Mastitis is often caused by a build-up of milk in the breast - called milk stasis.

You might get milk stasis and mastitis because:

In some cases, this build-up of milk can become infected with bacteria. This is called infective mastitis and you might need antibiotics to treat it.

Continuing to breastfeed with mastitis

If you develop mastitis, continuing to breastfeed will help you get better and it won't harm your baby. The affected breast might produce less milk for a few days. Encouraging your baby to breastfeed frequently from the affected breast might clear the blockage and help your milk production to increase quickly. You can try to:

increase the frequency of feeding to drain the breast fully or use a breast pump if your baby is unable to feed

start feeding with the affected breast first

express milk between feeds

make sure your baby is positioned and latching well for their breastfeeds (consult your midwife, health visitor or seek help from NCT breastfeeding counsellors or other professional breastfeeding support)

try different feeding positions so your baby stimulates the blocked area more effectively

before feeding, try softening your breast by expressing a little milk, which might make it easier for your baby to feed well

massage the affected area in a warm shower or using a warm compress before feeding.

(The Breastmilk It's Amazing, 2009; NHS Choices, 2016b; La Leche League, 2016)

Mastitis treatment

Mastitis is usually easy to treat, and most women recover well and quickly. Some self-help measures can be helpful, such as:

getting lots of rest and relaxation

staying hydrated

using paracetamol or ibuprofen for relief from pain or fever

avoiding tight or restrictive clothes or bras until you're better

continuing to breastfeed even if you have an infection. This will help improve your symptoms and won't harm your baby

it might also help to feed more frequently than usual

making sure your baby is positioned and attached well to your breast.

(NHS Choices, 2016b)

Contact your GP if you think you might have mastitis. In the meantime, continue with self-help measures before your appointment. You might need antibiotics to treat mastitis. If so you will need antibiotics that are safe to use while breastfeeding. You might also need to contact your GP if you:

continue to feel feverish or if your temperature rises above 38.4°C

see pus or blood in your milk

have a cracked nipple that looks infected

see red streaks on your breast or your breast becomes red, hot, and swollen.

(NHS Choices, 2016a; La Leche League, 2016; Essential Parent, 2017)

Some women with mastitis or recurrent mastitis can go on to develop a breast abscess - a collection of pus, which might need to be drained surgically (NHS Choices, 2016b). So if you think you might have mastitis talk to your GP as soon as possible.

Preventing mastitis

If you find you have reoccurring mastitis, seek breastfeeding support and make sure your baby's position and attachment is good. You should also check that your baby doesn't have any underlying medical conditions like a tongue-tie. Try to take these steps to help prevent mastitis:

Feed your baby frequently and let them finish their feeds.

Ask a breastfeeding counsellor to check your baby positions and attaches well and breastfeeds efficiently.

Breastfeed your baby exclusively for six months if you can.

Reduce breastfeeds gradually.

(NHS Choices, 2016b)

This page was last reviewed in July 2018
Further information

We support all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our support line on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk.

Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

Our support line offers practical and emotional support in many areas of pregnancy, birth and early parenthood: 0300 330 0700.

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

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

National Breastfeeding Line (government funded): 0300 100 021.

NHS information on mastitis and blocked breast milk ducts.

Best Beginnings - Bump to Breastfeeding DVD Chapter 7 'Overcoming Challenges'.

Healthtalkonline.org: Managing Breastfeeding - dealing with difficult times.

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Mastitis symptoms usually develop quickly with signs of inflammation normally appearing in one breast, often alongside feeling like you have flu. It's most common in women who are breastfeeding. Mastitis causes a woman's breast to become painful, inflamed and often red. It usually occurs within the first three months after giving birth (NHS Choices, 2016a).

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Nct what to expect to see in your babies nappy.

https://www.ouh.nhs.uk/maternity/feeding/documents/nappy.pdf

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A step-by-step guild to attaching baby to the breast.

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Pictures of different positions for breastfeeding.

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Rugby hold (or the 'clutch')

The rugby hold is a good position for twins as you can feed them at the same time, as well as caesarean babies as there's no pressure on the tummy and scar area.

Positioning

1. Sit in a chair with a cushion or pillow along your side.

2. Position your baby at your side (the side you want to feed from), under your arm, with their hips close to your hips.

3. Your baby's nose should be level with your nipple.

4. Support your baby's neck with the palm of your hand.

5. Gently guide them to your nipple.

Further help

For help with latching on (positioning your baby on your breast), watch our breastfeeding animation video:

Tip: If your baby finds latching on tricky, this position is good as you can guide your baby's head towards your nipple - and it's easier to see what's going on.

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Start4Life - How to Breastfeed | Breastfeeding Guide | Start4Life

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The rugby hold is a good position for twins as you can feed them at the same time, as well as caesarean babies as there's no pressure on the tummy and scar area. Positioning Sit in a chair with a cushion or pillow along your side.

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Biological Nurturing (laid back breastfeeding) - video and information.

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What is laid-back breastfeeding or biological nurturing?

Laid-back breastfeeding is where you to use a comfortable, reclined position to feed your baby. It's really a relaxed approach where breastfeeding is seen as a relationship between you and your baby, with no need to follow a series of instructions.

Laid-back breastfeeding is also known as biological nurturing or the natural breastfeeding position (Colson, 2003).

What are the benefits of laid-back breastfeeding?

Laid-back breastfeeding:

Helps to release your baby's many feeding reflexes.

Encourages high levels of the nurturing hormone oxytocin in both you and your baby, helping you both to learn how to breastfeed together.

Uses gravity, which helps to support your baby as they lie on your body, giving them the freedom to use their instinctive feeding behaviour. Gravity also helps your baby to latch more effectively as they're able to use their natural reflexes, so you're less likely to get sore nipples.

Uses skin-to-skin contact, although it also works well when you're wearing a thin layer of clothing or whatever you're comfortable in.

Many mums say laid-back breastfeeding helps them to bond with their baby and get to know them sooner. That's because laid-back breastfeeding encourages mums to spend lots of time with their baby in the laid-back position even when their babies are not hungry or feeding.

Can be used at any time - it's about you feeling comfortable and well-supported, and finding whatever position feels right for you and your baby.

(Colson, 2008, 2012, 2019)

Laid-back breastfeeding: how your newborn latches on

Mums and babies most commonly use laid-back breastfeeding in the hours after birth. This is when your baby may spend time lying tummy-to-tummy with you.

In this period of close contact, you might notice your baby wriggling, pushing with their feet, and moving their head from side to side on your chest. These are primitive feeding reflexes, and you are helping your baby to use these to find your breast (Vinall, 2015; UNICEF, 2019).

Laid-back breastfeeding after a caesarean

Laid-back breastfeeding is useful following a caesarean birth, or in any situation where it's difficult to sit comfortably upright. That's because it allows for you to find your own relaxed and supported position (Colson, 2019). If it's hard to move or lift your baby, ask someone to help you both to get comfortable.

Continuing with laid-back breastfeeding

As your baby learns to breastfeed, they'll probably adapt easily to different positions, making laid-back breastfeeding very flexible, whether you're at home or out of the house.

If you're finding breastfeeding difficult, uncomfortable or painful, the laid-back breastfeeding approach can often help and breastfeeding counsellors use it widely (Vinall, 2015). To find your nearest breastfeeding counsellor or support group, call our Infant Feeding Support line on 0300 3300 700.

How to do laid-back breastfeeding in public

Laid-back breastfeeding doesn't have to be a very reclined or exposing position. In fact, you can sit in any comfortable, slightly reclined position, much in the same way as you might on a sofa or a deep chair.

Many coffee shops, for example, have soft chairs and sofas that would be suitable for laid-back breastfeeding in public. You could also use a changing bag or your coat to support you when you recline if you're out and about.

Your baby can be more diagonal than if you were reclined right back. You only need to be wearing loose enough clothing to allow your baby access to your breast, to sit in comfort with your friends and enjoy being out of the house.

Tips: laid-back breastfeeding and helping your baby latch on

1. Lean back if you're sitting or recline on any supportive surface. But do not lie flat on your back. It's okay to adjust your position until it feels right.

2. Hold your baby close so they're lying on your tummy with their core fully supported. If you've had a caesarean birth, you might want to place your baby to one side - away from your scar.

3. There should be constant contact between you but you don't need to put pressure on their neck or back. As you relax into the chair or bed, your baby relaxes into your body.

4. In this position, your baby's feet and legs will brush against your body, and usually find something to push against (such as your leg/hand/the bed/your partner's hand).

5. You will notice them nuzzling their face or bobbing their head from side to side until they locate the breast, then open their mouth wide as they latch on. As his or her mouth finds the breast, his sucking reflex starts to work.

The great thing is, you can use laid-back breastfeeding whenever you like, for as long as you like. And just remember - cuddles will not spoil your baby (Unicef, 2018).
This page was last reviewed in October 2019.
Further Information

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

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

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

Colson S. (2003) Cuddles, biological nurturing, exclusive breastfeeding and public health. Journal of the Royal Society for the Promotion of Health. 123(2):76-77. Available at: https://doi.org/10.1177/146642400312300206 (accessed 22nd October 2019)

Colson S. (2019) Biological Nurturing - Instinctual Breastfeeding 2nd Edition. Pinter & Martin, London.

Colson S, Meek JH, Hawdon JM. (2008) Optimal positions for the release of primitive neonatal reflexes for early breastfeeding. Early Human Development. 84:441-449

Colson S, DeRooy L, Hawdon J. (2003) Biological nurturing increases breastfeeding duration. MIDIRS Midwifery Digest.13(1):92-97.

Rosin SI. (2019) A Case Study of Biological Nurturing. Journal of Human Lactation. 35(2): 318-322. Available at: https://doi.org/10.1177/0890334419829044 (accessed 22nd October 2019)

UNICEF. (2018) The Baby Friendly Initiative building a happy baby: a guide for parents. Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2018/04/happybaby_leaflet_web.pdf (accessed 22nd October 2019)

UNICEF. (2019) Meeting your baby for the first time. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/relationship-building-resources/meeting-baby-for-the-first-time-video/ (accessed 22nd October 2019)

Vinall R. (2015) The value of introducing laid-back breastfeeding Perspective. Dec 2015. Available at: https://www.nct.org.uk/sites/default/files/related_documents/Vinall%20The%20value%20of%20introducing%20laid-back%20breastfeeding_0.pdf (accessed 22nd October 2019)

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Laid-back breastfeeding: benefits and uses | Baby & toddler, Feeding articles & support | NCT

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Many mums and babies use laid-back breastfeeding straight after birth but it has many benefits even after that first snuggle. Here's how...

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Bottle feeding a breastfed baby.

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Infant Milks - First Steps Nutrition Trust

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Whether you're a health worker or a parent or carer, First Steps Nutrition Trust focuses on providing clear advice and information around the safe use of infant milks in the UK.

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How to prepare a bottle of infant formula safely.

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Here we provide tips and information on how to make up a baby's bottle using formula milk including how to mix baby formula.

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Baby feeding cues

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Further reading into the benefits of responsive breastfeeding.

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by Dr. Amy Brown

Responsive parenting e.g. responding promptly and appropriately to a baby's needs is widely recognised as an important protective element for infant health, wellbeing and development ¹. When babies feel secure in the care of a primary caregiver, they go on to have better outcomes socially, educationally and emotionally ².

