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Unicef UK Baby Friendly Initiative | Positioning and attachment

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0300 330 0700
8am - Midnight

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Salisbury & surrounding areas BF Facebook support 

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Salisbury & surrounding areas BF Facebook support 

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Salisbury Breastfeeding Support Group (UK)

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A support group for Mummies in the Salisbury, Wiltshire area - come and find advice, support, ask questions, help others and 'keep calm, carry on breastfeeding!' **please note - spamming is not...

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NHS VIDEOS | How do I express my milk? - NHS

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Watch this video on how to express your milk

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

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Answering your top five feeding questions

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How to sterilise your baby’s bottles and other feeding equipment safely and effectively, whether you’re using boiling, steam or cold water sterilising equipment.

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Reprinted from Mother-2-Mother.com (2000-2006), with permission from the author, Paula Y.

A note about exclusive pumping:

There are occasions that arise which may prevent a mom from being able to nurse her baby. A mother who has a baby who cannot or will not latch, for whatever reason, may assume there is no choice but for her to use infant formula. There is another option however, and one that doesn't seem to get the support or acknowledgment it deserves - exclusively pumping, also known as " EPing ".

In most cases, a mother who has made the decision to exclusively pump has not done so "lightly". She is aware of the irreplaceable benefits of her milk, and she wants her baby to have the best, so the most logical conclusion for her is to pump and provide her milk to baby by bottle.

Sadly, many (including health care providers) will tell mom that this is crazy idea, and "it'll never work"; "you'll run out of milk"; or will say "you simply will not be able to keep up". Without the support and information she needs, a mom may simply give up.

Those who don't give up often are faced with other issues to overcome. They often feel like they are in a class by themselves, excluded from the usual groups of moms who typically form into "support groups" either for breastfeeding mothers, or for formula feeding mothers.

They may feel they must explain "why" they are "bottle feeding" breastmilk - even to their health care providers who often ask.. "breast or bottle" assuming "bottle" is formula.

While everyone does agree that there are irreplaceable benefits to nursing baby directly from breast, everyone also must agree that breastmilk itself is irreplaceable. When faced with providing breastmilk, or not, then whenever possible it should be breastmilk regardless of the method of delivery.

There is no room or need for guilt here - the mother who has done all she can to bf "normally" isn't a failure - she is just doing the best she can in the situation she is in. Mothers who choose to exclusively pump are very dedicated mothers - determined to do the best they can for their precious babies, and they deserve respect and support.

Here are some tips and information regarding exclusive pumping:

All About Exclusive Pumping and Tips for EPing Moms by EPing Moms:
The Best... Expressed!
(italicized info shared by Shanna)
HOW OFTEN TO PUMP & WHEN?:

First and foremost - one should have a good quality, double electric pump. Some mothers rent them, others buy pumps such as the Hygeia EnJoye. The quality of the pump can make all the difference in the world!

A normal newborn baby nurses on average 8 to 12 times in a 24 hour period. Most experts suggest it is best if mom can come close to matching what the normal nursing baby would do at the breast, and recommend she pump about every two hours, not going longer than three hours between sessions. Understanding how milk production works can help moms in their efforts to establish good milk supply. The more frequently the breasts are emptied, the more milk mother should have. Therefore, if she were to pump at least every 3 hours, for about 20 minutes, she should establish and maintain a good milk supply. In the first couple of weeks, she may also want to pump at least twice at night, but not all mothers do this.

"It's insanely hard in the beginning but you need to pump every 2 to 3 hours around the clock. Prolactin levels (the hormone that tells your body to make milk) are highest in the early morning hours so mom would want to make sure she is pumping then as well. This is like the 1am to 5am stretch of time. If mom can at least get one pump in during this time, it will really help. The main concern is to get enough pumps in per day - a minimum of 7 pumps per day. I will say from experience that when I pushed myself to get in 8 pumps per day, my supply REALLY increased. Most of the time, I just couldn't push myself and ended up with 7 times. And to create a little bit of sanity, it is the number of pumps per day that you get in and not necessarily the amount of time you wait in between pumps that counts. So, if I needed to run an errand or just wanted to get out of the house without dragging my pump along, I would pump every 2 hours in the morning and then have a window of about 4 or 5 hours in the afternoon to do everything and would then pump again every 2 hours in the evening to get my total of 7 pumps in for the day. That being said, I did NOT get up to pump in the middle of the night if my baby wasn't awake. I thought that was cruel and couldn't do it! Ha! The sleep was more important to me (especially after the c-section). A lot of pumping is trial and error and this is why keeping info in a spreadsheet (or journal) is helpful. If you start sleeping through the night or going longer stretches and see a huge decline in your volume, you can always set you alarm to add another pump back in. I never had to but this can vary from mom to mom. I did the early morning pump as long as I was up feeding the baby, but if she slept 5 hours through the night, so did I! "

PUMPING - HOW LONG?

Most experts agree that whatever the reason for pumping, moms should pump for about 20 minutes. Most agree its best to pump at least 15 minutes, and to avoid going much longer than 20 minutes. Experts also encourage pumping about five minutes past when the milk stops flowing, often by doing so mom will elicit another letdown, and at the very least will maintain production as well as encouraging increase in supply if needed.

"The standard advice is to pump for 15-20 minutes. Even if you don't have milk flowing that entire time, you need to pump that long to get enough nipple stimulation. Also pumping at least 5 minutes after your milk stops flowing will tell your body that you need more milk; thus increasing your supply. 15 minutes should absolutely be the minimum pumping time. I've talked to women who only pumped for 10 minutes and eventually started losing their supply. They had to work really hard to rebuild it."

Pump Settings

"More is not better" when it comes to the suction settings on the breast pump. Most experienced moms do not set the pump speed on high, but rather keep it on lower setting for comfort.
"This one was a BIGGIE for me and I want to definitely pass this one on! There should be a suction setting on your pump and a speed dial. This is very important, the higher the suction does NOT mean the more milk you make. Your pump will probably have a suction setting of minimum, medium, and maximum. I had mine set on medium when I developed a blister. Once it healed, I turned it down to minimum and have never had another blister or pain again. I keep the speed at 3 but if you feel like too much areola is being sucked into the horn, then turning down the speed will remedy that. If you are in a lot of pain and turn down the settings, you might actually get more milk because you are more relaxed!"

HOW MUCH MILK PER BOTTLE?

Moms may find it surprising that the breastfed baby often takes less milk in the bottle than formula babies take in. This is because breastmilk is so well utilized by the baby's body that less is needed. Since breastmilk is so easily and completely digested, the breastfed baby needs to eat more often, but they don't need as much per bottle.

When a baby is nursed from the breast, research shows us that baby will vary their intake of milk from feeding to feeding, and the length of time at the breast doesn't always correlate with the amount of milk taken from the breast. Overall, the average bf baby takes in between 19 and 30 oz (or 570 - 900 mL) per day (24 hrs), but the amount taken per bottle may vary somewhat from feeding to feeding, just as it does at the breast, depending on baby's need at the time.

" According to the most current breastfeeding research, exclusively breastfed babies take in an average of 25 oz (750 mL) per day between the ages of 1 month and 6 months. This may vary a little from baby to baby, but the average range of milk intake is 19-30 oz per day (570-900 mL per day).
To estimate the average amount of milk baby will need at a feeding:

Estimate the number of times that baby nurses per day (24 hours).

Then divide 25 oz by the number of nursings.

This gives you a "ballpark" figure for the amount of expressed milk your exclusively breastfed baby will need at one feeding.

Example: If baby usually nurses around 8 times per day, you can guess that baby might need around 3 ounces per feeding every 3 hours when mom is away. (25/8=3.1).

NOTE: Current breastfeeding research does not indicate that breastmilk intake changes with baby's age or weight between one and six months."

You can find a quick and easy expressed breastmilk calculator here.

HOW TO BOTTLEFEED

It is important to remember that it is very easy to overfeed a baby using bottles. This is because the way a baby drinks from a bottle is very different than how a baby would nurse from the breast. A baby cannot control the flow of milk from a bottle thus experts recommend using slow flow or "newborn" type nipples, to reduce the risk of overfeeding.

The breastmilk should never be warmed in the microwave, since doing so not only creates hot spots that cannot fully be distributed evenly even when the milk is mixed (the heat adheres to the fats which "glob" together, and can result in scalding of a baby's mouth and throat), but it actually alters the composition of the breastmilk, damaging some of the nutrients. Shaking breastmilk is also not recommended (gently swirl to mix, instead).

Ideally bottlefeeding the baby should mimic how a mother breastfeeds her baby. The baby should be fed on cue, or demand, and not according to a rigid schedule. Breastmilk digests in about 90 minutes, so one would expect the feedings to be anywhere from 1.5 hrs to 3 hours apart. (younger babies often need to eat more frequently than older babies).

The bottle should be offered gently, in a non-stressful manner, with the baby drawing the nipple into the mouth. The type of bottle or nipple is not as important as the manner in which the bottle is offered. A typical nursing session lasts about 15 to 20 min, and care should be taken to allow baby to take his/her time to drink the bottle, not "rushing" through a feeding as quickly as possible. Changing position mid-way through a feeding is often recommended, as is holding baby is a more upright position. Propping a bottle is also not recommended.

INCREASING YOUR SUPPLY

There are wonderful tips on increasing milk supply below - those that work for nursing mothers also work for mothers who exclusively pump, the biggest "difference" is that nursing mothers are encouraged to put baby to breast often, and pumping mothers are encouraged to pump often. Probably THE most important thing to remember is to pump often and pump long enough to soften (or "empty") the breast.
"Some little tips to help increase your supply if you really need it. It's nice to have these on hand just in case:
First drink plenty of water. I don't drink a ton but I make sure to stay hydrated. Check your pee when you go (I know, sounds funny!). If it is light yellow to clear, you are plenty hydrated.
Make sure you eat! While you are pumping, you will keep the weight off, I promise! It can make you hungry as a horse and it does that for a reason. You need the extra calories because you are burning so much off! When I didn't eat enough, I would get really light headed and feel like I was going to drop my baby...not good! Eventually, your hunger should taper off (mine has).

Eat REAL oatmeal, not the instant. You can eat the quick oats (the ones that cook in 1 minute) or the old fashioned oats (that cook in 5 minutes). You can also make cookies that have oatmeal in them and get oatmeal that way (I prefer this way! Ha!). The way they process the instant oatmeal, it doesn't give you the same results. No one is sure how the oatmeal works but it does!

Get some rest (yeah, I know easier said than done!) If you are exhausted and have the opportunity to take a nap (even if it pushes your pump back) do it! You will actually get more milk that way! Even if you're not sleeping, rest by sitting down a lot. Conserving energy is important.

Don't stress too much. This all depends on how you personally handle stress. I tend to be a thinker, so I think things out a lot. It has to be some MAJOR stressful situation for it to hurt my supply.

Some suggest drinking dark beer, with or without alcohol. Some say it's the barley in it or something, that helps to increase supply. Plus some women just swear by the relaxation it gives them! You can have 1 or 2 beers without much crossing into your milk. ( Note: Most breastfeeding experts do not routinely recommend using alcohol to boost milk supply. More on alcohol and breastfeeding here.)

There is a tea called Mothers Milk Tea and it is supposed to increase your supply if you drink it.

There are herbs like Fenugreek and also prescription medications that will increase your supply if you really need it. I would use these as a last resort but they can be effective and are available!
Most importantly, good pumping habits will keep your supply up and increase it!"

PUMPING TRICKS & More Tips For EPing Moms by EPing Moms

(aka "Tricks of the Trade" shared by Shanna)

"Go hands free! This was the best trick I learned!! I went hands free and set my pump up by my computer and read my pumping board while I pump. It keeps me from looking down into my bottles wondering how much I'm getting, being bored out of my mind, and makes time FLY by! You can use an old nursing bra and just cut slits in the flap. Then you just slide the horns through. I did this for a while but I didn't want to wear the cut up bra all day long so that meant I had to literally change bras before each pump. At 7 times a day, that was a bit much!! So, I bought a pumping bra and LOVE it! It's the Easy Expressions bustier.

The best thing about this bustier is that it can be worn over any nursing bra. So, when it's time to pump, I put the flaps down on my nursing bra, wrap the bustier around, slide the horns through the holes, position them and zip it up. That's all!"
"The refrigerator trick. This is where you rinse your horns and/or collection bottles after each pumping session. You put them in a ziplock bag (or not, this is optional), and put them in the refrigerator. The idea is that since breast milk is good in the fridge for 5-8 days, any residue left on the horns won't matter. Then you can wash the horns/bottles once at night. I throw mine into the dishwasher (all except the white membranes) and it's easy, easy, easy!""Storage bags. Many of us started out using the Gerber Seal-N-Go bag but they get very pricey quickly. They are like $5.50 for a box of 25 bags. After researching it online, I found many other women were using regular freezer bags for freezing the milk....MUCH cheaper! Everything I've read shows that they are safe to use. From what I have found, I only buy Glad and not Ziploc. Ziploc seems to have a much higher rate of leaks. I write the date and amount of ounces on the label with a sharpie and put the milk in and freeze flat. I then take several of them and put them into a gallon size freezer bag and write the dates that are enclosed on the gallon bag. This helps by double bagging and keeping them grouped. This way the corners on the bags won't get poked and possibly cause the bag to leak. Also, whenever I want to get a bag, I can just dig through gallon size bags instead of tons of little bags floating around! : I usually put one or two days worth in a gallon bag." "Lube Up! It is perfectly safe to put the lansinoh on before pumping and still use the milk. Putting it on before and after pumping really helps to keep you from getting too sore. Purelan100 is also good (and cheaper). I've used this from the beginning. You can also rub Olive Oil on the horns and inside the nipple chamber to reduce friction. Olive Oil is antibacterial so it is helpful. This is also safe to use and pump milk with. I've done both of these and hadn't had a problem. There are times when I seem to get sorer than other times with no real explanation. But, it then goes away as quickly as it came! Who knows!""Taking Care of Baby When Pumping. Once I went hands free and had to do those early morning feedings by myself, I would sit on the floor and prop my baby up in her boppy pillow on the floor. I would get hooked up to the pump and start it and pump while I fed her. About the time she was done eating, I was done pumping and I would put her back in bed and go to sleep myself. This will cut down on your time tremendously! It also helps to do this if your pumping time happens to correspond to your baby's feeding time during the day. The bouncy seat is my best friend! I would put her in the bouncy seat and bounce it with my foot while surfing the net and pumping. It made time fly by and she was content. You may find other solutions if you have older children, or extra help.""Taking Care of Older Children, and Pumping. You may not need a lot of tricks for this one depending on the age of the child, or children. They will probably understand if you just explain that while you are pumping, they can't get up and get things without help. Some tricks other moms had mentioned to keep their other child entertained and kind of reward them would be to go shopping and let your child pick out a special toy or video that she really wants. Then when ever it comes time for you to pump, she can play with it. But, she ONLY gets to play with it when you pump. This helps to make pumping time special for her as well and can help prevent any resentment she might begin to feel."Excessive caffeine may cause problems (like keeping the baby wired!). I avoid caffeine completely (except chocolate) but even if you have 1 drink a day, it won't hurt. Just don't go over board. (More on caffeine here.)