There are many elements to responsive parenting but one of the central aspects within this relationship is the importance of responsive feeding. Responding to a baby's feeding cues (both of hunger and satiation), whether they are breast or bottle fed is an important step to helping a baby develop not only a secure attachment relationship, but in establishing longer term positive eating behaviours. Responsive feeding takes advantage of a young baby's natural ability to regulate their intake of calories - something that can disappear when a baby gets older ³. Feeding when they are hungry and being able to stop when they are full helps them to retain this ability ⁴.

Now infants can get
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However, the notion of responsive feeding can lead to significant concerns for new parents, particularly in relation to how often breastfed babies feed. One concern is whether feeding frequently is a sign that the baby isn't getting enough milk, exacerbated by not being able to see how much milk the baby is consuming. Others may worry about whether babies need to learn to feed less frequently in a set pattern. However, responding to a baby's natural cues is a critical step in establishing milk supply and encouraging healthy weight gain and development in babies.
How often do babies breastfeed?
As with everything, how often a baby naturally wants to feed will vary amongst individuals. However studies that explore how often babies breastfeed find that most do so between 8 - 12 times per 24 hours, although some feed much more than that (up to around 18 times in some studies). Most tend to feed towards the latter part of that range, with around 11 - 12 feeds per 24 hours ⁵.

Notably, babies calorie needs do not change vastly after the first few weeks, but they become able to take bigger feeds. This means that from around 8 - 12 weeks some babies start feeding in longer intervals. However, this pattern doesn't necessarily remain. Studies that have tracked this longitudinally find that many babies do start to feed less often but then start feeding again more frequently (akin to a newborn) around 4 months of age, before dropping down again. This fits with the commonly observed 'four month growth spurt', which is often seen as a mistaken need for solid foods ⁶. However, as with everything, some babies will continue to take smaller feeds more often until they move to solid foods (and, still even then). Just as with adults, some of us prefer set meals a day whereas others prefer to graze.

As well as being little and often, most babies don't naturally breastfeed to a set pattern e.g. every three hours. If allowed to feed whenever they want to, many breastfed babies are good at feeding according to hunger, which doesn't fit into a set pattern (how many adults truly eat or drink at precise set intervals?). Things like growth spurts and cluster feeding (where babies feed numerous times over a period of up to a few hours) are common and are thought to stimulate the body to produce more ⁷.

Variations will also occur according to the content of the mothers milk. Research has shown that fat content can vary between mothers. Mothers who produce milk with a higher fat content are more likely to have babies that have shorter feeds e.g. they take in a similar energy density to those with lower fat content in their milk who take a little longer to consume it ⁸.

Breastmilk also changes in content, particularly in terms of calories and fat. During a feed, milk becomes denser in fat as the feed progresses. Fat content and energy density are also higher during the day than the night. In hot weather breastmilk can also be less energy dense, encouraging infants to consume more of a higher water content milk ⁹. Again, this can affect the amount or frequency of how often babies feed. Generally, the less energy dense the milk, the more they take in.

Feeding frequency is also context dependent. In Western culture our norm is to separate from our babies to some extent. Baby wearing for most of the day and co-sleeping are normal from an evolutionary perspective but not common in our society today. Put simply, this means that babies do not always have easy and unfettered access to the breast. However, in cultures where co-sleeping and carrying infants in a sling are common, and babies therefore have free access to the breast, they feed far more frequently than this. An observational stud of the rural hunter- gatherer tribe known as the !Kung, found that babies breastfed on average four times an hour, with an average feed being two minutes or less ¹⁰. Other studies show less frequent feeds, but sill significantly more than in Western cultures. For example one study in rural Thailand found babies averaged 15 feeds over 24 hours ¹¹. In the UK, when babies do co-sleep, they feed more per night ¹².
Why do babies need to breastfeed so often?
Firstly, breastmilk is low in fat and protein but high in carbohydrates and lactose, which makes it easy - and quick - to digest. It is more easily digested than formula milk, which means that breastfed babies often feed more frequently than formula fed babies (approximately every two hours compared to three hour for formula fed babies) ¹³. Breastfed babies reach a fasting state quicker than formula fed infants, with 75% of breastfed infants reached a fasting state within 3 hours from the last feed compared to 17% of formula fed babies ¹⁴.

Breastfed babies also tend to consume less milk than formula fed babies at each feed, preferring to feed little and often compared to many formula fed babies. A baby's tummy has a maximum capacity of 90ml. Breastfed babies tend to take smaller feeds, not completely filling their stomach. In the first six months babies need around 750ml of milk a day meaning that even at maximum capacity that equates to feeding around every three hours ¹⁴. Research has shown that formula fed babies take in more milk from the first day of life (about twice as much on day one and three times as much by day two) ¹⁵.
Why is responsive feeding so important?
Meeting the frequent and unpredictable feeding needs of a breastfed baby can feel challenging and is a common reason why mothers stop breastfeeding - either through anxiety that something is wrong, or a belief that formula will offer a more convenient feeding schedule ¹⁶. However, responsive feeding is not only normal but important for a number of reasons.

Feeding responsively is particularly important when a baby is breastfed because it is intrinsically linked to establishing and maintaining a good supply of breastmilk. Breastmilk starts to be produced in small amounts during pregnancy. Once the placenta is removed after birth this production shoots up, supported by rises in the hormones prolactin and oxytocin ¹⁷.

However, once this initial surge has occurred, one of the most important things for breast milk supply is frequent feeding. Simply, the more milk is removed from the breast (either by a baby or by expressing), the more milk is produced. The human body is very clever at matching how much milk is removed (e.g. how much the body believes the baby needs) to how much it produce ¹⁸. One study that asked mothers to either feed their newborn baby responsively or to feed to a set 3 - 4 schedule found that babies who were fed responsively consumed a third more milk ¹⁹.

Because responsive feeding is linked to a better milk supply, it has a knock on effect onto outcomes for babies. Responsive feeding is associated with mature milk coming in quicker after the birth ²⁰, regaining birth weight faster ¹⁹, and a lower risk of jaundice ²¹. Conversely, supplementing with formula milk, particularly in the early days and weeks, can lead to a drop in supply, or difficulties with latch ²². Using a pacifier can also reduce milk intake as it can lead to a delay in how often babies are fed. Babies who use a pacifier feed on average for half an hour less each day which equates to one fewer feed< ²³.

Based on this, it is not surprising that babies who are fed responsively are more likely to continue being breastfeed ²⁴. Meanwhile, trying to breastfeed to a parent led routine is associated with stopping breastfeeding ²⁵. This can apply to wider parenting style; mothers who adopt a routine for feeding, sleep and day to day care of their infant are more likely to stop breastfeeding in the early days ²⁶. Notably, those who stop breastfeeding after using a routine are more likely to report breastfeeding difficulties e.g. low milk supply, pain on latch and a fussy baby - likely a knock on impact of lower milk supply from less frequent feeding ¹⁶.
What about night time feeding?
Babies' needs do not cease to exist simply because it is dark outside. One of the main needs infants have at night is to feed. A baby's stomach is still the same size and breast milk still easily digested at night as it is in the day. Research suggests that it is not until around two months that a baby's natural day and night circadian rhythm kicks in. Until that point, the concept of sleeping for an extended period of time is not something that babies are physiologically designed to do - and even then it can take a while to get into the habit ²⁷.

However, society continues to sell us the myth that babies should start sleeping through the night after the first few weeks, and that getting them to this stage is an achievement. Aside from evidence to the contrary, given that around a third of adults report at least mild insomnia, should we really believe that babies who cannot meet their own needs if they wake should be able to sleep all night? How many adults when they wake have a drink of water?

Waking at night is also thought to be protective. Babies want to be close to their mother at night and sleeping close to them helps babies maintain their temperature ²⁸, heart rate ²⁹ and have steadier breathing ³⁰. Sleeping too deeply may be a risk factor for SIDS. Babies who have died of SIDS are more likely to have longer periods of uninterrupted sleep and moved about less in their sleep ³¹.

Research exploring night waking in the first year brings estimates of between 30 - 80% of babies still waking at least once with a number of studies saying most babies continue to wake once or twice a night throughout the first year ³². Although sleep problems in older children can be an issue, waking at night as a baby has no link with later sleep problems or development ³³.

Feeding at night is also common - and important - in supporting breastfeeding. Firstly, the body takes into account feeds at night when establishing milk supply. Babies take in around a third of their milk supply at night (although in toddlers in cultures where co-sleeping is the norm, this can rise to 50% as many are busy and distracted during the day) ¹¹. Feeding at night is an important step in developing a good milk supply. Although it may be dark outside, the body still considers frequency of feeds at night when establishing milk supply.

Feeding at night is also an essential part of providing a high level of contraceptive cover through the Lactational Amenorrhea Method. This method offers 98% security of contraception as long as babies are fed responsively (and are under 6 months and receiving no formula milk or solid foods). Feeding at night is an important part of this ³⁴.

Additionally, feeding at night is important from a hormonal perspective. Prolactin is linked to milk supply; generally the higher prolactin levels you have, the more milk is made. Prolactin levels are already higher at night but also rise further when your baby feeds, so feeding at night is a great opportunity to really drive those levels higher and help your milk supply ³⁵.

Sometimes parents worry about their baby continuing to breastfeed at night based on the myths that a) babies should sleep through the night and b) breastfeeding stops babies sleeping through the night. However, rather than being something breastfed babies do more, breastfeeding at night should be recognised as something that is very normal. In countries where night-time infant care and co-sleeping is the norm, babies breastfeed around four times a night ³⁶.

Some studies do show that very young babies who are formula fed start sleeping for longer at an earlier age more, suggesting that breastfeeding was likely used as a tool to encourage the baby back to sleep quickly ³⁷ and have longer periods of deep sleep ³⁸. However once babies get a little older, this difference disappears. One study found that for babies aged 6 - 12 months, babies who were breastfed did more at night than babies who were formula fed. However they did not ³². Indeed, two studies exploring the sleep patterns of mothers who breast or formula fed found that breastfeeding mothers got more hours of sleep overall, alongside feeling in better health< ³⁹ whilst another found that mothers who were breastfeeding actually had more rest per night that those who formula fed because it took less time to resettle the baby ⁴⁰.

When parents are thinking about a routine for feeds, one of the most common places they start is by trying to reduce night feeds, and more generally encourage 'sleeping through the night'. However, sleep training can have a negative impact on breastfeeding success. One intervention to reduce night waking in babies aged 6 - 12 months found that although babies started sleeping for longer, breastfeeding rates dropped far more rapidly than expected during the course of the study ⁴¹.