Medications that have Sudafed (pseudoephedrine HCl) in them can affect milk supply! Be careful!
Regular birth control pills will impact milk supply, and some women even have a problem with the mini pill. Breastfeeding (and yes that's what you are doing even if it's not from "the tap") is a good deterrent for ovulation but not 100% so be careful! However, you may find you get hot flashes and things like that. It is normal because your body is acting like it's going through menopause. This suppresses ovulation and allows you to make milk. I thought I was going crazy until I learned this! Ha! Sometimes if you get your period back while pumping, it can decrease your supply. This can be fixed by taking a calcium/magnesium supplement. (I don't have mine back yet and loving it!).
"WHEN DOES THIS GET EASIER?
Around 3 months your supply will probably be established. This is when you can begin to drop the number of times per day that you pump and not see too much of a decrease in total output (this is again, where the spreadsheet comes in handy). That's why if you do the hard work in the beginning, I promise it will pay off when this time comes! If you don't keep up the number of pumps per day in the beginning, you may continue to have to pump a high number of times per day just to maintain a small supply. Of course, this is all dependent on how each woman produces milk. So, you may have such a great supply and so much frozen that you can drop pumps earlier. I began dropping pumps at 10 weeks and by 3 months I was down to 4 pumps per day! I lost a little with each drop but am currently at 50 ounces per day. There's no way my baby will ever eat that much so I see no reason to pump more. You will have to decide for yourself. Once you start dropping pumps, you will need to pump longer at each session (because you've gone longer in between pumps and need longer to empty your breasts). This is also dependent on the woman. I pump about 35-40 minutes per pump now on 4 times because I get another let down at about 36 minutes into it!"

I firmly believe that pumping is 10% physical and 90% psychological. If you try to view this as positively as possible, I think you will have a better outcome. That's why going hands free and doing everything to minimize your stress about pumping is important.

A lot of people don't understand pumping. I still get stupid questions like, "Why don't you just nurse?" Well, DUH! She won't nurse! Ha! You should do whatever makes you comfortable. Sometimes strangers ask me if I'm breastfeeding and if I don't feel like dealing with anything, I just say yes. I am after all! She's just getting it "to go" instead of from "the tap"! Ha!

Mostly though, I do all I can to educate. I know many women who didn't know this option was even possible and wished they had when breastfeeding didn't work out. Don't listen to doctors or nurses who tell you this isn't possible. There just isn't enough wide spread info out there and unfortunately most health care professionals give really bad advice (like only pump for 10 minutes). So, when they hear back from their patients on how they had supply problems or dried up, they just assume it's not possible to pump long term. On my online group, there are women who have been pumping for a year or longer! It is DEFINITELY possible!

Most importantly, if for any reason you just don't want to do it anymore, it is perfectly fine! Remember, a happy mommy = a happy baby. You have to do whatever is right for your entire family. Pumping is hard and can take its toll on you. There is no right or wrong when it comes to how you feed your baby! Remember that! We all have days when we want to wean. That's why support is SOOO important!"

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There are occasions that arise which may prevent a mom from being able to nurse her baby. A mother who has a baby who cannot or will not latch, for whatever reason, may assume there is no choice but for her to use infant formula.

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By Kelly Bonyata, BS, IBCLC

It is important to express your milk to establish and maintain milk supply if your baby is not nursing at all or not nursing well. By expressing, you will also have your milk available to feed baby - every bit of moms' milk that baby gets (even the tiniest amount) is like liquid gold.

When should mom start pumping?

If baby does not nurse immediately postpartum, mom should begin pumping within 6 hours of baby's birth - starting early makes a difference for future milk production.

What pump is best?

If baby is not nursing, seriously consider renting a hospital-grade pump (a multiple-user double pump such as those made by Ameda, Hygeia or Medela) that will allow you to pump both breasts at the same time. A hospital-grade pump is the best choice for maintaining or increasing milk supply.

If you are not able to rent a hospital-grade pump, consider buying a pump (preferably a quality double pump) and/or hand expression.

How much milk should mom be pumping if baby is not nursing?

Aim for pumping 750-800 mL (25-27 oz) per day by 7-10 days postpartum. If you have twins or higher order multiples, aim for pumping 800-950 mL (27-32 oz) by 14 days postpartum.

It's useful to evaluate mom's 24 hour pumping output at 10 days. If supply is borderline (350-500 ml / 11-17 oz) or low (less than 350 ml / 11 oz), then galactagogues (prescription meds or herbs to increase supply) or other interventions should be considered.

The research tells us that milk production at 2 weeks is an indicator of breastfeeding outcome, so it is important to get a good start. Even if milk production doesn't start out well, however, don't get discouraged-many moms will see an increase (even as late as 9-15 weeks after birth) if they continue with regular pumping.

How often should mom pump?

8-10 times per day: Until supply is well established, it is important to get at least eight good nursing and/or pumping sessions per 24 hours. Ten sessions per day is better, particularly if you have twins or higher order multiples.

These sessions don't need to be evenly spaced, but you should be nursing/pumping at least once during the night in the first few months or anytime you notice a decrease in supply. Avoid going longer than 5-6 hours without pumping during the first few months.

When pumping during the night, milk yield tends to be better if you pump when you naturally wake (to go to the bathroom or because your breasts are uncomfortably full) than if you set an alarm to wake for pumping.

If you are having a hard time getting in enough pumping sessions, adding even a short pumping session (increasing frequency even if milk is not removed thoroughly) is helpful.

How long should mom pump at each pumping session?

If baby does not nurse at all:

The first few days, before mom's milk comes in, hand expression is often the most effective way to express colostrum. Double pump for 10-15 minutes per session for additional stimulation.

Once mom's milk is in, pump for 30 minutes per session, or for 2-5 minutes after the last drops of milk.

If baby nurses but does not soften the breast well
Double pump for 10-15 minutes after nursing.

Empty the breast as thoroughly as possible at each session. To ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. Use breast massage prior to pumping, and massage and compressions during pumping to better empty the breasts and increase pumping output.

Additional tips

Rest & relax as much as possible.

Skin-to-skin (Kangaroo care) can make a significant difference in pumping output.

One study has shown that the moms of hospitalized babies who listened to guided relaxation or soothing music while pumping had an increased pumping output. When mom listened to a recording that included both music and guided relaxation while pumping, in addition to looking at photos of her baby, pumping output was increased even more. In this study, the interventions led to moms producing 2-3 times their normal pumping output. Milk fat content also increased for these moms in the early days of the study. (Reference: Keith DR, Weaver BS, Vogel RL. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 2012 Apr;12(2):112-9.)

If double pumping is difficult to coordinate in the beginning, then single pump, alternating sides. Move to double pumping as soon as you can.

Avoid any medications that might interfere with milk supply (hormonal birth control, pseudoephedrine, ethanol/alcoholic beverages, bromocriptine, ergotamine, cabergoline)

If supply is not increasing as expected by 7-10 days after birth, consider the use of galactagogues. Fenugreek, metoclopramide (Reglan) or domperidone (Motilium) can be helpful for increasing milk supply.

See Got Milk? for more information on milk supply.

References and additional information

Note: Premature infants are certainly not the only breastfed babies who have problems nursing at the breast, but much of the writing and research in this area involves premature babies and their mothers. Talk to your lactation consultant about adapting these guidelines for older babies.

@KellyMom

@ other websites

References

Mohrbacher N. Cutting Edge Breastfeeding Trends, Orlando, FL, June 9, 2004.

Wight NE. La Leche League International Conference Session-The Premature Infant and Breastfeeding: Myth, Reality and Evidence-Based Practices, San Francisco, CA, July 5, 2003.

Furman L, Minich N, Hack M. Correlates of lactation in mothers of very low birth weight infants. Pediatrics. 2002 Apr;109(4):e57.

Meier PP. Breastfeeding in the special care nursery. Prematures and infants with medical problems. Pediatr Clin North Am. 2001 Apr;48(2):425-42.

Hill PD, Aldag JC, Chatterton RT. Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants. J Hum Lact. 2001 Feb;17(1):9-13.

da Silva OP, Knoppert DC, Angelini MM, Forret PA. Effect of domperidone on milk production in mothers of premature newborns: a randomized, double-blind, placebo-controlled trial. CMAJ. 2001 Jan 9;164(1):17-21.

Hill PD, Aldag JC, Chatterton RT. Effects of pumping style on milk production in mothers of non-nursing preterm infants. J Hum Lact. 1999 Sep;15(3):209-16.

Bier JA, Ferguson AE, Morales Y, Liebling JA, Archer D, Oh W, Vohr BR. Comparison of skin-to-skin contact with standard contact in low-birth-weight infants who are breast-fed. Arch Pediatr Adolesc Med. 1996 Dec;150(12):1265-9.

Anderson GC. Current knowledge about skin-to-skin (kangaroo) care for preterm infants. J Perinatol. 1991 Sep;11(3):216-26.

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Establishing and maintaining milk supply when baby is not breastfeeding * KellyMom.com

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It is important to express your milk to establish and maintain milk supply if your baby is not nursing at all or not nursing well. By expressing, you will also have your milk available to feed baby - every bit of moms' milk that baby gets (even the tiniest amount) is like liquid gold.

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Unicef UK Baby Friendly Initiative | Hand expression

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This short clip, produced by the Unicef UK Baby Friendly Initiative, provides an overview of hand expression and how to hand express successfully.

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first bottle

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Meet Hazel. She's six weeks old and her mum Pam has been exclusively breastfeeding up until now. It's not been without some struggles but Pam has found drop-in groups, found people to help her and been supported by her husband Rob.You'll notice Hazel is dribbling milk a bit. It's her first time having a go with the bottle so we'll cut her some slack. As time goes on, mum will get more experienced at getting the balance of flow right for Hazel. Perhaps you don't know why, but today baby just isn't in the mood and the grumpiness continues. She might be overtired or need a nappy change or something else could be going on. That's normal and that's OK.Even with responsive bottle-feeding, it's possible a baby may overfeed. They can't easily switch off their sucking reflex and it is easier than breastfeeding, partly because the milk isn't gradually getting thicker and slower as the fat content rises. It's tempting to keep going but pause and see what cues your baby is showing. Maybe they need a chance to receive their feeling of fullness.

Today Hazel is going to have her first bottle of expressed breastmilk because Pam and Rob feel the time is right. Pam's latching issues have resolved and breastfeeding is definitely established.

Pam is really keen to make sure Hazel's breastfeeding skills are protected as much as possible.

A baby may take more than they need to so we may have to be careful.

After about six weeks, a baby on average takes 30ml for each hour in 24hrs. But some take a little less and some a little more. The time of day may also make a difference. So while a baby feeding every two hours will on average take around 60ml, we're not going to force that in. We're going to give baby a chance to take the lead.

10. Think about WHEN you give a bottle.
I don't mean in terms of how old the baby is - that's about when breastfeeding is established and you've thought about whether you need to give a bottle at all.

I mean what time of day and what impact that might have on your breastfeeding. We know that removing milk from your breasts between about midnight and 5am is particularly valuable because that's when your prolactin hormone levels are higher and removing milk sends precious signals to maintain supply. So a bottle being given by someone else at 2am may not be doing a breastfeeding mum the ultimate favour.

In the evening, when baby seems very restless and fussy might seem like a logical time. It's really normal for babies to be fussy for several hours often in the late afternoon and evening. We might even feel 'empty' and worry we don't have enough milk and a bottle might seem like a sensible choice but... it could be the worst time of all. Your baby may well be cluster feeding and sending crucial messages to develop your supply to meet their future needs. They are tanking up on really high fat content milk (that comes from an emptier breast, breasts can NEVER be entirely empty). They are coming to the breast for lots of other reasons that aren't just about milk. Giving a bottle at the end of a session of cluster feeding is probably less damaging than giving one to try and stop cluster feeding happening.

Talk to your breastfeeding counsellor or whoever is supporting you with breastfeeding if you feel you need to give a bottle. They can talk to you about your baby's history and behaviour and help you decide when is the right time for you. 8. Who gives baby the bottle can matter.
Sometimes babies take the bottle more easily if it isn't the breastfeeding mum who gives it. However, it's also true that whoever gives a bottle should be someone baby can trust. It's not the role for extended family and visitors who don't know baby well and may have their own ideas about how to do things. Bottle-feeding is also an act of communication - responding to baby and respecting baby.

9.
She knows that introducing a bottle teaches Hazel to feed in a different way and that leaving her breasts unused for a block of time could impact on her supply or leave her at risk of blocked ducts.

Pam has pumped for the first time and has brought a bottle along to a drop-in session to talk about responsive bottle-feeding.

The video here is a clip of our conversation. It's rough around the edges. You can hear my colleague at the beginning pressing record and the video runs out at the end because my iPad memory is full of my children jumping off sofas using 'time lapse'! But hopefully it gives you an idea.

Ten things that are important:
​
1. Put yourself in baby's shoes (or Babygro feet).
This is WEIRD. It isn't at all like breastfeeding. Breastfeeding smells of mummy and tastes of mummy and it's warm and comfy. Baby can control the flow and when she gets sleepy the milk gets thicker and slower. Bottles look different. They taste different. Mummy is holding me differently (sometimes with a tense look on her face). Someone else might be giving me milk. The temperature is different and lots of stuff that is really special about breastfeeding just isn't there.

Is the baby showing stress cues? What are they doing with their hands? What is their facial expression like? What do you think your baby is asking?

2. If it doesn't work out the first time, that's OK.
It can take time. It might take a different mood or a different place or a different time of day or a different person. A first bottle refusal is not the end of the world. It is very very likely that things will work out in the end. It's just time for carers to be scientists and experiment with different variables and try different things out.

It's easy to panic but the vast majority of breastfeeding babies move between breast and bottle without too much trouble. There isn't evidence to suggest that you HAVE to give the bottle before a certain age. There isn't evidence to suggest a baby who refuses a bottle today might refuse tomorrow. And let's imagine your nightmare scenario - they continue to refuse. There are a bunch of other ways to get milk into a baby without a breast or a bottle being involved: cup feeding, sippy cup feeding, finger feeding with a tube, syringe feeding.

3. Every bottle manufacturer claims their bottle is 'the best'.
Let's use some logic. No bottle is going to be quite the same as the breast. Babies remove milk from the breast by moving their tongue in a wave-like motion that causes a fluctuation between positive and negative pressure. The milk comes out of the breast to fill a vacuum created by the drop of the rear tongue and the tongue compresses the breast while the mother has occasional milk ejection reflexes. Meanwhile the milk in the breast gets gradually thicker. No bottle comes close to that.

Milk from the breast isn't removed by a hard suck.

An initial suck gets the nipple into the correct position in baby's mouth and holds it there but after that it's really about the rise and fall of the tongue and there isn't a continued hard sucking action removing milk.

We can't use a bottle that works like breastfeeding but let's try and use one that LOOKS like breastfeeding in the way the baby's lips and tongue are positioned and let's encourage the baby to do something to remove milk rather than let it pour out through gravity.

It seems logical that wide bottles (that don't have the longest thinnest nipples) and that allow baby to get an entire mouthful will help us to maintain the association that feeding means a wide gape and the tongue touching against something.

4. Let's allow baby to have as much control as possible.
We'll start with touching the bottle teat to the nose or under the nose and see if we can stimulate a gape. When they ask for the bottle, we gently place the bottle on the tongue (which ideally should be down over the gum ridge and extended). It might be helpful at the beginning to touch the teat to the roof of baby's mouth to help stimulate the sucking reflex. Then if we keep the bottle as horizontal as much as possible, the baby can control flow. If the teat really starts to empty (and you can see that by looking through the inside of the bottle), you may need to start tipping it a little so they don't just swallow air.

Let's respect them if they really start to protest. Are they saying the milk is too fast? Do their hands look tense? Do they want the bottle to come out completely so they can take a breather?

5. If we focus too much on avoiding air getting in, we may not be using the optimum flow.
If our focus is on tipping up the bottle and filling the entire teat with milk, the flow could be too fast. The baby may struggle to catch their breath and may take more milk than they want to (which could cause discomfort and impact on future breastfeeds). If the hole in the centre of the teat is covered with milk, that's fine and if sometimes it isn't, that's OK. You'll hear that swallowing sounds different and you'll respond. And baby will appreciate a burp afterwards.

6. Babies like to be close.
When they are held close, they feel anchored and supported. We can use our bodies to help them stay semi-upright too. They might even be calmed by using skin-to-skin. If you are using bottles regularly, it's recommended to swap the side of your body you hold baby on and the hand you use to bottle-feed. This means baby's vision is stimulated equally and one side isn't always blinkered against the body. Perhaps less of an issue for Pam and Rob when Hazel is probably going to get no more than one bottle of expressed milk a day.

7. It might not always be perfect.

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Giving a breastfed baby their first bottle

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Meet Hazel. She's six weeks old and her mum Pam has been exclusively breastfeeding up until now. It's not been without some struggles but Pam has found drop-in groups, found people to help her and been supported by her husband Rob.You'll notice Hazel is dribbling milk a bit.

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Sucking is a basic instinct that babies are born with. Babies suck for both food and comfort. Breastmilk also provides protection against disease so nature has made sure that babies love to be at the breast. They are comforted by the warmth, smell, delicious milk and reassuring sound of your heartbeat.

Breastfeeding offers a lot of security too, whether your baby is feeling lonely, frightened, sad, cross, or ill at ease with a new situation.

In the early days, it's easy to feel overwhelmed by your baby's need to nurse. But meeting his needs makes him feel safe and ensures you have plenty of milk. As he grows, your baby's nursing pattern will change and life with your new baby should settle down.

Whenever a substitute for sucking at the breast is used there is a risk of affecting the breastfeeding relationship, especially for a baby who has not yet mastered nursing at the breast.

Milk production

Dummy use may reduce your milk production and result in poor weight gain. In the early weeks it's really important to nurse often and ensure all sucking is at the breast to establish and maintain good milk production.

Breastfeeding problems

Using a dummy can make it harder for your baby to breastfeed comfortably and effectively (1). The shape and firmer feel of a dummy differs from your pliable breast. Some babies may prefer the stronger sucking trigger of a dummy, leading to 'confusion' about how to nurse at the softer breast. The result may be sore nipples for you and not enough milk for your baby. He may become frustrated and start to fuss, cry or refuse to breastfeed altogether.

Early weaning

Regular dummy use is associated with premature weaning (1,2). A dummy is often assumed to be an essential parenting tool. A baby is comforted by sucking, so what could be more convenient than a small portable device to pop in his mouth? But will offering a dummy cause problems with breastfeeding or can you combine the two?

Babies like to suck for pure pleasure even when milk flow slows. You have only to look at your older baby to see this-he frequently looks up into your eyes then breaks off sucking to give you a great big smile. You in turn smile and talk to your baby. These are the first steps in your baby's development of language and relationships.

Why give a dummy?

It's important to remember that a dummy is a substitute for the breast-an object to silence, or pacify a baby's crying until the real thing is available. For this reason it doesn't really make sense for people to suggest a baby is using his mother as a 'human dummy' when he wants to nurse for comfort.
There may be occasions when it's convenient to use a dummy-to calm your baby briefly when you can't nurse him immediately, for example if you're driving. Sometimes a baby with colic will find it soothing to suck on a dummy between feeds.

If you decide to give your baby a dummy, it's better to wait until breastfeeding is well-established and he is gaining weight well. You will also need to follow manufacturer's guidelines on cleaning and replacement.

In some hospitals premature babies may be given a dummy during tube feeding to stimulate their sucking reflex, help digestion and help them associate the action of sucking with receiving food. It's best if this is just a temporary substitute and efforts are made to establish breastfeeding as soon as possible.

Infections

Your baby has an increased risk of ear infections if he regularly has a dummy (3). Thrush can be a problem too, as it thrives on moist surfaces at room temperature.

Dental problems

Breastfeeding provides exercise for optimum development of a baby's mouth, tongue and jaws and many orthodontists say they see fewer dental problems in breastfed babies. Regular dummy use can affect the growth of teeth and the shape of babies' mouths, increasing the risk of sleep apnoea* and the need for braces later on (4,5). It can also increase the levels of decay-causing bacteria in babies' mouths (4).

Problems for mothers

You can be at risk of engorgement and mastitis when you introduce a dummy-a particular problem if you have an oversupply of milk. Your periods and fertility may also return earlier as your hormone levels are affected when your baby nurses less.

Don't forget

Many babies have no interest in using a dummy. You are the best pacifier in the world from your baby's point of view. And what could be more natural than to bring peace to your baby with the warmth of your presence through breastfeeding, rather than with a plastic device.

If breastfeeding is affected

Stop using the dummy so that your baby can concentrate on learning to feed well at the breast.

Offer a breastfeed while he is still calm and pay extra attention to how he is positioned and attached at the breast.

Encourage your baby to breastfeed at least 8-12 times in 24 hours, offering both sides and allowing him to nurse for comfort.

To encourage his interest in breastfeeding hand express so milk is flowing before offering the breast.

Ask your LLL Leader about the technique of breast compression which has been found to encourage babies to continue breastfeeding actively for longer.

Spend extra time cuddling, carrying and holding your baby, including skin-to-skin contact to help him relax and encourage his interest in breastfeeding.

Weaning from a dummy

Regardless of whether it affects breastfeeding, you and your baby can become over-attached to a dummy. It is easy to find yourself using it more and more and your toddler's language and social development may be delayed. It is recommended that parents stop using a dummy once a baby is 6 months old.

You may need to wean yourself from the convenience of popping in the dummy when your baby fusses and give extra attention, cuddling or nursing instead.

To reduce or cut out dummy use, try:

Offering to nurse instead.

Restricting your baby's dummy use to certain times such as only in the car.

Carrying him, taking him for a walk in the buggy, giving him a bath, playing games, singing or sharing other interesting activities.

If your baby has become accustomed to falling asleep with a dummy, the simplest option is to breastfeed him instead. From 6 months:

Try gently removing the dummy once he is asleep or very sleepy so that he gradually learns to fall asleep without it.

Keep trying as new sleep associations take a while to establish. You could introduce other sleep cues such as wrapping in a blanket, rubbing his back, rocking and/or a key word, for example 'shh'.

Extra time focussing on your baby's needs whilst working to reduce dummy use will help the change go more smoothly. If you have any questions or need support as you wean your baby from using a dummy you can contact an LLL Leader by calling our Helpline. You can find your local group here.

Breastfeeding, Dummies and SIDS

Some research has shown that using a dummy to settle a baby to sleep can reduce the risk of sudden infant death syndrome (SIDS) (6,7). The cause and effect is unknown, and may be related to other protective factors. It is possible that a baby falling asleep with a dummy mimics babies falling asleep at the breast (8,9) Babies generally keep a dummy in the mouth for less than 15 minutes at sleep times (10)-similar to the time it takes a baby to breastfeed to sleep.

Current recommendations for dummy use at sleep times (6,11) are that a dummy should:

Not be used to replace breastfeeding.

Not be replaced after a baby falls asleep.

Not be given to a baby who doesn't want it.

It would seem from these recommendations, that a baby who breastfeeds to sleep is unlikely to want or need a dummy.

*Sleep apnoea: irregular breathing during sleep.

Further Reading
Beginning Breastfeeding
My Baby Needs More Milk
Nipple Confusion?
Safe Sleep & The Breastfed Baby
Sleepy Baby - Why & What To Do

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

1. Righard, L and Alade, M. Breastfeeding and the use of pacifiers. Birth 1997; 24(2): 116-20.

2. Victoria, C et al. Pacifier use and short breastfeeding duration. Cause, Consequence or Coincidence. Pediatrics 1997; 99(3): 445-453.

3. Warren, JJ et al. Pacifier use and the occurrence of otitis media in the first year of life. Pediatric Dentistry 2001; 23(2): 103-07.

4. Palmer, B. Breastfeeding: Reducing the Risk for Obstructive Sleep Apnea. Breastfeeding Abstracts. 1999 Feb 18(3): 19-20.

5. Viggiano, D, et al. Breastfeeding, bottlefeeding, and non-nutritive sucking: Effects on occlusion in deciduous dentition. Arch Dis Child 2005; 89: 1121-23.

6. Hauck, FR et al. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics. 2005 Nov; 116(5): e716-23.

7. Li, DK et al. Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based casecontrol study. BMJ 2006 Jan 7; 332(7532): 18-22.

8. Blair, PS and Fleming, PJ. Dummies and SIDS: Causality has not been established. BMJ 2006; 332: 178.

9. Fleming, PJ et al. Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study .CESDI SUDI research team. Arch Dis Child 1999; 81: 112-6.

10. Weiss, P and Kerbl, R. The relatively short duration that a child retains a pacifier in the mouth during sleep: implications for sudden infant death syndrome. Eur J Pediatr. 2001; 160: 60-70.

11. Moon, RY et al. Sudden infant death syndrome. Lancet. 2007 Nov 3; 370(9598): 1578-87.

12. NICE Clinical Guideline CG 37: Postnatal care: Postnatal care up to 8 weeks after birth National Collaborating

13. Centre for Primary Care and Royal College of General Practitioners, 2006. http://www.nice.org.uk/guidance/cg37/chapter/1-recommendations#infant-feeding http://www.nice.org.uk/CG037

This information is available to buy in printed form from the LLLGB Shop

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Dummies and Breastfeeding - La Leche League GB

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Sucking is a basic instinct that babies are born with. Babies suck for both food and comfort. Breastmilk also provides protection against disease so nature has made sure that babies love to be at the breast. They are comforted by the warmth, smell, delicious milk and reassuring sound of your heartbeat.

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New parents need time to adjust to their new roles. Life may change dramatically, especially for a ﬁrst time mother-many women say they didn't feel prepared for the emotional upheaval they experienced on becoming a mother. Even experienced mothers can have difﬁculties juggling the needs of the new baby with those of older children.

At this time a pair of practical helping hands can make a big difference by allowing a mother time to recover from the birth and establish breastfeeding. In the early days, a baby will probably want to breastfeed a lot of the time they are awake. At this stage, a mother may only be managing to eat, sleep and nurse the baby.