Feeding responsively is therefore a critical element of establishing and maintaining milk supply, supporting weight gain and promoting positive longer term eating behaviour in children. More importantly, it is the norm and biological expectation of young babies, and a central element of a responsive parenting relationship however a baby is fed. Feeding responsively can be demanding for mothers though and as a society, rather than trying to normalise routines and scheduled feeding, we should be looking towards how we can value and support our new families better. Mothering the mother so she can breastfeed her baby, and more widely, supporting the new family and a unit makes the new responsibility of caring for a young baby that little bit easier.
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3. Fomon, S.J., Filmer, L.J., Thomas, L.N., Anderson, T.A., & Nelson, S.E. (1975). Influence of formula concentration on caloric intake and growth of normal infants. Acta Paediatrica Scandinavia , 64/2, 172 - 81.
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34. Labbok, M.H. et al. Multicenter study of the lactational amenorrhea method (LAM): I. Efficacy, duration, and implications for clinical application. Contraception 1997; 55(6):327-36

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35. Riordan, J. & Wambach, K. (2010) Breastfeeding and Human Lactation 4th ed. Jones and Bartlett, p. 89
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41. Hall, W.A., Saunders, R.A., Clauson, M., Carty, E.M. and Janssen, P.A., 2006. Effects of an intervention aimed at reducing night waking and signaling in 6-to 12-month-old infants. Behavioral Sleep Medicine, 4(4), pp.242-261.
http://www.tandfonline.com/doi/abs/10.1207/s15402010bsm0404_4 About Amy Brown:

Dr. Amy Brown is an Associate professor in Child Public Health in the Department of Public Health, Policy and Social Sciences at Swansea University, UK. Her research explores the psychology of maternal and infant health and wellbeing, particularly during the first 1001 days of pregnancy and the first two years of life. She has a particular expertise in infant nutrition, but her research also explores the wider yet inter related issues of normal baby behaviour, sleep, parenting and postnatal depression.

As part of her role, Dr Brown leads the MSc in Child Public Health - an interdisciplinary programme which explores the evidence base behind child public health policy in the UK and internationally. This programme is particularly popular amongst health professionals and graduate students alike and has attracted students from South Korea, Nigeria, Canada, Guatemala and Ghana to name a few.

Check out her book Breastfeeding Uncovered at:

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Importance of Responsive Feeding * KellyMom.com

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The importance of responsive feeding in establishing a good breastmilk supply by Dr. Amy Brown Responsive parenting e.g. responding promptly and appropriately to a baby's needs is widely recognised as an important protective element for infant health, wellbeing and development1. When babies feel secure in the care of a primary caregiver, they go on to [...]

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Responsive bottle feeding.

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Emma Pickett
IBCLC, Lactation Consultant and Breastfeeding Counsellor

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Responsive Bottle-Feeding - Attachment Parenting UK

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We know bottle feeding isn’t just about the milk. It’s also about holding the baby in a particular way & responding to cues.

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Guide to hand expressing and storing your 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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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: 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.

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Video showing how to hand express.

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This video guides mothers on how to hand express and talks about the times when hand expression might be useful.

See the Breastfeeding Network website for FAQs and a leaflet all about expressing and storing breastmilk.

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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This video guides you through how to hand express, and talks about the times when hand expression might be useful for you.

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Expressing using a breast pump.

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There are plenty of reasons why, if you choose to do it, expressing milk is a useful skill to have for your new baby. It can help in medical situations that mean your baby or you is struggling to breastfeed (Becker et al, 2016).

When you're away from your baby expressing milk will keep up your supply (Becker et al, 2016). It can even be a good trick to boost your supply if it's low (Becker et al, 2016).

Another plus of expressing is that babies learn to take a bottle or cup. This gives you more freedom to go to work, appointments or even an evening out with friends. It also allows your partner or other members of your family to become more involved in the early months (Becker et al, 2016). Here are the ways that you can start expressing your milk.

Watch our video for tips on expressing breastmilk.

Electric breast pumps

Breast pumps are useful when you need or want to give your baby milk in a bottle or cup but want to continue breastfeeding. You have two options when it comes to using a pump to express your breast milk: manual or electric.

Electric pumps use mains electricity, batteries or sometimes both. They are more expensive than hand pumps but they are usually less exhausting - a big bonus in the early newborn weeks. Electric pumps are also great if you need to express often for a baby who is in special care.

If one type of electric pump doesn't work for you, try another one to explore the options. You could do this either by returning it for a refund or hiring a pump instead of buying from an NCT breastfeeding counsellor.

It's good to check the fit - no-one's nipples are the same and you may need a different-sized funnel (Becker et al, 2016). If you're keen on efficiency you could consider 'double pumping'. This uses a double electric breast pump so you can express from both breasts at once.

Top tip: If there are different suction settings on your pump, start on a low one. You won't win any prizes - especially not from your painful nipples - by going straight for the hardest level. So build it up gradually.

Manual breast pumps

For some women, hand-operated pumps can seem less intimidating than electric pumps. That might in turn mean you're more relaxed using them. If you're more relaxed you'll produce more milk (Becker et al, 2016). Most pumps have flanges that go over your nipple and areola (the coloured skin around the nipple) and fit the breast. This helps draw the milk out by suction as you collect it in a bottle-shaped container.

Use them when your breasts are full and you should hold your baby while you pump if possible. This helps because skin-to-skin contact makes you produce the hormones that will bring on the milk (UNICEF, 2015).

Top tip: Make sure you sterilise all parts of the pump and whatever you're using to store your milk before you start expressing (NHS, 2016a).

Hand expressing

Your milk reaches the nipple through many different ducts. So as you press and release the breast tissue, your fingers mimic the action of your baby's tongue and mouth, squeezing milk from these ducts. That's how hand expressing works.

You can also use hand expressing to ease engorgement. It's handy if you're out somewhere without your breast pump, like a private office at work. Here's how to do it:

Massage your breasts or put a warm flannel on them first.

Position your hands under your breast with your thumbs upwards. The exact position will differ between women and you may or may not be touching your areola. The idea is to put pressure on the milk ducts. You may need to experiment to feel where they are.

Try pushing in towards your ribcage before rolling your fingers inwards. Move around so you affect different areas.

As you start to squeeze, milk will appear. Work around each breast, releasing the milk from all parts.

Express from one breast until the milk flow slows down and then start massaging the other. You can switch from breast to breast until the milk flow stops.

At first you may not be able to produce much but usually the more you express the easier it becomes.

Ask your midwife, health visitor or nurse to show you how to hand express your milk (NICE, 2014; NHS Choices, 2016a).

Top Tip: Find a container like a jug that has a wide rim for catching your milk and make sure it's sterilised (NHS Choices, 2016b). Make sure you have some sterile storage containers for storing your milk, like bags, bottles or containers with lids (Breastfeeding Network, 2009).

This page was last reviewed in October 2017
Further information

Our helpline offers practical and emotional support in many areas of pregnancy, birth and early parenthood: 0300 330 0700.

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

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

National Breastfeeding Line (government funded): 0300 100 021.

UK Association of Milk Banking has information on its network of milk banks across the UK.

Best Beginnings: view video footage online from 'bump to breastfeeding'.

Healthtalkonline.org provides a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.

American Academy of Pediatrics. (2011) Practical bottle feeding tips. Available from: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Practical-Bottle-Feeding-Tips.aspx [Accessed 1st October 2017].

Becker GE, Smith HA, Cooney F (2016) Methods of milk expression for lactating women. Cochrane Database Syst Rev 29:9. doi: 10.1002/14651858. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006170.pub5/full [Accessed 1st October 2017].

Breastfeeding Network. (2009) Expressing and storing breastmilk. Available from: https://www.breastfeedingnetwork.org.uk/wp-content/pdfs/BFNExpressing_and_Storing.pdf [Accessed 1st October 2017].

Healthy Children. (2011) Practical bottle feeding tips. Available from: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Practical-Bottle-Feeding-Tips.aspx [Accessed 1st October 2017].

NHS Choices. (2016a) Expressing and storing breast milk. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/expressing-storing-breast-milk/ [Accessed 1st October 2017].

NHS Choices. (2016b) Sterilising bottles. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/sterilising-bottles/ [Accessed 1st October 2017].

NICE. (2014) Breastfeeding recommendations. Available from: https://www.nice.org.uk/guidance/PH11/chapter/4-Recommendations#breastfeeding-3 [Accessed 1st October 2017].

UNICEF. (2015) Guide to bottle feeding. Available from: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2008/02/start4life_guide_to_bottle_-feeding.pdf [Accessed 1st October 2017].

UNICEF. (2018) Skin to skin contact. Available from: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/guidance-for-health-professionals/implementing-the-baby-friendly-standards/further-guidance-on-implementing-the-standards/skin-to-skin-contact/ [Accessed 1st October 2017].
Further reading
NHS. (2009) Breast milk ingredients and sleep. Available from: http://www.nhs.uk/news/2009/10October/Pages/Breast-milk-ingredients-and-sleep.aspx [Accessed 1st October 2017].

NHS Choices. (2017) Benefits of breastfeeding. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/benefits-breastfeeding/ [Accessed 1st October 2017].

NHS Choices. (2018) How to bottle feed your baby. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/bottle-feeding-advice/#how-to-bottle-feed-your-baby [Accessed 1st October 2017].

Peila C, Coscia A, Bertino E, Li Volti G, Galvano F, Barbagallo I, Gazzolo D (2017) Human milk adrenomedullin is unstable during cold storage at 4°C. Breastfeed Med. 12(9):561-565. doi: 10.1089/bfm.2017.0072. Available from https://www.ncbi.nlm.nih.gov/pubmed/28956619 [Accessed 1st October 2017].

Science News. (2015) Backwash from nursing babies may trigger infection fighters. Available from: https://www.sciencenews.org/blog/growth-curve/backwash-nursing-babies-may-trigger-infection-fighters [Accessed 1st October 2017].

University Hospital Southampton NHS Trust. (2014) Syringe and cup feeding your baby. Available from: http://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Pregnancyandbirth/Syringe-and-cup-feeding-your-baby-patient-information.pdf [Accessed 1st October 2017].

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Expressing milk: Which method is best? | Baby & toddler, Feeding articles & support | NCT

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There are plenty of reasons why, if you choose to do it, expressing milk is a useful skill to have for your new baby. It can help in medical situations that mean your baby or you is struggling to breastfeed (Becker et al, 2016).

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Padlet - Janet Rimmer nct breastfeeding multiples.

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Tamba - support for feeding twins & multiple babies.

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Video - showing real mothers feeding twins/multiples.

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Infant formula.

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Formula milk, also known as baby formula or infant formula, is usually made from cows' milk that has been treated to make it more suitable for babies.
There's a wide range of brands and types of formula available in pharmacies and shops. Always check labels carefully to make sure you're buying a suitable milk for your baby.

Formula comes in 2 different forms: a dry powder you make up with water, or a ready-to-feed liquid formula. While ready-to-feed liquid formula can be convenient, it tends to be more expensive and, once opened, needs to be used more quickly.

Formula milk provides babies with the nutrients they need to grow and develop. However, it does not have the same health benefits as breast milk for you and your baby. For example, it cannot protect your baby from infections.

First infant formula (first milk)
Suitable from birth
First infant formula (first milk) should always be the first formula you give to your baby.

The cows' milk in formula contains 2 types of proteins - whey and casein. First infant formula is based on whey protein which is thought to be easier to digest than other types of formula.

Unless a midwife, health visitor or GP suggests otherwise, first infant formula is the only formula your baby needs. Your baby can stay on it when you start to introduce solid foods at around 6 months and drink it throughout their 1st year.

There's no evidence that switching to a different formula does any good or harm. However, if you think a particular brand of formula disagrees with your baby, talk to a midwife or health visitor. They can help you decide whether to try a different type.

When your baby is 1 year old, they can start to drink whole cows' milk or sheep's or goats' milk (as long as it's pasteurised).

Find out more about drinks to give your baby.

Goats' milk formula
Suitable from birth
Different kinds of goats' milk formula are available in pharmacies and shops. They are produced to the same nutritional standards as cow's milk-based formula.

Goats' milk formula is not less likely to cause allergies in babies than cows' milk formula.