This is normal. At ﬁrst their mother and nursing will be at the centre of a baby's world. The security of a baby's bond with their mother is the basis for all other relationships. A breastfeeding mother generally feels an intense connection with her baby, both emotionally and physically, due to breastfeeding hormones and the practical need to stay close to nurse her baby.

This way, babies get what they need to thrive. A baby's wants are a baby's needs-they can't wait like an adult can. By meeting your baby's needs a mother gives them a secure attachment so they can develop into a conﬁdent child.

Why breastfeed?
When can a baby start eating solid food?
When will a baby sleep through the night?
When does breastfeeding stop?
Support for mothers is important
Ways to support a breastfeeding mother
What breastfeeding mothers say when asked what would help
What about partners?
What about dads?
Two women having a baby
What about other family members?
What about visitors?
Other ways to help
When a mum has no support

Why breastfeed?

Breastmilk has everything a growing baby needs in exactly the right amounts and is easy to digest. Research shows that a baby who is not breastfed is more likely to suffer from health problems, both as a child and throughout adulthood. Infant formula increases a child's risk of (amongst many other health problems): SIDS, Cancer, Obesity, Diabetes, and Allergies.

See Amazing milk for more information.

What about breastfeeding in public places?

Babies often want to breastfeed when people around them are eating and drinking-and why not? Mothers breastfeed in many public places and tend to be so discreet you may not even have noticed.

Breastfeeding is also convenient when a mother is out and about. She can spot early feeding cues and offer a feed before her baby gets frantic-well before those around her are even aware. After all, no one notices a baby nestled in mum's arms but a crying baby guarantees an audience!

When can a baby start eating solid food?

Breastmilk is a complete food so a healthy baby needs only breastmilk until about the middle of the ﬁrst year. There's no beneﬁt to be found in introducing solid foods before this time. If a baby seems hungry, more breastmilk usually does the trick-mothers could breastfeed more often, offering both sides. Many babies who start on solid foods from around six months quickly learn to feed themselves and enjoy sitting up with the family at mealtimes.

See Starting Solid Food.

When will a baby sleep through the night?

A baby will need to breastfeed during the night for a number of months to ensure they take in enough milk and to maintain their mother's milk production. Just as there's no ﬁxed age for when a baby is ready to walk or talk, there's no real way of knowing when they will be ready to sleep through the night. Consider whether you sleep through the night now? Many adults wake, turn over and go back to sleep as a matter of course. As a baby grows their sleep cycles will naturally get longer. In the meantime, they will wake and be likely to need the comfort of mother, her co-parent or other family member's presence to help them relax and fall back to sleep.

What about bottles and dummies? Bottles or dummies can confuse a baby's sucking technique, so if a supplement is needed, a spoon, ﬂexible feeding cup or syringe can be used. Giving formula affects a mother's milk production since a baby will take less breastmilk. Some mothers express milk for their partner, or another support person, to give but expressing takes more effort than simply breastfeeding. If a mother is ﬁnding night feeding exhausting you could encourage her to rest during the day, to try feeding lying down and to keep baby close at night so she doesn't have to get up. See our page on Safer Sleep for more information.

When does breastfeeding stop?

When does a baby's need to use nappies or a highchair stop? It's all very individual. It doesn't usually help to push children on to the next stage until they are ready. Breastmilk is just as nutritious as it was when they were tiny and it still protects them from infection. There is no evidence that continuing to breastfeed makes a toddler clingy-in fact the opposite may be the case. A toddler may seem big but emotionally they are still a baby. It's easier on mother and baby to let breastfeeding end gradually.

Breastfeeding bonuses

Nothing compares with breastmilk for growing healthy, clever babies.

No getting up to prepare bottles during the night.

Your baby's nappies won't smell bad.

No feeding equipment and expensive formula to buy for your baby.

Less to take with you when you go out with your baby.

Support for mothers is important

One very real problem is that many mothers don't receive enough support in the early days and months, and simply try to do too much. Most mothers who stop breastfeeding before they want to cite lack of support as the reason. They need time to recover and adjust, especially after a difﬁcult birth. Caring for a newborn really is a full time job, and that's before you add in essential jobs around the house and caring for any older children. All mothers need practical help and support.

The biggest challenges for all mothers are:

Getting enough sleep.

Keeping up with basic housework.

Lack of emotional support.

Isolation

The help you give can make a lot of difference to a new mother, especially when her baby seems to be nursing all the time and is waking at night. Be sensitive to her needs. What you can offer and do will partly depend on whether you are a friend or family member, and the closeness of your relationship. Some mothers will want more practical help, others more emotional help-and a mother may have strong views on what help she will accept and from whom.

Ways to support a breastfeeding mother

You may be her partner, the baby's dad or mum, a family member or friend. All mothers need support, and whatever your relationship to her there are things you can do to help.

With baby:

Walks in the fresh air. Consider wearing baby in a sling or other carrier.

Go out and about; babies are social people.

Read and sing to baby-they'll love hearing your voice.

Take a bath together, or bathe them in the baby bath. Many babies love bathtime!

Sleep with them. Visit our page on Safer Sleep and the Breastfed Baby.

Hold them on your chest while they nap to help your baby feel safe and relaxed.

Nappy changes are perfect for games and chat.

Talk to your baby about things around the house.

Take your baby to their mother whenever they need her.

Use the Magic Baby Hold: with your baby's back against your front, bring your left arm over their left shoulder (one arm on either side of yours), and hold their right thigh.

Try other comfort techniques.

Jiggle and sway. Babies tend to like side- to- side motion.

For the breastfeeding mother:

Make sure she has food and drinks.

Cut her food up for her if she's holding the baby!

Hold the baby so she can take a shower.

Help her get good help if she needs it.

Guard against too many visitors. Let others know when you need to be alone. Protect mum and baby from over-enthusiastic visitors and callers, and try to ensure you all have some peaceful uninterrupted time together. Turn off the phone and put a 'do not disturb' sign on the front door.

Look after older children. Provide fun activities and opportunity for exercise. Try to meet their needs for attention, sleep and healthy food.

Fight off any pressure to separate mum and baby. Help mum and baby spend lots of time snuggling together in the hours and days after birth.

What breastfeeding mothers say when asked what would help

"The best presents for a new mum are home cooked meals frozen in take away tubs- ready meals but real food!"
"Order a box set & takeaway!"
"I need friends supporting me, sharing laughter and tears, coffee and cake"
"Make sure I have water, muslin, remote control, phone, book & cake"
"Bring me snacks that are tasty, healthy and one-handed!"
"When it's really hot and my baby is going through a growth spurt, bring me long, cool glasses of water!"
"The best way anyone can help is by taking care of the pile of washing up!"
"Call me during the day to say 'Hi!' and ask how I'm doing""Please don't try and give my baby formula, the moment you do you undermine my confidence in my body's ability to sustain my baby"
"Give me support & encouragement and tell people who criticise or question me that I'm doing ok"
"Don't tell me it is 'normal' and that I should persevere if I am in pain"
"Pass me the phone with a breastfeeding counsellor on the other end if I'm in pain"
"Never say 'well you are breastfeeding' when I say I'm tired"
"Tell me it's ok to take one feed at a time"
"Give me a thumbs up!"
"Tell me my baby is beautiful""Take my older children to the park"

Below is lots of information about supporting a breastfeeding mother, divided into different sections. You may find useful information in all of the sections regardless of your own role and relationship to mum and baby.

What about partners?
Your baby doesn't need you to feed them.* So what can you do? Anything else! You are The Safe Person Who Is Not Mum.
Whether or not you are your baby's biological parent, and whatever your family looks like, your partner needs your support. In the early days, your baby will probably want to breastfeed a lot of the time they are awake. At this stage, your partner may only be managing to eat, sleep and nurse the baby. This is normal.

At first their mother and nursing will be the centre of your baby's world. Don't worry if you find you don't get to hold your baby for long before their mum is needed again. A baby's bond with their mother is the basis for all other relationships. Encouraging the closeness with mum will strengthen their love for you later. Soon that tiny baby will be reaching out to the rest of the world. They will want all the fun and excitement you can give!

You are different. Your shape, voice, hands, and smell are different. You hold baby differently. You teach them that different can be good, and when they are frazzled you may be just the difference that your baby needs needs.

As life settles down you and your partner will probably both need time to adjust to your new roles as parents. Many women say they didn't feel prepared for the emotional upheaval they experienced on becoming a mother. You'll also find lots of changes in your life.

Breastfeeding mothers often feel an intense connection with their baby, both emotionally and physically, due to breastfeeding hormones and the practical need to stay close to feed the baby. It can be easy to feel a bit left out of this. Try to get involved in practical ways. It will help you bond with your baby-your partner will love you for it and so will your baby.

You may both find that your baby becomes central to your life-their needs being met before either of yours. This is nature's way of ensuring babies get what they need to thrive.

Your first job is to support breastfeeding, not compete with it. A "relief bottle" may seem helpful, but it's more likely to cause breastfeeding problems and health risks for baby. Protect your partner from criticism and tell her she's doing a good job. Protect your partner from well meaning but unhelpful advice that undermines breastfeeding-even if it comes from your own mum!

Admire and praise your baby's mother. Your love and encouragement will work wonders. Firmly resist pressures to feed baby anything other than mum's own milk before he is six months old. Your baby doesn't need other foods until they can sit up and begin to feed themselves. Even then, breastmilk carries on being an important food for older babies and toddlers.

*Some non-gestational mothers do breastfeed their babies. See the section Two women having a baby

What about dads?

Dads feel different, they often have deep voices and a different smell. They move and hold a baby differently. At the end of a long day, dad, with all his special differences, can be just what baby and mother need. Dads are fun and have a special gift for playing with babies. They play the sort of exciting games babies enjoy. Your baby will adore your singing and funny noises (even if mum doesn't). And you'll probably enjoy your baby's toys as much as he does! Dads are just as good at cuddles as mums. A great way to comfort your baby is to use a carrier-babies usually love them and it's a handy way to settle your baby. At times when your baby is fussy or uncomfortable and nothing else works, the colic hold is a dad's speciality.

Caring for your baby teaches them that love comes from interacting with people as well as from food.

Try some of suggestions in the section above Ways to support a breastfeeding mother.

You can support your baby's mother by making the most of your paternity leave. Take as long as you can manage. Take it when the mother and baby would otherwise be at home alone. Concentrate just on the needs of mum, baby and any other children. Let everything else wait.

Meet your baby's need for you. Your baby needs you to be a dad, not a substitute mother. Spend time with your baby and enjoy your unique father-baby relationship.

Two women having a baby

For lesbian couples, if you're the non-gestational parent you may feel left out - especially if you have to explain you are the baby's mother too. Finding support for yourself and your breastfeeding partner is important. Your partner and your baby need you now, and your baby will need you more and more as they grow. You could be entitled to paid leave although your employer may not be aware of this, there are resources in Further Reading that might help.

In some couples two mothers do share breastfeeding; others find different ways to connect, you'll find lots of ideas in the section above Ways to support a breastfeeding mother.

Deciding to share breastfeeding, and how you do that, are personal decisions. You can read about how one couple shared breastfeeding here:

You will find resources in Further Reading, or contact your local LLL Leader who can help you talk about your options.

What about other family members?

Is the new baby in your family breastfed? New research has shown that breastfeeding is important for the baby's health and development and for the mother's health, both now and in the future. It's even good for the environment.

Research has found that breastfeeding works best when the baby is fed in response to hunger cues, not on a schedule. That's usually quite frequently, especially in the beginning. Fortunately, you can't feed too often.

Sore nipples aren't an expected part of breastfeeding; they are a sign that something isn't quite right. With some expert help, the mother should soon be breastfeeding comfortably.

Most medical experts, including the NHS and the World Health Organization, recommend that babies be breastfed exclusively- no formula or solid foods- for six months or so, and continue breastfeeding with solid foods added to their diet into these toddler years-even two years or more.

Much of this may be different from what you learned when you had your own babies. But guess what hasn't changed? New mothers still need lots of help, lots of support, and lots of loving family members around to prepare meals or throw in a load of laundry. They need people to be patient with them as they figure out both breastfeeding and motherhood. And babies still need their grandparents, aunties, uncles, cousins, siblings and other family members to love them. Your practical help and support are a golden investment in your family's future, and in your lives together.

What about visitors?

Prioritise tasks: the needs of people are best dealt with before housework. Avoid trying to take over baby care or expecting to be entertained when you visit. Concentrate on 'mothering the mother' and helping with household jobs.

Offer practical help with housework and essential tasks: grocery shopping, laundry, preparing meals or providing a meal that can simply be reheated, leaving her a sandwich lunch, washing up and cleaning the kitchen, t idying and vacuuming.

Bring her the things she needs while nursing: eg drinks, snacks, pillows, books, the TV remote, her mobile.

Make her a drink and offer your company for a while.

Tell her how well she's doing.

Listen if she is feeling worried, tired, or overwhelmed. She might find it easier to talk to you about her worries than to close family.

Help her ﬁnd another mother to talk to.

Help with the baby and any older children: changing nappies; care for the baby while mum sleeps, goes to the loo, takes a short walk or a bath.

Entertain and care for older children. Perhaps take them out for a walk, to the park or invite them round to play with your children. Help with the school run or taking older children to after school activities.

Other ways to help

Welcome breastfeeding so the mum feels comfortable nursing in your presence, be a breastfeeding advocate. Avoid undermining her conﬁdence by asking negative questions like, "Are you sure the baby is getting enough to eat?" or, "Why aren't they sleeping through the night yet?". Offer a sympathetic ear rather than advice when she complains or seems tired-try to support and encourage.

Find out about what is normal for nursing babies of different ages. Remember that breastfeeding problems have breastfeeding solutions. Bottles or weaning are rarely the answer.

Encourage or help the mum to ﬁnd the support she needs. Mothers can easily get skilled help from an LLL Leader by calling our Helpline.
An offer to take the mother to her local LLL group when she feels ready may be very welcome. It can be hard to get out of the house when you have a new baby.

Many mothers will appreciate having someone familiar with them when they go to a new group for the ﬁrst time, and any woman is welcome at meetings. Some groups may also run meetings for couples.

When a mum has no support

LLL meetings are a great place to meet other mothers and to share experiences. If there is no LLL group in your area you may be able to attend online meetings, and join Facebook groups to get support and share experiences with other breastfeeding mums. Contact us for details.

Homestart are a national charity who help families with young children. Their website has lots of practical ideas and stories, and also details of how to contact Homestart in your area.

Your Health Visitor will have details of local activities including post natal groups. Libraries and playgroups are good places to meet other mums.

If you, or a mum you are supporting, is feeling depressed or down you might find useful information on our Adjusting To Motherhood page.

Written by mothers of LLLGB and adapted by Ellen Mateer. The original text of Supporting a Breastfeeding Mother was sponsored by Jill Welsh in memory of her mother, Rose Wesby, who encouraged her to breastfeed and showed her the gentle art of mothering.

Further Reading
Amazing Milk
Beginning Breastfeeding
Comfortable Breastfeeding
Caesarean Birth & Breatsfeeding
Dummies & Breastfeeding
Is My Baby Getting Enough Milk
Out and About With Your Breastfed Baby
Parenting when you partners breastfeeds
Rhythms & Routines
Safe Sleep and the Breastfed Baby
Smoking & Breastfeeding
Starting Solid Food
Relactation & Induced Lactation
Mothers on ... support from our nearest & dearest
LLL's father concept - it's not just about dads!
Relactation and Induced Lactation
The Womanly Art of Breastfeeding LLLI. London: Pinter & Martin, 2010.

Other online Information
Breastfeeding in a Same-Sex (Female) Relationship
Induced Lactation and the Newman-Goldfarb Protocols for Induced Lactation
Breastfeeding Without Birthing

The information on this page is adapted from Supporting a Breastfeeding Mother and Parenting when your partner breastfeeds which are available to buy in printed form from our shop.

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Supporting a Breastfeeding Mother - La Leche League GB

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New parents need time to adjust to their new roles. Life may change dramatically, especially for a ﬁrst time mother-many women say they didn't feel prepared for the emotional upheaval they experienced on becoming a mother. Even experienced mothers can have difﬁculties juggling the needs of the new baby with those of older children.

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Feeding should be comfortable for both you and your baby. If you experience any discomfort, or have concerns about your baby's feeding, talking to someone who can help could make all the difference.
Watch our video to find out about support for breastfeeding.
Common problems with breastfeeding include:
Sore nipples
Tongue tie
Sore breasts
Unsettled baby and frequent feeding
Baby refuses the breast

Sore nipples

An unfamiliar feeling of tingling, or pressure, without actual pain, is normal when you first start to breastfeed. But if breastfeeding hurts your nipples, then the most likely reason is that you and your baby need to change the way he latches on. Read about how to deal with sore nipples.

Tongue-tie

Some babies find a comfortable, effective latch hard to achieve because of tongue tie. Read our article on tongue-tie.

Sore breasts

When your baby is feeding, your breasts 'let down' milk. A few women find this sensation painful. You may also feel your womb contracting. It should pass quickly; try to relax and breathe through it and ask your midwife for tips. Find out more in our article here.

Unsettled baby and frequent feeding

If your baby seems unhappy, unable to sleep, or difficult to feed, do ask for help. Many women worry a great deal when their babies seem to need to breastfeed a lot, or for prolonged periods of time, and show by their crying they don't like being placed in a crib or cot for very long. Read about how to deal with frequent feeding here.

Baby refuses the breast

If your baby is very sleepy and doesn't seem interested in feeding, then do seek help. It could be that the after-effects of the birth or pain relief used during labour are affecting his responses. Other babies fight and struggle at the breast, and seem to resist it. Find out more here.

For problems that are more likely to affect your breastfeeding, as your baby gets older click here.

Further information

NCT supports 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 helpline 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.

National Breastfeeding Line (government funded) 0844 209 0920

NHS information on mastitis.

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

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

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Breastfeeding problems and concerns in the early days

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Feeding should be comfortable for both you and your baby. If you experience any discomfort, or have concerns about your baby's feeding, talking to someone who can help could make all the difference. Watch our video to find out about support for breastfeeding.

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Breastfeeding groups | Southern Health NHS Foundation Trust

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Home "Our services "Children's services "Breastfeeding support service "Breastfeeding groups

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If you get sore nipples when breastfeeding, it's usually because your baby's not positioned and attached properly at the breast.
It's important not to stop breastfeeding. With help, feeding should quickly become more comfortable again.

Get help early for sore nipples

If you find 1 or both nipples hurt at every feed, or your nipples start to crack or bleed, it's important to get help from your midwife, health visitor or breastfeeding supporter as soon as you can.

They can watch as you feed your baby and help you get them correctly positioned and attached to the breast.

When your baby is effectively attached, your nipple rests comfortably against the soft palate at the back of their mouth.

If your baby is poorly attached to the breast, the nipple is nearer the front of their mouth and can be pinched against the hard palate, causing pain.

Flattened, wedged or white nipples at the end of a feed are 1 sign your baby may not be properly attached. Your baby may also seem unsettled after feeds.

Having sore nipples when you're trying to breastfeed a new baby can be stressful and upsetting.

Try to carry on breastfeeding or express milk by hand if you can, and ask for help early.
Learn more about expressing milk by hand

Self-help tips for sore nipples

Bear in mind that self-help tips will not be effective if your baby is poorly attached during breastfeeds.

But you may find it helps to:

change breast pads at each feed (if you're using them) - if possible, use pads without a plastic backing

wear a cotton bra so air can circulate

keep feeding your baby for as long as they want - keeping breastfeeds short to "rest" your nipples will not ease nipple pain and could affect your milk supply

avoid using nipple shields (a thin, protective cover worn over your nipple as you breastfeed) or breast shells (a hard, protective cover worn inside your bra) - these will not improve your baby's attachment to the breast

If your nipples start to crack, try dabbing a little expressed breast milk onto them after feeds.

Important

Get help early if your nipples are cracked or bleeding, as this increases your risk of getting an infection in your nipple.

If nipple pain does not improve

If your baby is properly positioned and attached at the breast during feeds and your nipples are still sore, ask your midwife, health visitor or breastfeeding supporter for help.

There may be an underlying problem, such as thrush.

Video: How do I know if my baby is properly latched?

In this video, a midwife talks about how to check if your baby is latched on properly when breast feeding.

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Sore or cracked nipples when breastfeeding

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If you get sore nipples when breastfeeding, it's usually because your baby's not positioned and attached properly at the breast. It's important not to stop breastfeeding. With help, feeding should quickly become more comfortable again.

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National Breastfeeding Network Live Chat

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National Breastfeeding Network Live Chat

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The National Breastfeeding Helpline offers a web chat breastfeeding support service for mums and their supporters in the UK. This is perfect if you prefer not to access breastfeeding support via phone or drop in group. It is a confidential one-to-one secure online chat with a trained breastfeeding supporter. It works like instant messaging - it's just typing, there are no webcams, and the only people who can see the chat are you and the volunteer supporter.

How it works

If you see this sign we are available to chat. Click on the 'chat' sign at the bottom of the page to begin a conversation.

If you see this sign it means there are no volunteers available to chat at the moment. Please try again later, or call our Helpline on 0300 100 0212 between 9.30am-9.30pm
Opening hours
At the moment we do not have set opening hours for web chat, it depends when volunteers are available. If the sign says 'chat' but you are not connected to a volunteer in less than a minute, it means the volunteers are busy on other chats. Please try again later or call the Helpline.
How does live chat work?
Before you start the web chat please ensure you have a reliable internet connection. Mobile phone signals can vary and if you move around during your chat and lose signal, the chat will be disconnected.

When you click on the 'chat' button, a new pop up window will open.

If you have been given a reference number from a previous chat, you can enter it in the box that says 'reference number'. This means the volunteer you chat to will be able to see your previous conversations.

If you haven't chatted to us before, you don't have a reference number, or you don't want the volunteer to see previous conversations, no need to enter anything in the box.

When the new window appears you'll see a message that says 'please wait while an agent responds to your chat request'. If a volunteer is available to chat, she will greet you and her message will appear in your window.

You can tell when the volunteer is typing by the small icon on the bottom left hand side showing a pen writing on a notepad. The text won't be displayed as we type but only when we've completed a sentence or paragraph.

Once the volunteer's message appears, it's your turn to reply. Simply click in the box at the bottom and start typing. The volunteer won't see your message until you press enter or click on the 'send' button.

Sometimes if the volunteer has a lot to say, it might take a while for her message to appear. Please don't close the window while we're typing or you might miss out on some important information. Our volunteers will make it very clear when they are ending a chat.
Is this service confidential?
All chats are completely secure and confidential between yourself and the volunteer.
How does live chat differ from calling the Helpline?
The volunteers who answer on live chat also answer calls on the phone helpline. You will receive the same independent, non-judgemental, mother centred support and information that you would on the phone helpline.
If the volunteer (or you) feels it would be more appropriate to talk things through on the phone, she may suggest this. You can refuse this and no one will call you without you explicitly giving your permission and your phone number.

Can I save the conversation to refer back to later or print out?

At the end of the conversation, before you close the pop up window, you will be asked if you want to receive an email transcript of the call. Simply enter your email address in the box provided and a transcript will be sent directly to you. We won't use this email address for anything else.
Use the service - UK users only Page last updated February 2017

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National Breastfeeding Helpline - Live Chat Support - The Breastfeeding Network

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The National Breastfeeding Helpline offers a web chat breastfeeding support service for mums and their supporters in the UK. This is perfect if you prefer not to access breastfeeding support via phone or drop in group. It is a confidential one-to-one secure online chat with a trained breastfeeding supporter.

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Tongue-tie (ankyloglossia) is where the strip of skin connecting the baby's tongue to the bottom of their mouth is shorter than usual.

Credit:

SCIENCE PHOTO LIBRARY

https://www.sciencephoto.com/media/266498/view

Some babies who have tongue-tie do not seem to be bothered by it. In others, it can restrict the tongue's movement, making it harder to breastfeed.

Tongue-tie is sometimes diagnosed during a baby's newborn physical examination, but it's not always easy to spot. It may not be obvious until your baby has problems feeding.

See a health visitor, midwife or GP if you're concerned about your baby's feeding and think they may have tongue-tie.

Signs of tongue-tie

To breastfeed successfully, a baby needs to latch on to both the breast tissue and nipple, and their tongue needs to cover the lower gum so the nipple is protected from damage.

Some babies with tongue-tie are not able to open their mouths wide enough to latch on to the breast properly.

If you're breastfeeding your baby and they have tongue-tie they may:

have difficulty attaching to the breast or staying attached for a full feed

feed for a long time, have a short break, then feed again

be unsettled and seem to be hungry all the time

not gain weight as quickly as they should

make a "clicking" sound as they feed - this can also be a sign you need support with the positioning and attachment of your baby at the breast

Tongue-tie can also sometimes cause problems for a breastfeeding mother. Problems can include:

Most breastfeeding problems, however, are not caused by tongue-tie and can be overcome with the right support.

If you're finding breastfeeding difficult, ask a midwife, health visitor or a breastfeeding specialist for help.

Read more about breastfeeding problems and how to overcome them.

Other signs of tongue-tie

Other signs that may indicate your baby has tongue-tie include:

difficulty lifting their tongue up or moving it from side to side

difficulty sticking their tongue out

their tongue looks heart-shaped when they stick it out

Treating tongue-tie

Treatment is not always needed, if your baby has tongue-tie but can feed without any problems. If their feeding is affected, treatment involves a simple procedure called tongue-tie division.

Tongue-tie division

Tongue-tie division involves cutting the short, tight piece of skin connecting the underside of the tongue to the bottom of the mouth.

It's a quick, simple and almost painless procedure that usually improves feeding straight away.

The procedure

Tongue-tie division is done by doctors, nurses or midwives.

In very young babies (those who are only a few months old), it is usually done without anaesthetic (painkilling medicine), or with a local anaesthetic that numbs the tongue.

The procedure does not seem to hurt babies. This is because there are very few nerve endings in the area around the bottom of the mouth. Some babies sleep through the procedure, while others may cry a bit.

A general anaesthetic is usually needed for older babies with teeth, which means they'll be unconscious throughout the procedure.

The baby's head is held securely while sharp, sterile scissors with blunt ends are used to cut the skin.

It only takes a few seconds, and you can start feeding your baby immediately afterwards.

There should not be much bleeding. Your baby may get a white patch (ulcer) under their tongue, but this should heal in 1 to 2 days. It will not bother your baby.

Research suggests most babies who have treatment for tongue-tie find breastfeeding easier afterwards.

The Association of Tongue-tie Practitioners (ATP) can help you find a tongue-tie practitioner.

Older children and adults

Untreated tongue-tie may not cause any problems as a child gets older, and any tightness may resolve naturally as the mouth develops.

However, tongue-tie can sometimes cause problems such as speech difficulties and difficulty eating certain foods.

Speak to a GP if you think you or your child are having problems caused by tongue-tie.

Tongue-tie division can be carried out in older children and adults, although it's usually done under general anaesthetic.

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Tongue-tie (ankyloglossia) is where the strip of skin connecting the baby's tongue to the bottom of their mouth is shorter than usual. Some babies who have tongue-tie do not seem to be bothered by it. In others, it can restrict the tongue's movement, making it harder to breastfeed.

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Find out about colic, including what the symptoms are, what you can do to help soothe your baby, and when to get medical help.

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0300 330 5453

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A breastfeeding mother with a thrush infection of the nipple, areola and/or breast can experience pain in these areas both during and between feeds. If a baby's mouth is infected it can be sore, making him fussy during feeds.