Goats' milk formulas are not suitable for infants with cows' milk allergy (also known as cows' milk protein allergy), as the proteins they contain are very similar.

Hungrier baby formula (hungry milk)

Suitable from birth (but ask a midwife or health visitor for advice first).

This type of formula contains more casein than whey, and casein is harder for babies to digest.

Although it's often described as suitable for "hungrier babies", there's no evidence that babies settle better or sleep longer when fed this type of formula.

Anti-reflux (staydown) formula

Suitable from birth (but only under medical supervision).

This type of formula is thickened with the aim of preventing reflux in babies (when babies bring up milk during or after a feed).

Although it's available in pharmacies and supermarkets, it's recommended you only use it on the advice of a health professional.

The instructions for making up anti-reflux formulas may be different to standard formula. The usual guidelines for making up formula recommend using boiled water that has stood for no more than 30 minutes, so that the temperature is still above 70C.

Some manufacturers of anti-reflux formula recommend making it up at lower temperatures than are usually recommended. Otherwise it may get lumpy. Follow the instructions on the pack or speak to a health professional for advice.

It's important to take extra care when making up and storing these products as powdered formula is not sterile and making it up at lower temperatures will not kill any harmful bacteria it may contain.

Speak to a midwife, health visitor or GP if you have any concerns.

Comfort formula

Suitable from birth (but ask a midwife or health visitor for advice first).

This type of formula contains cows' milk proteins that have already been partly broken down (partially hydrolysed). This is supposed to make it easier to digest and help prevent digestive problems such as colic and constipation. However, there's no evidence for this.

Partially hydrolysed formulas are not suitable for babies who have cows' milk allergy.

Lactose-free formula

Suitable from birth (but only under medical supervision).

This formula is suitable for babies who are lactose intolerant. This means they cannot absorb lactose, which is a sugar that's naturally in milk and dairy products.

Lactose intolerance is rare in babies. Symptoms include diarrhoea, abdominal pain, wind and bloating.

Lactose-free formula is available in pharmacies and shops, but if you think your baby may be lactose intolerant, it's important to speak to a midwife, health visitor or GP.

Hypoallergenic formula

Suitable from birth (but only under medical supervision).

If your baby is diagnosed as being allergic to cows' milk, a GP will prescribe an appropriate infant formula with fully hydrolysed (broken down) proteins.

Formula with partially hydrolysed proteins (comfort formula) is available in pharmacies and shops, but it's not suitable for babies with cows' milk allergy.

Follow-on formula

Suitable from 6 months (but ask a health visitor for advice first).

Follow-on formula should never be fed to babies under 6 months old.

Research shows that switching to follow-on formula at 6 months has no benefits for your baby. Your baby can continue to have first infant formula as their main drink until they are 1 year old.

The labels on follow-on formula can look very similar to those on first infant formula. Read the label carefully to avoid making a mistake.

Good night milk

Suitable from 6 months (but ask a health visitor for advice first).

Some follow-on formula has cereal added to it and is sold as a special formula for babies to have at bedtime.

This type of formula is not needed, and there's no evidence that babies settle better or sleep longer after having it.

Good night formula should never be given to babies under 6 months old.

Soya formula

Suitable from 6 months (but only under medical supervision).

Soya formula is made from soya beans, not cows' milk. It's occasionally used as an alternative to cows' milk formula for babies who have cows' milk allergy.

There are some concerns about the fact that soya contains phytoestrogens. These are found naturally in some plants.

The chemical structure of phytoestrogens is similar to the female hormone oestrogen. Because of this, there are concerns that they could affect a baby's reproductive development, especially in babies who drink only soya-based infant formula.

Babies' low body weight means they take in much higher amounts of phytoestrogens than older children or adults who eat soya products as part of a varied and balanced diet.

Also, because soya formula contains glucose, so it is more likely to harm a baby's teeth.

Only use soya formula if it has been recommended or prescribed by a health visitor or GP.

Growing-up milk (toddler milk)

Suitable from 1 year (but ask a health visitor for advice first).

Growing-up and toddler milks are marketed as an alternative to whole cows' milk for toddlers and children over 1 year old. There's no evidence to suggest that these products provide extra nutritional benefits for young children.

Whole cows' milk is a suitable choice as a main drink for your child from age 1. Semi-skimmed cows' milk is a suitable main drink for children over 2 who are eating a balanced diet.

It's recommended that all children aged 6 months to 5 years have vitamin drops containing vitamins A, C and D every day.

See more about vitamins for children.

Types of milk to avoid

Not all milk is suitable for feeding babies. You should never give the following types of milk to a baby under 1 year:

condensed milk

evaporated milk

dried milk

goats' or sheep's milk (but it's fine to use them when cooking for your baby, as long as they are pasteurised)

other types of drinks known as "milks", such as soya, rice, oat or almond drinks

cows' milk as a drink (but it's fine to use it in cooking)

Further information

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Formula milk, also known as baby formula or infant formula, is usually made from cows' milk that has been treated to make it more suitable for babies. There's a wide range of brands and types of formula available in pharmacies and shops. Always check labels carefully to make sure you're buying a suitable milk for your baby.

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Signs your baby is getting enough milk.

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Combined breastfeeding & infant formula feeding.

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It can take several weeks for you and your baby to feel happy and confident with breastfeeding.
Once you've both got the hang of it, it's usually possible to offer your baby bottles of expressed milk or formula alongside breastfeeding.

This is sometimes called mixed or combination feeding.

Why combine breast and bottle?

You may want to combine breastfeeding with bottle feeding if you:

are breastfeeding and want to use a bottle to offer your baby some expressed breast milk

want to breastfeed for some of your baby's feeds, but give bottles of formula for 1 or more feeds

are bottle feeding your baby and want to start breastfeeding

need to leave your baby and want to make sure they have some milk while you're away

Introducing formula feeds can affect the amount of breast milk you produce. There is also a small amount of evidence to show babies may not breastfeed as well because they learn to use a different kind of sucking action at the bottle than at the breast.

These things can make breastfeeding more difficult, especially in the first few weeks when you and your baby are still getting comfortable with breastfeeding.

Your breastmilk supply will usually not be affected if you start bottle feeding your baby when they are a bit older, you are both comfortable with breastbeeding, and you breastfeed every day.

Introducing formula feeds

If you're combining breastfeeding with formula feeds both you and your baby can carry on enjoying the benefits of breastfeeding.

If you choose to introduce infant formula:

it's best to do it gradually to give your body time to reduce the amount of milk it makes - this helps lower your chance of getting uncomfortable, swollen breasts, or mastitis

if you're going back to work, start a few weeks beforehand to give both of you time to readjust

if your baby is 6 months old or more and can drink milk from a cup, you may not need to introduce a bottle at all

For more information, see drinks and cups for babies.

Giving your baby their first bottle

It may take a while for a breastfed baby to get the hang of bottle feeding, because they need to use a different sucking action.

it usually helps to give the first few bottles when your baby is happy and relaxed - not when they're very hungry

it may help if someone else gives the first bottle feeds, so that your baby is not near you and smelling your breast milk

you might want to try using a different position for bottle and breastfeeding

See more advice on how to bottle feed.

Restarting breastfeeding

If you want to start breastfeeding more and give your baby fewer bottles, it's a good idea to ask your midwife, health visitor or breastfeeding supporter for support.

These tips may help too:

Hold and cuddle your baby as much as possible, ideally skin to skin. This will encourage your body to make milk and your baby to feed.

Express your breast milk regularly. Expressing releases the hormone prolactin, which stimulates your breasts to make milk. About 8 times a day, including once at night is ideal. It may be easier to express by hand to begin with - your midwife, health visitor or breastfeeding supporter can show you how.

Try bottlefeeding while holding your baby skin to skin and close to your breasts.

If your baby is latching on, feed little and often. Do not worry if your baby does not feed for long to begin with. See tips on how to get your baby properly positioned and attached.

Choose times when your baby is relaxed, alert and not too hungry, and do not force your baby to stay at the breast.

Decrease the number of bottles gradually, as your milk supply increases.

Consider using a lactation aid (supplementer). A tiny tube is taped next to your nipple and passes into your baby's mouth so your baby can get milk via the tube as well as from your breast. This helps to support your baby as they get used to attaching to the breast. Your midwife, health visitor or breastfeeding supporter can give you more information.

See more tips on boosting your milk supply.

Help and support with mixed feeding

If you have any questions or concerns about combining breast and bottle feeding:

talk to your midwife, health visitor or breastfeeding supporter

call the National Breastfeeding Helpline on 0300 100 0212 (9.30am to 9.30pm, every day)

find breastfeeding support near you

Video: why combine breast and bottle feeding?

In this video, 3 mothers discuss ways to combine breast and bottle feeding.

Community content from HealthUnlocked

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How to combine breast and bottle feeding

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It can take several weeks for you and your baby to feel happy and confident with breastfeeding. Once you've both got the hang of it, it's usually possible to offer your baby bottles of expressed milk or formula alongside breastfeeding. This is sometimes called mixed or combination feeding.

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Breastmilk changes in the first week.

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In the first few days, you and your baby will be getting to know each other. It may take time for both of you to get the hang of breastfeeding.
This happens faster for some women than others. But nearly all women produce enough milk for their baby.

Preparing to breastfeed before the birth

It's good to find out as much as you can about breastfeeding before you have your baby. It may help you feel more confident when you start breastfeeding your baby.

Antenatal classes usually cover the most important aspects of breastfeeding, such as positioning and attachment, expressing, and how to tackle common breastfeeding problems.

Find antenatal classes near you.

You can find out about breastfeeding from your midwife, family and friends, and useful helplines and websites.

There are lots of groups and drop-ins, some specially designed for pregnant women who want to know more about breastfeeding. You can find out more by asking your midwife, health visitor, local peer supporter or GP. Or visit your local Children's Centre.

Skin-to-skin contact

Having skin-to-skin contact with your baby straight after giving birth will help to keep them warm and calm and steady their breathing.

Skin-to-skin means holding your baby naked or dressed only in a nappy against your skin, usually under your top or under a blanket.

Skin-to-skin time can be a bonding experience for you and your baby. It's also a great time to have your first breastfeed. If you need any help, your midwife will support you with positioning and attachment.

Skin-to-skin contact is good at any time. It will help to comfort you and your baby over the first few days and weeks as you get to know each other. It also helps your baby attach to your breast using their natural crawling and latching-on reflexes.

You'll still be able to bond with and breastfeed your baby if skin-to-skin contact is delayed for some reason, for example if your baby needs to spend some time in special care.

If necessary, your midwife will show you how to express your breast milk until your baby is ready to breastfeed. They can also help you have skin-to-skin contact with your baby as soon as it's possible.

Skin-to-skin after a caesarean

If your baby is delivered by caesarean, you should still be able to have skin-to-skin contact with your baby straight after delivery.

Colostrum: your first milk

The fluid your breasts produce in the first few days after birth is called colostrum. It's thick and usually a golden yellow colour. It's a very concentrated food, so your baby will only need a small amount, about a teaspoonful, at each feed.

Your baby may want to feed quite often, perhaps every hour to begin with. They'll begin to have fewer, but longer feeds once your breasts start to produce more "mature" milk after a few days.

The more you breastfeed, the more your baby's sucking will stimulate your supply and the more milk you'll make.

Your let-down reflex

Your baby's sucking causes muscles in your breasts to squeeze milk towards your nipples. This is called the let-down reflex.