Women describe the pain of thrush as severe, even excruciating. They dread feeds, even though they want to nurse their babies, and have real worries about how they will continue breastfeeding. Without appropriate help and support, many mothers give up breastfeeding before they are ready. The good news is that appropriate treatment can protect mother and baby from stopping breastfeeding before they are ready.

Signs and Symptoms
Research about thrush and its treatment
Eliminating other possibilities
Treatment
Hygiene
Diet
Supplements and complementary therapies
Thrush medication
Topical medication for the mother
Medication for baby
Applying ointments or creams
Oral medications
When treatment doesn't work as hoped
Eliminating thrush

Signs and symptoms

Symptoms of thrush in a baby
Your baby may have one or more of the following symptoms:

White patches inside his cheeks or on his tongue or gums. These look like left over milk. When wiped off they leave red sore areas which may bleed.

Your baby's mouth may be uncomfortable or painful, making him fussy during and between feeds. He may slip on and off the breast and may make a clicking sound.

Symptoms of thrush in a mother
Having two or more of these symptoms makes it more likely that thrush is involved, especially if these include shiny or flaking skin:

Burning nipple pain

Flaking skin on the nipple or areola

Shiny skin on the nipple or areola

A loss of colour in the nipple or areola

Painful breasts without tender spots or sore lumps

Stabbing pains in the breasts behind the areola.

Nipple thrush is more likely when:

A mother has thrush affecting any other part of her body - such as vaginal thrush.

Any other family member has a candida infection, for example athlete's foot, nappy rash or jock itch.

Mother or baby has been treated with antibiotics or corticosteroids, or mother takes the contraceptive pill.

Thrush is also associated with:
Research about thrush and its treatment

Researchers have conflicting views on the diagnosis and treatment of thrush. This is not helped by the fact that thrush can be associated with bacterial infection. It has been suggested that thrush cannot spread in milk ducts. However, some practitioners believe thrush may enter milk ducts by tracking back from skin at the nipple, causing stabbing pains in the front of the breast.

Eliminating other possibilities

Try adjusting your nursing position and your baby's latch-on before assuming pain is due to thrush. This is especially important if:

Breastfeeding has always been painful.

Your nipples are flattened, wedge-shaped or appear white after feeds.

An LLL Leader can help with this. Sudden onset of pain after a period of comfortable breastfeeding may suggest a thrush infection. Visiting your GP for a diagnosis is important as other skin diseases, including eczema, dermatitis, psoriasis, impetigo, herpes and bacterial infection can have similar symptoms to thrush. A mother may also experience breast pain for other reasons, e.g. engorgement, blocked ducts, mastitis, circulatory problems (Raynaud's syndrome) or if her baby is sucking incorrectly.

Treatment

With appropriate treatment, many women and babies overcome thrush and continue their nursing relationship. There are practical, effective steps you can take to combat thrush alongside any medication you use. Thrush spreads easily and spores linger on anything they touch ready to infect the next contact. Therefore, a fourfold approach to treatment may be needed:

Hygiene

Diet

Dietary supplements and complementary therapies

Medication.

Hygiene

Careful hand washing by all family members is essential, particularly after nappy changing or using the toilet. Wash your baby's hands too.

Keep a separate towel for each person in the family, or at least for you and your baby. Wash towels frequently at 60ºC. Or use paper towels for drying hands and dispose of them immediately.

Keep your nipples as dry as possible between feeds and, ideally, avoid breast pads. If you use breast pads choose disposable ones and wrap and dispose of them immediately after use, or wash re-usable ones immediately at a high temperature.

Wash anything that comes into contact with the affected area, immediately after use at a high temperature.

Wear a clean cotton bra every day and wash all clothes in hot water, at least 50ºC if possible. Hang in the sun to dry or dry them at a hot temperature. A hot iron can also kill yeasts.

Use sterilising fluid to regularly clean any items that could carry thrush: toys, pump equipment, bottles, teats, dummies. Or boil feeding and pump equipment for 20 minutes and replace teats and dummies weekly.

Replace toothbrushes, toiletries and cosmetics as they may have become infected.

Thrush cannot thrive in acidic conditions. Add 120 - 240ml (½ - 1 cup) distilled white vinegar to baths and in final rinses in washing machines.

Diet

When fighting any infection, eating a balanced diet and drinking enough water is a good idea. Limit sugar and other refined carbohydrates as they seem to make thrush symptoms worse. This can be a challenge as those with thrush often crave these foods. Many processed foods contain refined carbohydrates, so read food labels carefully. Note that fruits and juices contain sugar in the form of fruit sugar.

Some mothers have found that particular foods exacerbate their thrush and decide to limit them. These can include yeasty foods (such as bread, alcohol and mushrooms), dairy products or artificial sweeteners. If you decide to make major changes to your diet, you may find it helpful to consult a dietician.

Avoid giving your baby infant formula

Research has shown that bottle-fed babies are more likely to develop thrush.2 Although yeasts can grow in breastmilk, your breastmilk contains substances that help limit thrush growth. Formula, on the other hand, has high levels of added iron, which may encourage the growth of yeasts.

Avoid storing expressed milk

when you and your baby have a thrush infection. Freezing does not kill yeast cells so it's possible to reinfect your baby with thrush in stored milk.

Supplements and complementary therapies

Thrush is more common in mothers who are run down or under stress. Sweetened and processed foods are low in nutrients. So try to eat a varied diet of vitamin and mineral rich foods instead. Although scientific evidence is lacking, some mothers decide to try the following alongside prescribed medication:

Nutritional supplements from health food stores and chemists.

Therapies from registered homeopaths or naturopaths.

Altering the relative acidity (pH) of your nipple skin may reduce itching. Rinse your nipples with:

5 - 10 ml (1 - 2 tsp) of distilled white vinegar in 160 ml (1/4 pint) of water four times a day

Or 5 ml (1 tsp) of sodium bicarbonate in 240 ml (1 cup) of water once or twice a day Herbal products and essential oils should not be applied to your nipples, as it is not clear how safe they are for your baby.

Lactobacillus acidophilus tablets

Follow dosage on the packet until you are free of symptoms for 2 weeks

Grapefruit seed extract

250mg daily or 5 - 15 drops in 150 ml water 2 - 5 times daily

Garlic

3 triple strength deodorized tablets, 3 times daily

Zinc acetate or zinc gluconate

45mg daily

B vitamins

100 mg of each daily (avoid nutritional yeast)

Thrush medications

Prescribed medication

Complete the course of medication

Even if symptoms improve earlier, certain medication needs to be used for a particular period of time to clear the infection. Follow the guidelines provided with the specific medication or ask your doctor or pharmacist for more detailed guidance.

Treat both mum and baby

Thrush spreads easily, so both you and your baby need simultaneous treatment to avoid reinfecting one another - even if one of you is symptom free. Research has shown that mothers often test positive for thrush before symptoms appear.

Topical medications for the mother

When deciding whether to use medications you will want to weigh the potential benefit against the possible side effects. Treatment will depend on whether there is any inflammation or an associated bacterial infection. You can discuss this with your GP and health care team. You may find it helpful to share this page with your doctor. Doctors may prescribe one of the following creams or ointments when thrush is diagnosed. See Applying creams or ointments for information on application and oral treatment.

NYSTATIN

Nystatin

Some strains of thrush are becoming resistant to nystatin. Use for at least 14 days.

CLOTRIMAZOLE

Canestan

Risk of contact dermatitis. Clotrimazole is less effective for topical infections of the breasts than miconazole

NYSTATIN Tri-adcortyl Contains a corticosteroid. Used occasionally for persistent with triamcinolone

Tri-adcortyl

Contains a corticosteroid. Used occasionally for persistent with triamcinolone eczema-like inflammation associated with a thrush infection. Ask your doctor about safe use while breastfeeding.

Medications for baby

Treatments for thrush in a baby's mouth are in the form of liquids or gels. To work effectively, they need to be applied to all the nooks and crannies in a baby's mouth as directed by your doctor or pharmacist. Always wash your hands before and after application.

* MICONAZOLE (Daktarin Gel) is recommended as first-line treatment in children under two years.7 Due to risk of choking, manufacturers recommend it is not used for babies under 4 months of age and used only with care from 4 to 6 months. Divide each dose before applying and keep away from your baby's throat to avoid choking. If applying using a finger, keep your fingernails short.

* NYSTATIN (Nystan) oral suspension is recommended as the second-line of treatment where miconazole is ineffective or causes side-effects. The easiest way to apply this is to pour the correct dose onto a measuring spoon and apply with a dropper or swab. Discard the swab after use. If the dropper has been in contact with your baby's mouth, sterilise it before replacing in the bottle. Some strains of thrush are becoming resistant to nystatin.

Please note: Oral gel applied to your breast is unlikely to be effective; it has not been formulated for this use in this way, so will not have effective topical properties.

Applying ointments or creams

Unless your doctor states otherwise, creams (usually water-soluble) or ointments (usually oily) need to be applied after feeds several times a day for the recommended period of time and until you've been free of symptoms for at least two days. Take care to wash your hands before and after application. Wipe away any excess cream or ointment before nursing your baby. A water-soluble cream is more likely to have been absorbed by the skin. An oily ointment is best avoided as it may need removing with warm water and mild soap. Vigorous washing can cause further soreness.

* As you will be feeding your baby more often than you apply the medication, ask your doctor how often and how much to apply.
* You may find it helpful to use the cream after your baby nurses to sleep, especially if he is likely to sleep for a while.
* Resistant yeasts can replicate themselves every 30 minutes, so if thrush is persistent, ask your GP about applying the above medications in smaller more frequent doses while using the same amount in 24 hours.
* Be aware that symptoms may get worse as the thrush starts to die off, before you notice any improvement.
* Always taste a topical medication yourself as your baby will be tasting it. Some medications used for athletes foot (eg Timodine) are foul-tasting and should be avoided at all costs!

Oral treatments

Oral fluconazole (Diflucan) is usually only used when there is a definite diagnosis of thrush and topical treatments have been ineffective. A loading dose of 150-200mg followed by 100mg daily is required for up to 2 weeks. If things do not improve within this time, seek help for other causes. Although it is licensed to be given to babies in neonatal units, fluconazole is not licensed in the UK for use by breastfeeding mothers of babies under 6 months. It is only available for mothers of younger babies at the discretion of the GP.

When treatment doesn't work as hoped

Sometimes it can take time to find an effective treatment for your infection. If symptoms don't improve or get worse:
* Check for other sources of pain. An LLL Leader will be able to share information on other possible causes of nipple and breast pain.
* Check for possible sources of reinfection, especially if symptoms improved at the start of treatment. Treating any other candida infections in the family may help.
* Consider whether diet and hygiene need to be changed.

Let your doctor know if treatment was not effective or improved things only slightly:
* Another cream or ointment may be more effective if the diagnosis for thrush is certain.
* You and your doctor may need to investigate other possible causes of pain and skin changes.
* Other family members who have a candida infection may need treatment. In particular, if you have vaginal thrush, your partner may need treatment too.

If you are considering switching treatments, try the new preparation on just one side, while continuing on the other breast with the original treatment. You have two breasts so using them to experiment with treatments may help!

Eliminating thrush

It may take a little time and persistence to deal with a thrush infection and enjoy comfortable feeds once more. Sometimes it takes a little effort to find the right medication for your thrush. Many mothers have found using diet, hygiene, supplements and alternative therapies alongside any medication can make a great deal of difference and help prevent thrush returning.

Written by Sue Upstone and mothers of LLLGB

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Nipple pain

References
1. Francis-Morrill, J. Diagnostic value of signs and symptoms of mammary candidosis among lactating women. J Hum Lact 2004; 20(3): 288-94.
2. da Costa Zöllner, MSA et al. Candida spp. occurrence in oral cavities of breast feeding infants and in their mothers' mouths and breasts. Pesqui Odontol Bras 2003;17(2): 151-5.
3. Francis Morrill, J et al. Risk factors for mammary candidosis among lactating women. JOGNN 2005; 34: 37-45.
4. Francis Morrill, J et al. Detecting Candida albicans in human milk. J Clin Microbiol 2003; 41(1): 475-478. 5. Wiener,
S. Diagnosis and management of Candida of the nipple and breast. J Midwifery Womens Health 2006; 51(2):125-8.
6. Chetwynd, EM et al. Fluconazole for postpartum candidal mastitis and infant thrush. J Hum Lact 2002; 18(2): 168-71.
7. http://www.nhs.uk/chq/Pages/2448.aspx
8. Brent, NB. Thrush in the breastfeeding dyad: results of a survey on diagnosis and treatment. Clin Pediatrics 2001; 40(9): 503-6.
9. Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.
10. *Medications and Mothers' Milk. Hale, TW. TX: Hale publishing, 2010
11. Moorhead, AM et al. A prospective study of fluconazole treatment for breast and nipple thrush. Breastfeeding Review 2011; 19(3): 25-29.

This information is available to buy in printed form from the LLLGB Shop

Please note: Information is provided for educational purposes only. If you are concerned about your health, or that of your child, consult with your health care provider regarding the advisability of any opinions or recommendations with respect to your individual situation.

Copyright LLLGB 2016

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Thrush and Breastfeeding - La Leche League GB

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A breastfeeding mother with a thrush infection of the nipple, areola and/or breast can experience pain in these areas both during and between feeds. If a baby's mouth is infected it can be sore, making him fussy during feeds. Women describe the pain of thrush as severe, even excruciating.

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By Kelly Bonyata, BS, IBCLC

What is Normal?

It is normal for your breasts to become larger and feel heavy, warmer and uncomfortable when your milk increases in quantity (" comes in ") 2-5 days after birth. This rarely lasts more than 24 hours. With normal fullness, the breast and areola (the darker area around the nipple) remain soft and elastic, milk flow is normal and latch-on is not affected.

How to prevent or minimize engorgement

Nurse early and often - at least 10 times per 24 hours. Don't skip feedings (even at night).