Some women get a tingling feeling, which can be quite strong. Others feel nothing at all.

You'll see your baby respond when your milk lets down. Their quick sucks will change to deep rhythmic swallows as the milk begins to flow. Babies often pause after the initial quick sucks while they wait for more milk to be delivered.

Occasionally this let-down reflex can be so strong that your baby coughs and splutters. Your midwife, health visitor or breastfeeding supporter can help with this, or see some tips for when you have too much breast milk.

If your baby seems to be falling asleep before the deep swallowing stage of feeds, they may not be properly attached to the breast. Ask your midwife, health visitor or breastfeeding supporter to check your baby's positioning and attachment.

Sometimes you'll notice your milk letting down in response to your baby crying or when you have a warm bath or shower. This is normal.

How often should I feed my baby?

In the first week, your baby may want to feed very often. It could be every hour in the first few days.

Feed your baby as often as they want and for as long as they want. They'll begin to have fewer, but longer feeds after a few days.

As a very rough guide, your baby should feed at least 8 to 12 times, or more, every 24 hours during the first few weeks.

It's fine to feed your baby whenever they are hungry, when your breasts feel full or if you just want to have a cuddle.

It's not possible to overfeed a breastfed baby.

When your baby is hungry they may:

get restless

suck their fist or fingers

make murmuring sounds

turn their head and open their mouth (rooting)

It's best to try and feed your baby during these early feeding cues as a crying baby is difficult to feed.

Building up your milk supply

Around 2 to 4 days after birth you may notice that your breasts become fuller. This is often referred to as your milk "coming in".

Your milk will vary according to your baby's needs. Each time your baby feeds, your body knows to make more milk for the next feed. The amount of milk you make will increase or decrease depending on how often your baby feeds.

Feed your baby as often as they want and for as long as they want. This is called responsive feeding. In other words, responding to your baby's needs. It's also known as on-demand or baby-led feeding.

In the beginning, it can feel like you're doing nothing but feeding. But gradually you and your baby will get into a pattern and the amount of milk you produce will settle down.

It's important to breastfeed at night because this is when you produce more hormones (prolactin) to build up your milk supply.

In the early weeks, before you and your baby have become comfortable with breastfeeding, "topping up" with formula milk or giving your baby a dummy can lower your milk supply.

Speak to a midwife or health visitor if you are worried about breastfeeding or you think your baby is not getting enough milk.

They might suggest giving your baby some expressed breast milk along with breastfeeding.

Find out more about how to tell if your baby is getting enough milk and tips for building up your milk supply.

Dealing with leaking breasts

Sometimes, breast milk may leak unexpectedly from your nipples.

Wearing breast pads will stop your clothes becoming wet with breast milk. Remember to change them frequently to prevent an infection.

Expressing some milk may also help. Only express enough to feel comfortable as you do not want to overstimulate your supply.

If your baby has not fed recently, you could offer them a feed as breastfeeding is also about you being comfortable.

Help and support for breastfeeding

Find out more about positioning and attachment, including how to get comfortable and make sure your baby is properly attached.

If you are having difficulties with breastfeeding, take a look at breastfeeding problems.

Ask a midwife or health visitor 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).

Got a breastfeeding question?

Use the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

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Sign up for Start4Life's weekly emails for expert advice, videos and tips on pregnancy, birth and beyond.

Community content from HealthUnlocked

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In the first few days, you and your baby will be getting to know each other. It may take time for both of you to get the hang of breastfeeding. This happens faster for some women than others. But nearly all women produce enough milk for their baby.

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Milk supply - increasing milk production.

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There may be times when breastfeeding is challenging. Never ignore any issues you may have - talk to your health visitor, midwife, GP or breastfeeding specialist as soon as possible, they will be able to help you sort it out quickly.

Here are some common breastfeeding issues, and tips on what to do.

Generally, the more your baby feeds, the more breast milk you'll produce. However, if you're worried that your baby isn't getting enough milk, talk to your midwife, health visitor or a breastfeeding specialist as soon as possible. With their help and advice, you'll be able to identify any issues and work out the best way to resolve it. Things that can affect your milk supply include:

Sore nipples

If breastfeeding hurts and you have sore nipples it's likely that your baby is not latching on well. When your baby latches, make sure they start with a wide mouth (like a yawn) to allow your breast to reach the back of the roof of the mouth. Have a look at our step-by-step guide to latching on.

Feeding by the clock

Let your baby guide you as to how often to feed, especially in the early days, rather than sticking to set times. This is known as 'feeding on demand' and will ensure you maintain a good milk supply.

Did you know?

Breast milk is produced on a supply and demand system, so if you're feeding hours apart, you may start producing less milk.

Topping up with first infant formula

Your baby will want to feed less if you are topping up with first infant formula milk (as their tummy is fuller for longer), the less often you feed, the less breast milk you produce. If you are planning on topping up with formula, it's best to wait until breastfeeding is well established.

Dummies

If possible, avoid using a dummy until you and your baby are happy with breastfeeding (usually after your baby is at least one month old). If your baby gets used to having a dummy before breastfeeding is well established, it may interfere with learning how to properly latch on. This is because babies suck dummies in a different way to how they breastfeed. Also, if your baby has a dummy in between feeds, this may reduce how frequently your baby wants to feed (if your baby is feeding less often, you'll produce less milk).

Being apart from your baby

If you have to spend time apart from your baby, and you're unable to breastfeed, this will impact the amount of breastmilk you produce. Regularly expressing your milk will help maintain your milk supply.

Medication

Most medicine, including medication for postnatal depression, common painkillers and most antibiotics, can be taken while breastfeeding without harming your baby. But if you need to take medication that is not advised during breastfeeding, talk to your midwife, health visitor, pharmacist or GP. They will be able to best advise you.

The Breastfeeding Friend from Start4Life, available 24 / 7, has lots of useful information and expert advice to share with you.

Is my baby getting enough milk?

This is a very common question, especially when you first start breastfeeding. While you can't always tell exactly how much your baby is drinking, there are positive signs that they're feeding well, including:

feeds begin with a few rapid sucks followed by long, rhythmic sucks and swallows with occasional pauses. Your baby's cheeks stay rounded, not hollow, during sucking and you can hear and see them swallowing

your baby seems calm and relaxed during feeds, and comes off the breast by themselves when they've had enough, and appears content and satisfied after most feeds

after feeds your breasts feel softer and your nipples should look the same (not flattened, pinched or white)

you may feel sleepy and relaxed after feeds

In the first 48 hours, your baby is likely to have only 2 or 3 wet nappies. Wet nappies should then become more frequent, with at least 6 every 24 hours from the fifth day onwards. If your baby is feeding well, they should start gaining weight steadily after the first 2 weeks (it's normal for babies to lose some of their birth weight in the first 2 weeks).

Here is a top tip...

It can be hard to tell if disposable nappies are wet. To get an idea, add 2 to 4 tablespoons of water to a nappy - this'll give you a better idea of what to look and feel for.

In the beginning, your baby will produce a black tar-like poo called meconium. After about 5 or 6 days, they should pass at least 2 soft yellow poos. Breastfed babies' poo is runny and doesn't smell.

Increasing your breast milk

If you feel you need to boost your milk supply, there are a few ways you can do this:

try not to give your baby anything other than breast milk. The more you breast feed your baby, the more you'll produce

if you want to give your baby a dummy, try to wait a few weeks - or until you are both comfortable and confident with breastfeeding

let your baby feed when they want to, for as long as they need to

when you're feeding, offer both breasts - remember to switch breasts each feed

holding your baby close, especially skin-to-skin, will help increase your milk supply

avoid weaning until your baby is ready - this is usually around six months

If you're doing all these things already but still concerned you have low milk supply, ask your midwife to refer you to a breastfeeding specialist. Feeding specialists are very understanding and can have a look at how your baby's feeding and offer practical advice, help and support.

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If you're breastfeeding and worried your baby isn't getting enough, have a look at these tips on how to increase your breast milk

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There may be times when breastfeeding is challenging. Never ignore any issues you may have - talk to your health visitor, midwife, GP or breastfeeding specialist as soon as possible, they will be able to help you sort it out quickly. Here are some common breastfeeding issues, and tips on what to do.

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Video showing effective feeding and attachment.

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

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

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

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Breastfeeding challenges with tips for self care.

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If you have any problems with breastfeeding, it's important to ask for help from your midwife, health visitor or a breastfeeding specialist as soon as possible.
That way issues like sore nipples or breast engorgement can be sorted out early.

Here are some of the problems breastfeeding mums sometimes have, plus tips on how to tackle them.

Sore or cracked nipples

Sore nipples usually happens because your baby is not well positioned and attached at the breast.

Putting up with it could make pain or discomfort worse, so it's important to get help from your midwife, health visitor or breastfeeding specialist as soon as you can.

See more advice on sore nipples.

Not enough breast milk

When you first start breastfeeding, you may worry that your baby is not getting enough milk. It can take a little while before you feel confident that your baby is getting what they need.

Learn the signs that your baby is getting enough milk.

Offering your baby both breasts at each feed and alternating which breast you start with will help to stimulate your milk supply. So will keeping your baby close and holding them skin to skin.

See more ways to boost your breast milk supply.

Breast engorgement

Breast engorgement is when your breasts get too full of milk. They may feel hard, tight and painful.

Engorgement can happen in the early days when you and your baby are still getting used to breastfeeding. It can take a few days for your milk supply to match your baby's needs.

Engorgement can also happen when your baby is older and not feeding so frequently, perhaps when they start having solid foods.

See how to manage breast engorgement.

Baby is not latching on properly

Breastfeeding is a skill that you and your baby need to learn together. It may take you both a while to get the hang of it.

If you are finding breastfeeding painful or your baby does not seem to be satisfied after feeds, they may not be latching onto the breast properly.

Find out how to latch your baby on.

Learn the signs that your baby is well attached.

Too much breast milk

Occasionally women make too much breast milk and their babies struggle to cope.

It's best to get your midwife, health visitor or breastfeeding specialist to watch a feed to see if they can spot why this is happening. They can also show you different positions to help your baby cope with large amounts of milk.

Read more on how to tackle too much breast milk.

Breastfeeding and thrush

Thrush infections can sometimes happen when your nipples become cracked or damaged. This means the candida fungus that causes thrush can get into your nipple or breast.

If you suspect you or your baby has a thrush infection, see your health visitor or GP.

See how to spot the signs of thrush while breastfeeding.

Blocked milk duct

If breast engorgement continues, it can lead to a blocked milk duct. You may feel a small, tender lump in your breast.

Frequent feeding from the affected breast may help. If possible, position your baby with their chin pointing towards the lump so they can feed from that part of the breast.

See more help for blocked milk ducts.

Mastitis

Mastitis (inflammation of the breast) happens when a blocked milk duct is not relieved. It makes the breast feel hot and painful, and can make you feel very unwell with flu-like symptoms.

It's important to carry on breastfeeding. Starting feeds with the tender breast may help.

See more self-help tips for mastitis.

If you are no better within 12-24 hours, or if you feel worse, contact your GP or out-of-hours service as you may need antibiotics.

Breast abscess

If mastitis is not treated, or if it does not respond to treatment, it can lead to a breast abscess, which may need an operation to drain it.

Read more about breast abscesses.