Nurse on baby's cues ("on demand"). If baby is very sleepy: wake baby to nurse every 2-3 hours, allowing one longer stretch of 4-5 hours at night.

Allow baby to finish the first breast before offering the other side. Switch sides when baby pulls off or falls asleep. Don't limit baby's time at the breast.

Ensure correct latch and positioning so that baby is nursing well and sufficiently softening the breasts.

If baby is not nursing well, express your milk regularly and frequently to maintain milk supply and minimize engorgement.

Signs & Symptoms of Engorgement

When? Engorgement typically begins on the 3rd to 5th day after birth, and subsides within 12-48 hours if properly treated (7-10 days without proper treatment).

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How does the breast feel? The breast will typically feel hard, with tightly stretched skin that may appear shiny, and you may experience warmth, tenderness, and/or throbbing. Engorgement may extend up into the armpit.

How does the areola feel? The areola will typically feel hard (like the tip of your nose or your forehead) rather than soft (like your earlobe), with tight skin that may appear shiny. The nipple may increase in diameter and become flat and taut, making latch-on challenging.

You may also have a low-grade fever.

Moms' experiences of engorgement differ. Engorgement:

May occur in the areola and/or body of the breast;

May occur in one or both breasts;

May build to a peak and then decrease, stay at the same level for a period of time (anywhere from minimal to intense), or peak several times.

Tips for treating engorgement

Before nursing

Gentle breast massage from the chest wall toward the nipple area before nursing.

Cool compresses for up to 20 minutes before nursing.

Moist warmth for a few minutes before nursing may help the milk begin to flow (but will not help with the edema/swelling of engorgement). Some suggest standing in a warm shower right before nursing (with shower hitting back rather than breasts) and hand expressing some milk, or immersing the breasts in a bowl or sink filled with warm water. Avoid using warmth for more than a few minutes as the warmth can increase swelling and inflammation.

If baby is having difficulty latching due to engorgement, the following things can soften the areola to aid latching:

While nursing

Gentle breast compressions and massage during the nursing session can reduce engorgement.

After nursing for a few minutes to soften the breast, it may be possible to obtain a better latch by removing baby from the breast and re-latching.

Between feedings

If your breast is uncomfortably full at the end of a feeding or between feedings, then express milk to comfort so that the breasts do not become overfull.

Hand expression may be most helpful (though obviously second to breastfeeding) as this drains the milk ducts better.

Mom might also use a hand pump or a quality electric pump on a low setting for no more than 10 minutes (engorged breast tissue is more susceptible to damage). A "juice-jar" pump may also be used.

Massaging the breast (from the chest wall toward the nipple area) is helpful prior to and during milk expression.

It's not good to let the breasts get too full, but you also don't want to overdo the pumping, as too much pumping will encourage overproduction. If you do need to express milk for comfort, your need to express will likely decrease gradually over time; if it does not, then try gradually decreasing the amount you express.

Use cold compresses (ice packs over a layer of cloth) between feedings; 20 minutes on, 20 minutes off; repeat as needed.

Cabbage leaf compresses can also be helpful.

Many moms are most comfortable wearing a well fitting, supportive bra. Avoid tight/ill-fitting bras, as they can lead to plugged ducts and mastitis.

Talk to your health care provider about using a non-steroidal anti-inflammatory such as ibuprofen (approved by the American Academy of Pediatrics for use in breastfeeding mothers) to relieve pain and inflammation.

AVOID:

Excess stimulation (for example, don't direct a shower spray directly on the breasts).

Application of heat to the breasts between feedings. This can increase swelling and inflammation. If you must use heat to help with milk flow, limit to a few minutes only.

Restricting fluids. This does not reduce engorgement. Drink to thirst.

Contact your lactation consultant or health care provider if:

Engorgement is not relieved by these measures.

Baby is unable to latch or is not having enough wet/dirty diapers.

You have mastitis symptoms: red/painful breast, temperature greater
than 100.6 degrees F, chills, body aches, flu-like symptoms.

You have any questions.

Other treatments for engorgement

Cabbage

Applying cabbage leaf compresses to the breast can be helpful for moderate to severe engorgement. There is little research on this treatment thus far, but there is some evidence that cabbage may work more quickly than ice packs or other treatments, and moms tend to prefer cabbage to ice packs.

What are cabbage compresses used for?

Engorgement.

Extreme cases of oversupply, when the usual measures for decreasing supply (adjusting nursing pattern, nursing "uphill," etc.) are not working

During weaning, to reduce mom's discomfort and decrease milk supply.

Sprains or broken bones, to reduce swelling.

To use cabbage leaves:

Green cabbage leaves may be used chilled or at room temperature.

Wash cabbage leaves and apply to breasts between feedings.

For engorgement or oversupply: Limit use as cabbage can decrease milk supply. Leave on for 20 minutes, no more than 3 times per day; discontinue use as soon as engorgement/oversupply begins to subside.

During the weaning process: Leave the leaves on the breast until they wilt, then apply new leaves as often as needed for comfort.

For further information on how to use cabbage leaves:

"Juice Jar" breast pump

This simple pump can be useful to help with engorgement, and to draw the nipple out when baby is having a difficult time latching on.

Find an empty glass jar or bottle at least 1 liter in size with a 5 cm or larger opening. The type of bottle that cranberry juice comes in is often a good size.

Fill the jar nearly full with very hot water. The glass will get very hot and you will need to hold it with a towel.

Pour all the water out of the jar.

Use a cool washcloth to cool down the rim and upper part of the jar so you can touch it without burning yourself (test it with your inner arm).

Place your breast gently into the mouth of the jar so that it makes an airtight seal. Some moms lean over a table to do this, others put the jar in their lap on a pillow and lean forward. Expect this to take a few minutes, so make yourself comfortable.

As the air slowly cools inside the jar, it creates a vacuum inside the jar and this gentle suction expresses milk from the breast. Break the suction immediately if you feel discomfort - if the jar cools too quickly it may create excessive suction which can damage breast tissue.

Repeat for the other breast.

Some moms need to repeat this, others find it works sufficiently with only one try.

Fenugreek seed poultice

This is a traditional treatment for engorgement or mastitis. Steep several ounces of fenugreek seeds in a cup or so of water. Let seeds cool, then mash them. Place on a clean cloth, warm, and use as a poultice or plaster on engorged or mastitic breasts to help with let-down and sore spots. For more information, see Fenugreek.

Additional Resources

@

Reverse Pressure Softening ... aids latching when mom is engorged

@ other websites

Prevention and Treatment of Engorgement by Becky Flora, BS, IBCLC

References:

Veldhuizen-Staas C. Overabundant milk supply: an alternative way to intervene by full drainage and block feeding. Int Breastfeed J. 2007; 2: 11. doi: 10.1186/1746-4358-2-11

Cotterman KJ. Too Swollen to Latch On? Try Reverse Pressure Softening First. Leaven, April-May 2003;39(2):38-40.

Hill PD, Humenick SS. The occurrence of breast engorgement. J Hum Lact. 1994 Jun;10(2):79-86.

Humenick SS, Hill PD, Anderson MA. Breast engorgement: patterns and selected outcomes. J Hum Lact. 1994 Jun;10(2):87-93.

Lawrence R and Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. St. Louis: Mosby, 2005, p. 278-281.

Moon JL, Humenick SS. Breast engorgement: contributing variables and variables amenable to nursing intervention. J Obstet Gynecol Neonatal Nurs. 1989 Jul-Aug;18(4):309-15.

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, Texas: Hale Publishing, 2010, p. 679-683.

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 3rd ed. Boston and London: Jones and Bartlett, 2004, p. 205-207, 228.

Roberts KL, Reiter M, Schuster D. A comparison of chilled and room temperature cabbage leaves in treating breast engorgement. J Hum Lact. 1995 Sep;11(3):191-4.

Roberts KL. A comparison of chilled cabbage leaves and chilled gelpaks in reducing breast engorgement. J Hum Lact. 1995 Mar;11(1):17-20.

Smith A, Heads J. Breast Pathology. In: Walker M, ed. Core Curriculum for Lactation Consultant Practice. Boston: Jones and Bartlett, 2002, p. 175-180.

Snowden HM, Renfrew MJ, Woolridge MW. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev. 2001;(2):CD000046.

Walker M. Breastfeeding and Engorgement. Breastfeeding Abstracts, November 2000;20(2):11-12.

Wilson-Clay B, Hoover K. The Breastfeeding Atlas, Third Edition. Austin, Texas: LactNews Press, 2005, p. 109-111.

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It is normal for your breasts to become larger and feel heavy, warmer and uncomfortable when your milk increases in quantity ("comes in") 2-6 days after birth. This rarely lasts more than 24 hours. With normal fullness, the breast and areola (the darker area around the nipple) remain soft and elastic, milk flow is normal and latch-on is not affected.

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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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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 swollen, painful, inflamed and it might appear red or darker, depending on skin colour. It usually occurs within the first three months after giving birth (NHS Start for Life, no date).

Mastitis symptoms

Mastitis usually occurs in one breast, but may affect both. Symptoms usually develop quickly and might include:

What causes mastitis?

Mastitis is often caused by excess milk in the breast leading to inflammation of the milk ducts and a disruption of the makeup of the breastmilk or microbiome.

You might get mastitis because:

you have an abundant supply of breastmilk

you are feeding your baby and also expressing as well

your baby is not attached well to the breast, and you need support to find a position that is comfortable for both of you

your baby is missing feeds, or you are delaying feeds, or maybe missing feeding cues (perhaps as a result of using a dummy)

you are weaning from the breast, (it's better to reduce breastfeeds gradually).

the kind of birth you have could also affect the chance of mastitis. This is because both caesarean surgery and the antibiotics received as a result of surgery disrupt the mother's microbiome.

something is putting pressure on the breast or has bruised it; for example, a tight bra or tight clothing, bag strap, seat belt, baby carrier

Using nipple shields has been associated with an increased likelihood of mastitis

In some cases, a large breastmilk supply can cause an imbalance in the breastmilk causing the growth of harmful bacteria. This is called infective mastitis and you might need antibiotics to treat it.

(La Leche League GB, 2023; NHS, 2023; Mitchell et al, 2022)

For some women mastitis recurs every couple of weeks. This could be because:

Previous issues of attachment, position, or supply were not resolved.

Previous infectious mastitis was not resolved with antibiotics.

(Mitchell et al, 2022)

Continuing to breastfeed with mastitis

If you develop mastitis, continuing to breastfeed in response to your babies needs will help improve the symptoms and won't harm your baby. It has previously been thought that extra feeding or expressing was helpful along with breast massage, however there is now evidence this will not help and may make things worse.

(La Leche League, 2023; NHS, 2023; Mitchell et al, 2022)

Mastitis treatment

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

continuing to breastfeed in response to your baby's needs

getting lots of rest and relaxation

applying cold to the affected area

staying hydrated

using paracetamol or ibuprofen for relief from pain or fever

avoiding tight or restrictive clothes or bras until symptoms improve (see our article about maternity and nursing bras for more tips).

avoid nipple shields unless essential for feeding your baby. If using nipple shields seek support from a breastfeeding counsellor to use them without causing further issues

(NHS, 2023; Mitchell et al, 2022)

Continue with self-help measures, and if the inflammation has not cleared after 12-24 hours, or symptoms worsen (eg a fever and flu-like symptoms), you could see your GP (NHS, 2022).

You might need antibiotics to treat mastitis if there is an infection, however antibiotics will not be helpful if no infection is present. If you're breastfeeding, your GP will be able to prescribe 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

(NHS, 2023; Mitchell et al, 2022)

Some women with mastitis or recurrent mastitis can develop a breast abscess - a collection of pus, which might need to be drained surgically (Mitchell et al, 2022).

Preventing mastitis

If you find you have recurring mastitis, it's a good idea to seek breastfeeding support to help make adjustments to your baby's latch and to discuss ways to manage your breastmilk supply. It might also be helpful to check that your baby doesn't have any underlying medical conditions, such as a tongue-tie. Try to take these steps to help prevent mastitis:

If expressing as well as breastfeeding, build up the frequency slowly.

If you have infective mastitis, ask your GP about a breast milk culture to ensure the right antibiotics are being used.

When weaning from the breast, reduce breastfeeds gradually.

This page was last reviewed in July 2023
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 (open 8am to midnight every day of the year), 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.

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

Sarah Oakley's parent-friendly explanation of 'The Mastitis Spectrum'

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

You might find attending one of our NCT New Baby courses helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified Postnatal Practitioner 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.

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Mastitis: symptoms and treatment | Baby & toddler, Feeding articles & support | NCT

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Mastitis is a painful breast condition. Here we discuss its symptoms, treatment, how to continue breastfeeding with mastitis and how to help prevent it.

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The longer you feed your baby your own milk, the more they will benefit. Only giving them breast milk until they are about six months old is ideal and there are lots of benefits to breastfeeding beyond six months. Breastfeeding is something you and your baby can learn together.

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There's no one correct position for breastfeeding. Any of these styles may work well for you and your baby.

In the early days of breastfeeding, while you're still learning, you may find it easier to use the same hand for both breasts.

This means you will hold your baby across your lap to feed on one breast, and then to feed from the other breast, you'll hold your baby under your arm.

Side-lying hold:

Lying down with your bodies parallel.

Cradle hold (same arm):

Holding your baby across your lap, supporting her with the same arm as your breast.

Cradle hold (opposite arm):

Holding your baby across your lap, using the opposite arm to the breast she is feeding from to support her.

Rugby ball hold:

Holding your baby underarm.

Twins hold:

Using a cushion under your babies as you gently support them with your hands on their upper backs.

Koala hold:

Supporting your baby while she's straddled across your knees in an upright position.

Laid-back breastfeeding (biological nurturing):

Semi-reclined, with your baby lying across your stomach or shoulder.