Breastfeeding and tongue tie

In about 1 in 10 of babies, the strip of skin that attaches the tongue to the floor of the mouth (frenulum) is shorter than usual. This is known as tongue tie.

Some babies who have a tongue tie do not seem to be bothered by it. In others, it can stop the tongue moving freely, which can make it harder for them to breastfeed.

The good news is that tongue tie easily treated.

See the signs of tongue tie in breastfed babies.

Got a breastfeeding question?

Sign up to Facebook and message the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

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If you have any problems with breastfeeding, it's important to ask for help from your midwife, health visitor or a breastfeeding specialist as soon as possible. That way issues like sore nipples or breast engorgement can be sorted out early. Here are some of the problems breastfeeding mums sometimes have, plus tips on how to tackle them.

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Fussy/colicky baby.
Self care is at the bottom of the page.

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My baby feeds all evening, and my breasts feel empty - have I run out of milk?

Every time I try to put my baby down to sleep, he cries! What am I doing wrong?

Why does my baby cry at the breast sometimes, even though he still seems hungry?

If you've ever asked questions like this during the rollercoaster weeks of new parenthood, you're in good company! Most new parents, unless they have been around newborn babies a lot before, are surprised and sometimes confused by how intensely their baby needs to be held and comforted. At times, it can feel like very hard work, or even as if, whatever you try, nothing quite works. Babies on the TV might sleep quietly in their beds between feeds, but real babies often don't!

Here is some information that may help you make sense of your baby's behaviour and work out whether there is a problem that needs fixing, or whether your baby is just doing what normal babies do. If you haven't had your baby yet, reading ahead can help prepare you for what to expect, so that you take this stage in your stride!
This article about normal newborn behaviour assumes that your baby is full-term, healthy, feeding well and growing normally. If your baby was born early, is unwell, or if you are not sure whether your baby is feeding or growing well, please check with your midwife, health visitor, doctor or breastfeeding supporter. Here is a (non-exhaustive) list of signs that more could be going on than just normal newborn behaviour:

your baby's poo output is less than expected (What's in a nappy);

your baby loses more than 7% of birthweight by day 5 or keeps losing weight after day 5;

your baby grows at an average of less than 20-30g per day after day 5;

your baby doesn't wake at least 8-12 times in 24 hours to feed;

your baby seems to be in pain;

your baby cries inconsolably for hours, even in your arms;

your baby develops patches of dry skin/eczema or a wheeze;

your baby has green/mucousy stools or blood in their stool;

breastfeeding is painful for you and not getting any better;

your baby is often unhappy or frustrated at the breast;

your baby often feeds for more than 40 minutes per breast or doesn't stop breastfeeding until you take him off the breast.

If any of these apply to you, please seek further help from your healthcare provider or a breastfeeding supporter.
"Fussy periods"

When they aren't feeding, many babies sleep most of the time during the first few days after birth. This may be nature's way of letting both mother and baby recover from their birth experience.

Around 10-14 days old, though, your baby may "wake up", sometimes quite suddenly, and you may be shocked by the change! From now on, your baby will spend increasing amounts of time awake. At times, it can feel like hard work to make sense of what he needs and to help him get back to sleep when he's had enough of being awake.

Many young babies have a "fussy period" of a few hours each day, when they especially need lots of calming and soothing. This is most commonly, though not always, in the evening and first part of the night, and tends to build in intensity over the next few weeks. The peak age for crying is around 6-8 weeks.

Why babies need so much help in the evening

Many pregnant women notice that their unborn baby seems most active when they lie down at bedtime. This could be because they have stopped walking around and lulling their baby back to sleep!

It is common for newborn babies to continue this pattern of evening wakefulness during the first few weeks after birth. By about 6 weeks, most babies are learning that the night is for sleeping, and (though they may still need to feed at night for many months) will begin to settle to sleep more quickly after a feed. You can gently help your baby learn the difference between night and day by taking him out in the daylight, especially in the morning, and keeping the lights low at night.

Another reason for babies to be unsettled by the end of the day is that their brains feel like they are on fire! Babies' brains are growing amazingly fast - they double in size in the first year. Every day, they take on lots of new information and experiences, and by the evening they are so excited by the day's learning that it takes them a long time to wind down towards sleep.

In busy households, with other adults and children coming back at the end of the day, some babies may find all the extra activity overwhelming, too. And if it's been just you and the baby all day, by the evening you may be feeling frazzled yourself, and in need of nurture and care, just like your baby! Unlike adults, babies can't just "switch off" and relax; they need lots of help from calm, loving adults.

Breastfeeding - more than just milk

Breastfeeding provides babies with much more than just milk. A frazzled baby seeks the breast because the rhythm of sucking, the closeness and security of being held, and the feel and smell of his mother's body help him to feel safe and calm.

Most babies like to feed more often in the evening. Milk flow might be a bit slower than it is first thing in the morning, but this isn't a problem; it means that babies can do lots of calming, soothing sucking at the breast without getting uncomfortably full. If your baby cries when you offer the breast yet again, it won't be because the breast suddenly doesn't work! It's much more likely that they've just had enough for the moment. The signals for "I'm hungry" are very similar to "I'm bored/tired/sad/uncomfortable/need a cuddle". Your baby still needs help, they just don't want the breast again right now.

You can find some ideas below of other ways to soothe a frazzled baby. If you're not sure what your baby wants, try offering the breast first, but if it seems to make things worse, try something else, and offer again when they are calmer.

The "fourth trimester"

Some experts talk about the "fourth trimester" of pregnancy; the first few months after birth, when babies' brains are still in an "unfinished" state. Human babies have to be born while their brains are still relatively immature, in order to fit through their mother's upright, restricted pelvis.

Your baby will learn to calm down and manage his own emotions when he is ready, but a young baby can't do this yet. You don't need to be worried that, by giving her the help she needs now, she will be "clingy", "spoiled" or more dependent later. In fact, the opposite is true. Psychologists know that babies whose needs are met promptly early on are more likely to develop into trusting, confident children, because they find the world to be a safe place and know that they can always find help if they need it.

In the early months, if you are managing to keep your baby safe, fed, comfortable and reasonably happy, you are doing a great job.

A typical evening with a newborn

You feed your baby until she looks fast asleep. You carefully put her down in her bed. Either immediately or soon afterwards she wakes up and cries. You think she must be hungry... maybe breastfeeding isn't working? You feed her again until you think she can't possibly fit in any more milk, and put her down.... and so on, until the early hours of the morning.

Although (especially if you haven't breastfed before) you may worry that your baby cries at the breast because there's a problem with feeding, as long as the signs of milk intake (weight, wet & dirty nappies) are OK ( What's in a nappy and My Baby needs more milk) , and your baby is happier the rest of the time, it's probably nothing to do with hunger, or a breastfeeding malfunction! Your baby is most likely to have woken up because they were put down.

The conditions that adults might prefer for sleep - quiet, dark, being left alone - are scary for babies, who fear being abandoned more than anything. For our ancestors, a baby who was left alone was a baby who probably wouldn't survive. Your baby has an "alarm", carefully developed over thousands of years of human evolution, that is programmed to go off if she senses that she has been left alone.

What can you do about it?

Here are some ideas you might like to try:

Babies, like other small primates, feel safest held closely against an adult body, especially an adult who is moving around. Try swaying or gently dancing with your baby.

If you want to put your baby down, try to help him feel he is still with you: warm his bed, put something in it that smells of you, rock the crib, leave your hand resting on him while he falls asleep, etc.

Wait about 20 minutes until he is in deep sleep before putting him down. If you put him down too soon, he is more likely to wake up, perhaps quite upset, because he wanted to be asleep.

Carrying your baby in your arms or a sling meets most of the same needs as breastfeeding, and can be done by another adult. Dads or other close care-taking adults are often brilliant at this. A baby who is not hungry will still head towards a milky breast if they smell it close by. If they really don't want to nurse again, they might protest when they get there, which can be confusing for everyone!

You don't need to put your baby down if you don't want to.

If you do want to, enlist the support of other people who can get to know and love your baby. If you don't have another adult living with you, could a family member or friend come and stay for a while? Do you have an older neighbour who misses their grandchildren? A teenager who is brilliant with babies? Even very young babies can have close relationships with several adults (and older children) at once, and another pair of arms can be helpful to both you and your baby at the end of a long day.

Try going outside - babies are often happier outdoors.

Babies often seem more relaxed when you are surrounded by other adults; they know the sabre-toothed tiger can't get them! Visiting a pub garden can work really well on summer evenings. If you are at home and don't have company, try the radio or TV on a channel with people talking.

Experiment with singing, dancing, music, massage, bathing, rocking, walking.

Try turning the lights and the noise down. Some babies are more sensitive to lights and noise than others.

If you can do so safely, (Safe sleep and the breastfed baby) you might want to experiment with sharing a bed with your baby. Learning to feed lying down in a safely prepared bed means that you won't have to move your baby once he's asleep, and you can get some rest while you feed. If you are worried about whether your baby will be safe in bed with you, you might want to try it in the daytime first, with another adult keeping an eye on both of you.

Make sure you get something to eat (prepare a meal/snack in advance) and get a nap or at least a rest earlier in the day if you can, to prepare for the time of day when your baby needs you the most.

Sometimes nothing works; you can still let your baby know you are there with him in his distress.

If your baby is crying as if they are in pain, check with your doctor. There is more information here about possible reasons for crying. (Unhappy baby)

If you feel overwhelmed by your baby's needs, get help & support. Looking after a crying baby is really hard, but much harder if you feel unsupported. Your midwife, health visitor, GP or a parent support group can all help.

Although attending a La Leche League meeting will not guarantee you more sleep, knowing that this phase is normal and will pass can really help. Other mothers who have experienced the intensity of the early weeks with a baby will welcome and encourage you. Many LLL groups offer support on Facebook too. (Find a group)

You are working enormously hard to understand and meet your baby's needs. Every baby is different, and you are becoming an expert on your baby. There is no "right" or "wrong" way to be with your baby (any more than there is a right or wrong way to be with a partner or friend); there is only what works for you both, today.

This can feel scary at first (if only babies came with an instruction manual!), but as time goes on, you will feel able to try different ideas for calming your baby, and come up with some new ones. As the weeks go by, you will learn more about what helps your baby (and what doesn't!) and become more confident about knowing when they are OK, and when to get help. As your baby gets older and more experienced, he will find the world, and his own bodily sensations, less alarming.

These early weeks, which can feel like "forever", will pass. Before you know it, you will be able to support a newer parent who is wondering how on earth they will get through it, because you did!

Written by Jayne Joyce, on behalf of LLLGB, January 2019

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"Fussy evenings" with a newborn - La Leche League GB

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My baby feeds all evening, and my breasts feel empty - have I run out of milk? Every time I try to put my baby down to sleep, he cries! What am I doing wrong? Why does my baby cry at the breast sometimes, even though he still seems hungry?

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Breastfeeding Network information on alcohol and medication.

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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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Weight gain - guidance

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Sleep - co- sleeping and information on how to cope with sleep deprivation.

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To reduce the risk of sudden infant death syndrome (SIDS) the safest place for a baby to sleep is in their own clear, flat, separate sleep space, such as a cot or Moses basket. However, we know that many parents find themselves co-sleeping whether they mean to or not. Wherever you're planning for your baby to sleep we recommend making your bed a safer place for baby. Our advice on co-sleeping with your baby will tell you how.

When not to co-sleep

Whether you choose to co-sleep or it is unplanned, there are some key risks you should avoid.
Co-sleeping with your baby is very dangerous if:
In these scenarios, it is always best to put baby in their own safe sleep space, such as a cot or Moses basket. Keeping the cot or Moses basket next to your bed might make this easier.
Never fall asleep on a sofa or armchair with your baby. The risk of SIDS is 50 times higher for babies when they sleep on a sofa or armchair with an adult. They are also at risk of accidental death as they can easily slip into a position where they are trapped and can't breathe.
Co-sleeping more safely

Keep pillows and adult bedding away from your baby or any other items that could cover their head or cause them to overheat. A high proportion of babies who die as a result of SIDS are found with their head covered by loose bedding.

Follow all The Lullaby Trust's other safer sleep advice to reduce the risk of SIDS such as sleeping baby on their back

To reduce the risk of accidents, do not bring other children or pets into bed with you.

Try to make sure or check that baby cannot be trapped, wedged or fall out of bed or get trapped between the mattress and the wall

Never leave your baby unattended in an adult bed

For more info on co-sleeping and safer sleep read our guide for parents
If you are bedsharing with your baby you should consider any risks before every sleep. It is easy for your situation to change if you are unwell or have drunk any alcohol, which means your baby will be safest in a separate sleep space such as a cot or Moses basket on that occasion.

Co-sleeping with your baby: FAQs

I am worried I might fall asleep while I breastfeed my baby at night, is this ok?

Click here to open this question

Breastfeeding reduces the chance of SIDS. If you feel you might fall asleep we would recommend you prepare the bed as described above so it is safer for baby if this happens.

Make sure you know the advice on when never to co-sleep so you know when to take particular care. It is really important that you do not accidentally fall asleep with your baby on a sofa or armchair. If you think you might fall asleep on a sofa or armchair, put the baby down in a safe place to sleep.

Should I co-sleep with my baby?

Click here to open this question

The safest place for a baby is their own separate sleep space, such as a cot or Moses basket. We would just advise you to read all the information on co-sleeping and how to reduce the risks, so you can make an informed decision for you and your baby.

However, there are some circumstances where we would strongly recommend against co-sleeping such as on a sofa or armchair, if anyone in the bed smokes or has drunk alcohol or your baby was premature or a low birth weight.

Can I co-sleep with twins or multiples?

Click here to open this question

If you choose to bedshare with twins or multiples we would advise not to bedshare with more than one baby at a time due to risk of accidents associated with bedsharing with more than one baby or child.

Is it safer to co-sleep using a nest or pod than with a baby just lying on the adult bed?

Click here to open this question

No. We do not recommend that babies sleep on soft surfaces such as pods or nests. If you choose to co-sleep with your baby the safest place is a clear space on a firm flat mattress the same as we would advise with a cot.

Why do you advise against co-sleeping in certain scenarios?

Click here to open this question

It is estimated that around half of SIDS deaths occur whilst co-sleeping, and that most of these are in high risk situations. We do not know the cause of SIDS and why these deaths happen but we do know what some of the risk factors are and that removing those risks greatly lowers the chance of SIDS occurring.

For that reason we strongly advise against co-sleeping when there are risk factors such as a baby being premature or a parent having drunk alcohol.

What bedding should I use for my baby when we co-sleep?
The Lullaby Trust has worked with Public Heath England, Unicef UK Baby Friendly and Basis on two publications to support families with safer sleep advice and advice on co-sleeping more safely. We have also collaborated on a guide for health professionals to have more open and productive discussions with families about safer sleep and co-sleeping. These can be downloaded below.

Click here to open this question

Adult bedding should be kept well away from your baby along with any belts or cords from clothing. Keep adult bedding at your waist height and add an extra layer of clothing if you are cold

A baby sleeping bag is a good way of giving your baby their own bedding when bedsharing.

Baby sleeping bags should be well fitted, so the baby can't wriggle down inside. Most sleeping bags are fitted according to a baby's weight, rather than age.

You might also be interested in reading the two Unicef Baby Friendly publications, which are both endorsed by The Lullaby Trust:

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Some parents choose to share a bed (known as co-sleeping) with their babies. Read our advice on how to co-sleep more safely.

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Donor breast milk.

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Receiving Donor Human Milk

As an NHS service, most babies receive human donor milk whilst receiving care in a neonatal unit. The team looking after your baby should discuss the risks and benefits of donor milk.

We have a Q & A sheet which you can read and you will have an opportunity to ask any questions.

If you agree to your baby receiving donor milk, you will be asked to complete a consent form.

This also helps us to track which milk your baby receives for future reference.

Research

Here are some links to guidelines and research which you may find helpful when making your decision.

National Institute of Clinical Excellence - Donor milk banks service operation - please click.
"... research has consistently shown that breast milk is the best nourishment for babies and that it is highly beneficial to their health in the short, medium and long term. Women are recommended to breastfeed their baby exclusively for 6 months and continue to breastfeed after 6 months as part of a balanced diet... if after discussion with experienced staff, mother is unable to express sufficient milk or does not wish to express for a baby unable to feed at the breast, donor milk can be used. Donor breast milk banks provide donor milk for babies, including preterm babies and babies with growth restriction."

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As an NHS service, most babies receive human donor milk whilst receiving care in a neonatal unit. The team looking after your baby should discuss the risks and benefits of donor milk. We have a Q & A sheet which you can read and you will have an opportunity to ask any questions.

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A video showing a natural Caesarean birth. It’s quite informative and may be a good tool to approach your health care providers if its something you would like to consider.

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The natural caesarean - a woman centred technique

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Information on newborn sleep.

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Information to support parents with sleep in the first few months.

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Use of dummies.

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Can dummies affect breastfeeding?

Sucking is a powerful reflex that babies have in the weeks after they're born. Babies don't just get nutrition from their mother's milk when they breastfeed - breastfeeding also satisfies their sucking instinct.

Babies who are not able to breastfeed for whatever reason, might satisfy their sucking instincts by using dummies (Cinar, 2003). Yet any substitute for sucking the breast can put the relationship between the breast and the baby at risk. That's especially true for a baby who has not yet mastered breastfeeding (La Leche League GB, 2019).

When can dummies be used for babies?

Research suggests that it's best to avoid dummies in the first weeks after birth. That's because they're associated with shorter duration of exclusive breastfeeding (Adair, 2003; Kronborg and Vaeth, 2009). Some studies say this is caused by sucking confusion but other studies disagree with this idea (Newman, 1990; Howard et al, 1999).

After breastfeeding is established, dummies can be used. Evidence shows dummies used for healthy babies who are breastfed don't significantly affect the proportion of babies who exclusively breastfeed at three months (Jaafar et al, 2011). So the use of dummies should be limited to soothing babies after breastfeeding is well established (Adair, 2003; Horne et al, 2014).

Does a dummy reduce the risk of SIDS?

Many studies have suggested dummy use and breastfeeding are important factors for preventing cot death (also known as SIDS [sudden infant death syndrome]) (Hauck et al, 2005; Alm et al, 2016).

It's unclear how dummies might protect against SIDS or even if they do actually reduce the risk of SIDS at all (Horne et al, 2014; Blair et al, 2019).

Experts do not specifically recommend using dummies to protect babies from SIDS (Fleming et al, 1999). That's because even studies that reported a remarkable reduction of SIDS with dummy use still say that actually recommending dummies is open to debate (Mitchell et al, 2006). Any association between using dummies and reduced risk of SIDS could be down to lots of other factors, for example:

Dummies might prevent babies from rolling onto their front.

Sucking on a dummy may keep babies' tongues forward.

A baby that sucks on a dummy might be more still at night, so less likely to become covered by blankets.

Parents may check on their baby more frequently if their baby has a dummy (Grocock, 2018; Ball, 2019).

What are the advantages of a dummy?

The main advantage of babies having dummies is that they can satisfy their sucking instincts if they're not breastfed. Using dummies can calm babies and help them to fall asleep (Cinar, 2004). Dummies can also be used to sooth babies at other times, for example to help reduce pain during hospital procedures (Adair, 2003; Horne et al, 2014).

As discussed above, another advantage could be that dummies might protect against SIDS although more evidence is needed (Horne et al, 2014).

What are the disadvantages of using a dummy?

Using dummies can be helpful and convenient but there are some disadvantages. The most important concern is that use of dummies can decrease how often as well as how long babies are breastfed for (Adair 2003; Kronborg and Vaeth 2009; Horne et al 2014).

Another disadvantage of using dummies is that they might also transport bacteria and fungus, which can increase the rate of infections, particularly otitis media - middle ear infection (Uhari et al, 1996; Adair, 2003; Rovers et al, 2008). Mums whose babies used dummies reported more episodes of coughs, wheezing, earache, diarrhoea and gastroenteritis among babies up to six months old (North et al, 1999).

Dummies might also affect how baby teeth grow (Larsson, 1994).

Are dummies bad for baby teeth?

Some studies have found harmful effects on the way teeth grow if dummies are used for a long time (Larsson, 1994). Effects of dummies on baby teeth include overbite, malocclusion, cross bite and open bite (Poyak, 2006).

Using an orthodontic or flat dummy is much better for your baby's teeth, so that can help. These dummies are much better designed than dummies were in the past (Levrini et al, 2007).

It's also suggested that parents wean their children off dummies by two years old and discontinue using them before they turn three (Poyak, 2006).

One mum, Helen, says: "My little boy had started sucking his thumb and I thought an orthodontic dummy has got to be better than that because at least one day I can take it away."

Tips on how and when to stop your baby from using a dummy

If you think using a dummy is affecting breastfeeding (fewer daily feeds, weight gain affected, or difficulties in attaching to the breast) or if you want to wean a younger baby from a dummy, you could try the following:

1. If the dummy is being used as a sleep cue, then introducing a different sleep cue can help.

2. Give extra attention to your baby by cuddling or nursing instead.

3. Try different ways to soothe your baby, such as carrying them in your arms or a sling, or increasing skin-to-skin contact with them. This helps them to feel better.

4. You could restrict your baby's dummy use to certain times only, such as in the car.

5. Rewards might work better for an older child - your local children's centre or health visitor can offer support with this. Some areas even have 'dummy fairies' at Christmas.

6. Try picking a good time to stop using a dummy - when your child is feeling well, things are stable and they're happy.

7. Have a go at hiding the dummy away so your child doesn't see it.

(Cinhar, 2004; Huffington Post, 2015)
This page was last reviewed in July 2018.
Further information

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

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

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

Adair SM. (2003) Pacifier use in children: a review of recent literature. Pediatric Dentistry. 25(5):449-458.