Laid-back breastfeeding after a caesarean:

Semi-reclined, with your baby lying vertically on you, to protect your caesarean wound.

If you find a position that works for you and your baby, it's fine to stick with it. But as your baby gets older, and you become more practised, you will probably want to change positions.

Your position may also depend on where you are when you're breastfeeding.

Last reviewed: November 2013

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There's no one correct position for breastfeeding. Any of these styles may work well for you and your baby. In the early days of breastfeeding, while you're still learning, you may find it easier to use the same hand for both breasts.

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When should I feed my baby?

As a rough guide, babies need to feed at least eight to 12 times (sometimes more) over 24 hours during the first few weeks (NHS, 2019a; UNICEF, 2010). That means they'll probably need to feed every two to three hours.

Watch our video for tips on how often and how long to breastfeed your baby for.

It's best to feed babies responsively or in a baby-led way rather than sticking to a feeding schedule (WHO, 2009; Entwistle, 2013; Fallon et al, 2016). Letting your baby feed when they want will help them get the milk they need. It will also stimulate your milk supply (Infant and Young Child Feeding, 2009).

What if I'm struggling or worried about the number of feeds?

We know from the experiences of new mums that breastfeeding responsively can feel emotionally and physically challenging (Fallon et al, 2016).

A baby that breastfeeds frequently can give parents a sense of reassurance but it can also cause worry. Some people may think frequent feeding is a sign of insufficient milk, or that baby isn't getting enough breastmilk during feeds. This sometimes leads to women supplementing feeds with formula milk or deciding to stop breastfeeding (Leurer, 2015).

Try and keep in mind that a newborn baby's stomach is really small. They need to feed little and often (NHS, 2020). It's really common for babies to have a good feed and then appear to be hungry again quite quickly. This doesn't mean something is wrong or that they're not getting enough milk. It's just the way newborn babies feed (Kent et al, 2012).

All of this also means that newborn feeding is frequent. In fact, much of the time, it's not really a question of clearly-defined 'feeds' with clear beginnings and endings (WHO 1998).

Your baby knows your voice, your smell and your taste but they are much less familiar with the 'world' outside your womb. Staying close to you gives them a vital sense of safety and reassurance. This builds their confidence that they are loved and cared for (Crenshaw, 2007).

If you're worried, it can really help to talk through your concerns with a breastfeeding counsellor. So call our Infant Feeding Support line on 0300 330 0700.

Will I produce enough milk?

The more you breastfeed your baby, the more milk you will produce (Daly & Hartmann, 1995). If your baby is attached properly, and you're both comfortable and feeding them when they ask for it, you will make enough milk for them (Kent et al, 2012; WHO 2019).

How do I know when to feed my baby?

When your baby is hungry they may give you little signals, known as early feeding cues (NHS, 2019a,b). They might:

* get restless

* suck their fist or fingers

* make murmuring sounds

* turn their head and open their mouth (rooting).

Looking out for and responding to these cues is important. It can help prevent your baby from becoming upset and frustrated, which will make it more difficult to feed them (WHO, 2009). Here's what you might see...

How long should each feed last?

Every baby is different and they will go through different patterns of feeding as they grow (Kent et al, 2012). How much milk a baby needs per breastfeeding session will vary. It's best to be guided by your child (Kent et al, 2012).

Some feeds will seem to last a long time, with your baby dozing for short periods before wanting more. And more. And still more! It's normal for a young baby to be on the breast many times a day and night. 12-15 'visits' to the breast is well within a normal range (Entwistle, 2013).

As a general rule, babies who are feeding well will feed for between five and 40 minutes at each feed (UNICEF, 2010). Your baby will let you know when they've had enough milk. They will usually come off the breast themselves, look sleepy or calm, and look around (UNICEF, 2010).

During each breastfeed, your milk changes slightly. So the milk at the end of the feed is more creamy and filling than the milk at the beginning of the feed (Ballard and Morrow, 2013). Offer one breast and let your baby feed until they stop drinking. If they still appear hungry, offer the second breast - allowing them to drink as much as they want (NICE, 2015).

Should I wake my baby up to feed?

In most cases, healthy, thriving newborns will wake up for feeds and, provided they are well latched on, get all the milk they need (Australian Breastfeeding Association, 2017). But there might be reasons why a newborn might be more sleepy and therefore need to be woken up for feeds.

This includes medical reasons, such as jaundice, infection or a heart problem, or perhaps because the pain relief used during birth is still affecting them (Australian Breastfeeding Association, 2017). If you're worried your baby might be sleeping too much and this is affecting their feeding, talk to your health visitor or call our Infant Feeding Support line on 0300 330 0700.
This page was last reviewed in March 2021
Further information

We support all parents, however they feed their child. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline 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.

National Breastfeeding Line (government funded): 0300 100 0212.

Australian Breastfeeding Association. (2017) Do I need to wake my baby for feeds? Available at: https://www.breastfeeding.asn.au/bfinfo/do-i-need-wake-my-baby-feeds [Accessed 20 March 2021].

Ballard O, Morrow AL. (2013) Human milk composition: nutrients and bioactive factors. Pediatric Clinics of North America. 60(1):49-74. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/ [Accessed 20 March 2021].

Crenshaw J. Care practice #6: No separation of mother and baby, with unlimited opportunities for breastfeeding. Journal of Perinatal Education2007;16(3):39-43. Available at: doi:  10.1624/105812407X217147 (Accessed 26 Apr 21)

Daly SEJ, Hartmann PE (1995). Infant Demand and Milk Supply. Part 1: Infant Demand and Milk Production in Lactating Women. Journal of Human Lactation. 11(1):21-26. doi:10.1177/089033449501100119 Available at https://journals.sagepub.com/doi/10.1177/089033449501100119 [Accessed 13 April 2021]

Entwistle FM. (2013) The evidence and rationale for the UNICEF UK Baby Friendly Initiative standards. UNICEF UK. Available at: https://www.unicef.org.uk/babyfriendly/about/evidence-and-rationale-for-the-baby-friendly-standards/ [Accessed 20 March 2021].

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D. (2016) Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database of Systematic Reviews. (9):CD009067. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009067.pub3/full [Accessed 20 March 2021].

Kent JC, Prime DK, Garbin CP. (2012) Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 41(1):114-121. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1552-6909.2011.01313.x [Accessed 20 March 2021].

Leurer MD, Misskey E. (2015) "Be positive as well as realistic": a qualitative description analysis of information gaps experienced by breastfeeding mothers. International Breastfeeding Journal. 10(10):2-11. Available at: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0036-7 [Accessed 20th March 2021].

NHS. (2019a) Breastfeeding: the first few days. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-first-days.aspx#building [Accessed 20 March 2021].

NHS. (2019b) Breastfeeding: is my baby getting enough milk? Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 20 March 2021].

NHS. (2020) Your breastfeeding questions answered. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 20 March 2021].

NICE (2015) Postnatal care up to 8 weeks after birth. CG37. Available at: https://www.nice.org.uk/guidance/cg37 [Accessed 20 March 2021].

UNICEF. (2010) Baby Friendly Initiative. Breastfeeding checklist for mothers - How can I tell that breastfeeding is going well? Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf [Accessed 20 March 2021].

World Health Organization. (1998) Evidence for the Ten Steps to Successful Breastfeeding. Geneva: World Health Organization.

World Health Organization. (2009) Session 2 The physiological basis of breastfeeding. In: Infant and Young Child Feeding. Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Available at: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 20th March 2021].
Further reading
Hoddinott P, Craig, LCA, Britten J, McInnes RJ. (2012) A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open 2:1-14. Available at: https://bmjopen.bmj.com/content/2/2/e000504 [Accessed 20 March 2021].

Martin CR, Ling PR, Blackburn GL. (2016) Review of infant feeding: key features of breast milk and infant formula. Nutrients, 8(5):279. Available at:   https://www.mdpi.com/2072-6643/8/5/279 [Accessed 20th March 2021].

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How often should I breastfeed my baby? | Baby & toddler, Feeding articles & support | NCT

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Read our tips on when to breastfeed your baby and how much milk they need.

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When it comes to feeding their baby, some parents decide to exclusively breastfeed and some to exclusively formula feed. Many families decide to combine breastfeeding and formula feeding; this often called combination feeding or mixed feeding (NHS, 2019).

What is mixed feeding?

Mixed feeding usually means mixing breast and bottle feeding. The content of the bottle can be either breastmilk or formula milk.

Watch our video to find out more about mixed/combination feeding.

Why do some families combination feed?

You might start mixed feeding for a variety of reasons.

If you and your baby have some difficulties getting breastfeeding established or if there are concerns about your baby's weight, you might be advised to give some formula feeds alongside breastfeeding.

You might need to leave your baby for periods of time (for example, if you are returning to work).

Your partner might want to be involved with feeding.

You might be bottle feeding and want to start or resume breastfeeding.

It can be helpful to talk to a breastfeeding counsellor, a midwife or health visitor about your options and the potential impact on breastfeeding of mixed feeding (see below). You could also call our infant feeding line on 0300 330 0700.

How do I combine bottle feeding and breastfeeding?

Some families choose to express milk and feed it to their babies through a bottle. They might do this if someone else would like to feed the baby or if the mum has to be away from their baby for a while.

Others choose to substitute some breastfeeds for formula. If you want to do this, you and your baby will adjust more easily if you reduce the number of feeds gradually (NHS, 2019).

You can offer formula feeds before, during, after or instead of a breastfeed. Talk to your midwife, health visitor or a breastfeeding counsellor about this, as different options will suit different circumstances. And will also depend on what you wish to achieve ultimately.

There are some cases when formula might be given before a breastfeed (for example, with babies who are not breastfeeding well). In other cases, the formula feed might be given instead of a breastfeed. This might happen if you're not with your baby and can't breastfeed or if someone else is sharing the feeding.

Gradually cutting down breastfeeding reduces the chance of your breasts becoming uncomfortably engorged. It will also reduce your risk of developing mastitis (NHS, 2019). It helps to reduce the number of breastfeeds slowly, starting with the one which is convenient for you (NHS, 2020). If you substitute a breastfeed with a formula feed, it may take around five to seven days for the amount of milk your breasts are producing to adjust to missing that one feed (NHS, 2017).

If you 'top up' with formula during one or more feeds, rather than replacing an entire feed, this is likely to extend the gap between breastfeeds. It will also signal to your breasts to make less milk (NHS, 2020).

On the other hand, if you've been advised to 'top up' as a temporary measure and want to return to exclusive breastfeeding, it is important to express milk between feeds to prevent a decrease in the amount of milk you make (NICE, 2017). Try and feed your baby any available breastmilk before each formula feed.

What effect will combining breastfeeding and formula feeding have?

Your baby will enjoy the benefits of breastmilk, even if you're not exclusively breastfeeding. For instance, they will still gain some of the antibodies that will protect them against infection (NHS, 2019).

If you want to feed your baby with both breastmilk and formula milk, it is recommended to wait until feeding is firmly established before introducing a bottle (NHS, 2019). This can take up to a month (La Leche League, 2019).

It's best to wait until breastfeeding is established because breastmilk supply is generally driven by frequent, effective removal of milk from the breasts. Giving your baby formula reduces your milk supply, which is particularly important when you are both getting used to breastfeeding. If your baby breastfeeds less often, your breasts produce less milk (Daly and Hartmann, 1995).

You might have heard that babies can get 'nipple confusion' but there is no evidence that this exists (Kotowski et al, 2020).

How many breastfeeds does an older combination-fed baby need?

Older babies, beyond the newborn stage, can maintain your breastmilk supply alongside formula feeding as long as you breastfeed several times a day. Much older babies - from eight or nine months - can breastfeed just a handful of times a day, and there is still a supply.

Very well-established breastfeeding, with a baby who is one year or older, can continue with as few as one or two feeds in 24 hours.

If your baby is over six months they can use a beaker or cup rather than a bottle (NHS, 2020).

Tips to introduce a bottle to a breastfed baby

You might find your baby does not want to take a bottle at first. The different sensations may confuse them and they don't know the bottle contains food. But there are lots of different things you can try to help your baby:

Offer a bottle when your baby is relaxed and happy, rather than very hungry.

Maybe ask someone else to offer a bottle so they can't smell their mother's milk.

Try softening the teat with warm, boiled water.

Hold your baby in a different position from their usual breastfeeding one. It might help your baby get used to the new way of feeding.

Try a different bottle or teat, this might make a difference.

(La Leche League, 2019)

Unicef (2016) recommend feeding responsively, which means following your baby's cues, whether breastfeeding or bottle feeding. They also recommend using paced bottle feeding. The way a baby is fed with the bottle can affect their comfort, their control of the amount of milk they drink, and the transition between breast and bottle (Kotowski et al, 2020).

Tips for paced bottle feeding

Hold your baby upright, close to your body. (If your baby is lying back, they are less able to control how much milk they swallow, so they can overfeed.)

Touch the teat against the baby's top lip to encourage them to pull it into their mouth.

Hold the bottle horizontal, so that when the baby is actively sucking, they get milk and when the baby is pausing, they don't get milk.

Give the baby several breaks by removing the bottle from their mouth.

Watch what the baby is doing, rather than how much milk they have drunk. End the feed when the baby is no longer drinking.

(UNICEF, 2016; La Leche League, 2019)

This all helps to build a close, loving relationship, a responsive feeding relationship, and avoids overfeeding your baby.

Where can I go for breastfeeding support?

If you have questions, concerns or need support, you can speak to one of our breastfeeding counsellors by calling our infant feeding 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.

Further information

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

Best Beginnings has video clips from the 'Bump to Breastfeeding' DVD.

UNICEF have produced a summary guide for parents on how to responsively bottle feed babies.

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Mixed feeding: combining breastfeeding and bottle feeding | Baby & toddler, Feeding articles & support | NCT

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Here we look at mixed feeding your baby, which is combining breastfeeding and bottle feeding