Alm B, Wennergren G, Molborg P, Lagercrantz H. (2016) Breastfeeding and dummy use have a protective effect on sudden infant death syndrome. Acta Pardiatrica. 105: 31-38. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049485/ [Accessed 19th September 2019]

Ball, H. (2019) Dummies, baby sleep info source. University of Durham. Available at: https://www.basisonline.org.uk/hcp-dummies/[Accessed 19 September 2019]

Cinar ND. (2004) The advantages and disadvantages of pacifier use. Contemporary Nurse. 17:1-2, 109-112. https://www.tandfonline.com/doi/abs/10.5172/conu.17.1-2.109 [Accessed 19th September 2019]

La Leche League GB. (2019) Dummies and breastfeeding. Available at: https://www.laleche.org.uk/dummies-and-breastfeeding/ [Accessed 19th September 2019]

Fleming PJ, Blair PS, Pollard K, Platt W, Leach C, Smith I, et al. (1999) Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study. Arch Dis Child. 81(2):112-116. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1718026/ [Accessed 19th September 2019]

Grocock R, Robertson C, Brown N. (2018) Dummies: a review of the evidence; Journal of Health Visiting. 6(4). Available at: https://www.magonlinelibrary.com/doi/full/10.12968/johv.2018.6.4.182 [Accessed 19th September 2019]

Hauck FR, Omojokun OO, Siadaty Ms. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Paediatrics. 116(5):e716-e723. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16216900 [Accessed 19th September 2019]

Howard CR, Howard FM, Lanphear B, deBlieck EA, Eberly S, Lawrence RA. (1999) The effects of early pacifier use on breastfeeding duration. Pediatrics. 103(3):e33. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10049989 [Accessed 19th September 2019]

Horne RSC, Hauck FR, Moon RY, L'Hoir MP, blair PS. (2014) Dummy (pacifier) use and sudden infant death syndrome: Potential advantages and disadvantages. J Paediatrics Child Health. 50:170-174.

Huffington Post. (2015) 9 Ways to wean your baby off the dummy. Available at: https://www.huffingtonpost.co.uk/2014/08/14/9-ways-to-wean-your-baby-off-the-dummy_n_7336610.html [Accessed 19th September 2019]

Jaafar SH, Jahanfar S, Angolkar M, Ho JJ. (2011) Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database Syst Rev. (3):CD007202. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007202.pub2/full [Accessed 19th September 2019]

Kronborg H, Vaeth M. (2009) How are effective breastfeeding technique and pacifier use related to breastfeeding problems and breastfeeding duration. BIRTH. 36:1. Available at: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1523-536X.2008.00293.x [Accessed 19th September 2019]

Larsson E. (1994) Artificial sucking habits: etiology, prevalence and effect on occlusion. Int J Orofacial Myology. 20:10-21. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9055659 [Accessed 19th September 2019]

Levrini L, Merlo P, Paracchini L. (2007) Different geometric patterns of pacifiers compared on the basis of finite element analysis. European J Paediatric Dentistry. 8(4):173-178. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18163851 [Accessed 19th September 2019]

Mitchell EA, Blair PS, L'Hoir MP. (2006) Should pacifiers be recommended to prevent sudden infant death syndrome? Pediatrics. 117(5):1755-1758 Available at: https://www.ncbi.nlm.nih.gov/pubmed/16651334 [Accessed 19th September 2019]

Newman J. (1990) Breastfeeding problems associated with the early introduction of bottles and pacifiers. J Hum Lact. 6(2):59-63. Available at: https://www.ncbi.nlm.nih.gov/pubmed/2346601 [Accessed 19th September 2019]

North K, Fleming P, Golding J. (1999) Pacifier use and morbidity in the first six months of life. Pediatrics. 103: E34. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10049990 [Accessed 19th September 2019]

Poyak J. (2006) Effects of pacifiers on early oral development. Int J Orthod Milwaukee. 17(4):13-6. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17256438 [Accessed 19th September 2019]

Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG. (1999) Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Fam Pract. 2008 Aug;25(4):233-6. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18562333 [Accessed 19th September 2019]

Uhari M, Mantysaari K, Niemela. (1996) A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis. 22(6): 1079-83. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8783714 [Accessed 19th September 2019]

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Dummies, pros and cons: your dummy questions answered | Baby & toddler, Your baby's health articles & support | NCT

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Whether it's to do with breastfeeding, teeth or SIDS, here are some things to consider when deciding whether to give your child a dummy.

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Video showing hand expressing.

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Unicef UK Baby Friendly Initiative | Hand expression

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Information leaflet on harvesting colostrum before birth, including storing and transporting t the hospital.

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COVID Vaccine & Breastfeeding

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On 30th December, a month after licensing the Pfizer/BioNTech vaccine, the UK's Medicines and Healthcare products Regulatory Agency (MHRA) revised its guidance so that pregnant and breastfeeding women can now receive the covid-19 vaccine. The change came after strong pressure from campaigners, clinicians, and affected women, including a piece we wrote for BMJ Opinion . The MHRA previously recommended that breastfeeding women should be denied the vaccine, which was interpreted by NHS trusts as a blanket ban. This was at odds with the EU, USA, and Canada, where women have been encouraged to make risk-benefit decisions based on their own specific circumstances. The MHRA's volte-face is welcome news, but why were breastfeeding women initially excluded?

If the MHRA held public advisory committee meetings like the US when assessing vaccines for emergency use applications, the rationale for their original and revised recommendations could be openly scrutinised. [1] The MHRA's initial position, which disregarded a breastfeeding individual's particular level of exposure to the virus or her likelihood of developing a severe form of the disease, seemed due to a lack of evidence. Pfizer, AstraZeneca, and Moderna vaccine trials did not enroll breastfeeding women, and so no specific safety data are currently available. But absent data are rarely a valid justification for broad exclusions. Men who are trying to conceive have not been cautioned about the vaccine, even though no data exist about possible effects on spermatogenesis. Any data gap leaves open a possibility of risk. No plausible biological mechanism for how an inactivated, recombinant vaccine would cause harm to a breastfed baby has yet been proposed. [2] Theoretical risk must be weighed against the established benefits of acquiring immunity to covid-19 and of continued breastfeeding.

The Green Book, which provides information on vaccines in the UK, did not offer further explanation for the MHRA's stance, merely stating that the licensor "advised vaccination should not be given whilst breastfeeding." [3] The Green Book saw this as a "very precautionary approach" which protected women and infants. But in our view, the MHRA's approach was not cautious; it was reckless to insist on exposing these women, their families and-in the case of healthcare workers-their patients, to a potentially lethal virus. It also threatened the UK's already low breastfeeding rates.

The US approach has been quite different. Recommendations from The Advisory Committee on Immunization Practices (ACIP), approved by the Centers for Disease Control (CDC), agreed from the outset that breastfeeding women could choose to receive or refuse the Pfizer/BioNTech vaccine. The American College of Obstetricians and Gynecologists (ACOG) released a Practice Advisory and its message was clear: "vaccines should not be withheld from lactating individuals who otherwise meet criteria for vaccination." The Royal College of Obstetricians and Gynaecologists in the UK made no such statement supporting a woman's right to choose, tweeting that "there isn't sufficient evidence to recommend the routine use of #COVID19 vaccines to pregnant or breastfeeding women." [4]

Surely the number of doctors, nurses, and carers at work who are breastfeeding is vanishingly small? This seemed to be the assumption made by the MHRA. That several thousand doctors and healthcare workers are breastfeeding while caring for patients may come as a surprise to many. But it shouldn't. Guidelines from the NHS and WHO strongly support breastfeeding until an infant is two years of age and beyond. These targets are often thought relevant only to women in developing countries, and it's wrongly presumed that for mothers in the West, breastfeeding ceases to be of benefit after six months. No wonder breastfeeding rates in the UK are some of the lowest in the world, with 8 out of 10 women stopping before they want to. [5]

Any woman should be enabled to continue breastfeeding for valid reasons of maternal and infant comfort, health promotion, or medical necessity. To support breastfeeding beyond the first few months is a public health priority which policy makers cannot afford to ignore. The MHRA's previous guidance reinforced society's perception of breastfeeding as a lifestyle choice. This belied the effort and expense incurred by those who breastfeed, a physically and emotionally demanding commitment which does not come naturally to many infants or their mothers. Many women cite the importance of breastfeeding for their mental health, and as a powerful way to reconnect with their baby after a day's separation. When women faced a decision to either stop breastfeeding or not be vaccinated, many felt personally and professionally conflicted. Stopping feeding abruptly is not like cancelling a subscription: it is associated with negative emotions-known as breastfeeding grief-risk of engorgement and mastitis, as well as being a sudden physical and emotional transition for a child. [7] Doctors told us they were prepared to lie in order to receive the vaccine, even though this was in breach of their duty to act with honesty and integrity. [8]

The MHRA now recommends breastfeeding women should have a "risk/benefit discussion with a healthcare provider" before receiving a covid-19 vaccine. While a step in the right direction, this is not a solution. There is currently minimal capacity in an overwhelmed NHS for appointments to discuss a decision for which there are no data. When consenting at the point of being vaccinated, the Joint Committee on Vaccination and Immunisations (JCVI) states that a breastfeeding patient "should be informed about the absence of safety data for the vaccine in breastfeeding women." [9] This is not a discussion; it is a washing of hands. We have also heard from breastfeeding doctors who are still being denied the vaccine, despite the new regulations. Even when the patient group direction (PGD) and trust-specific paperwork is updated, lasting damage has been done to the confidence of breastfeeding women and those administering the vaccines.

Allowing those who breastfeed to receive a covid-19 vaccine should not set a precedent for condoning gaps in evidence. Women must be allowed to make choices about their bodies, but this is a travesty of empowerment if female populations are not also studied. There are understandable ethical difficulties in trialling novel therapies in lactating women, but robust research on the vaccines' safety in breastfeeding must nevertheless be an urgent priority. Currently no European trials are underway in humans to collect such data, even though many breastfeeding healthcare workers are willing to contribute. On one UK-based Facebook group alone, over 400 breastfeeding doctors stated their enthusiasm to get vaccinated, be followed-up and then donate milk samples for analysis.

This data gap is not an anomaly. It is the result of a system of researching and licensing drugs that routinely discriminates against women, excludes them from the evidence base, and denies them the right to make informed choices about their own health. We implore researchers, industry leaders and the MHRA to remember that pregnant and breastfeeding individuals are essential patient populations, not merely women who can wait.
Helen Hare is an Acute Medicine CT2 working in Emergency Medicine and is breastfeeding an 18-month-old. Kate Womersley is an Academic FY2 and is breastfeeding a 9-month-old. Competing interests: None declared We have referred to 'women', 'mothers', and 'breastfeeding'. Other parents and families use different words, and we respect their chosen terminology.
Editor's note: An earlier version of this piece was published on 21 December 2020.
References:

1. https://www.fda.gov/advisory-committees/about-advisory-committees/common-questions-and-answers-about-fda-advisory-committee-meetings

2. Unlike the Pfizer vaccine, the AstraZeneca Covid-19 vaccine contains a live adenovirus vector, but this virus is not replicating and does not cause infection in the recipient.

3. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/943663/Greenbook_chapter_14a_v3.pdf

4. https://twitter.com/RCObsGyn/status/1334849583877386240

5. https://www.unicef.org.uk/babyfriendly/about/breastfeeding-in-the-uk/

6. https://abm.me.uk/wp-content/uploads/GP-Guide-Breastfeeding-beyond-infancy.pdf

7. https://www.pinterandmartin.com/why-breastfeeding-grief-and-trauma-matter

8. https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/domain-4-maintaining-trust

9. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948338/jcvi-advice-on-priority-groups-for-covid-19-vaccination-30-dec-2020.pdf

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Why were breastfeeding women denied the covid-19 vaccine? - The BMJ

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On 30th December, a month after licensing the Pfizer/BioNTech vaccine, the UK's Medicines and Healthcare products Regulatory Agency (MHRA) revised its guidance so that pregnant and breastfeeding women can now receive the covid-19 vaccine. The change came after strong pressure from campaigners, clinicians, and affected women, including a piece we wrote for BMJ Opinion .