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Please ask your midwife to go through these topics with you during your pregnancy, to help you prepare for feeding.

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You might have questions about medicines you are taking, or what to do if you have a cold or sore throat. You might want to have an alcoholic drink whilst breastfeeding. You might be unsure about a beauty treatment, or a medical procedure.

These links help you know if these things are safe & what to do.

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Breastfeeding shouldn't hurt! If you are experiencing pain with feeding, please check in with your midwife, health visitor or come to one of the groups for support. Often it is about helping you hold your baby in a way they can latch deeply, but if that doesn't help, there may be other reasons which you can read about below.

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Have a look down this column to help you find out about breastfeeding & breastmilk.

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For information about feeding your baby in a language other than English, please look at the links here. For YouTube videos, you may be able to view them with subtitles in your preferred language.

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Please use this column to find out where to get support with feeding. If you live outside of Hillingdon, please scroll further down, or ask your midwife or health visitor.

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Some local social media for you to link to - On our Facebook page, you will find updates, or notifications about any last minute changes to the drop-in support groups.

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Having a premature baby, or more than one at the same time, brings their own unique challenges!

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These links help you through common problems and concerns around feeding, or if your baby seems to be uncomfortable.

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A quick guide folder of feeding information, put together by our Infant Feeding Team at Hillingdon

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A quick guide folder of feeding information, put together by our Infant Feeding Team at Hillingdon

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Learning to hold your baby in a way that they can attach (latch) to your breast well takes practice... please ask for support and try different positions until you find what works for you.

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You might find yourself needing to express your milk from time to time, for example, if baby is sleepy in the first few days, if you have to be away from your baby, or if your breasts are feeling too full and baby is finding it difficult to latch on deeply.

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In this column, you will find information on how to help breastfeeding get off to a good start.

Find out about skin to skin, knowing how your milk supply works, how often you baby will feed, and some information for your partner and baby's grandparents to know how to support you.

All this in combination help to get feeding going well.

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Breastfeeding is healthiest choice, and has numerous benefits for you and your baby. The World Health Organisation therefore recommend that babies are exclusively breastfed for the first 6 months, then alongside solid foods until 2 years or beyond.

If you are thinking about, or have already started giving formula supplements to your baby because you are having a problem with breastfeeding or worried about your supply, please reach out for support. Our contact details are in the 2nd column of this padlet page.

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Meeting your baby - skin to skin contact.

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Meeting your baby - skin to skin contact.

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Skin to skin contact helps your baby feel secure and for you to connect with him or her. It has many benefits including helping your baby learn to feed.

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

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How can I tell that breastfeeding is going well?

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How can I tell that breastfeeding is going well?

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This quick guide asks those key questions to help you know if breastfeeding is going well...

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Safety concerns about formula preparation machines 

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Safety concerns about formula preparation machines 

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Due to ongoing reports that there are concerns about the safety of feeds made using formula preparation machines, we do not recommend their usage. This link tells you more about that.

See further down this column for information on how to make up formula feeds safely.

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It is important that infant milks are made up safely. Powdered infant formula is not sterile and needs to be made up at a temperature which will kill any potential bacteria present. All equipment needs to be sterilised, and it is important to know how to make up and store milk safely.

The bacterial contamination of powdered infant formula

This report summarises evidence about the known risks associated with potential bacterial contamination of powdered infant formula (PIF). We believe that maintaining the minimum 70 ⁰ C water temperature for making up PIF is essential but also recommend a review of water cooling times and alternative preparation methods. In addition, we recommend an urgent independent review by the Food Standards Agency of risks and/or benefits of the use of probiotics in infant milk products bearing in mind the known risks associated with potential pathogen presence in PIF.

Information and our concerns about formula preparation machines (including the Tommee Tippee Perfect Prep machine) can be found on pages 37-40 of this report.

Latest evidence on formula preparation devices

In October 2023 a paper was published which confirms that, despite their marketing claims, formula preparation devices often do not deliver water hot enough (i.e. at least 70˚C) to kill any bacteria that may be in the powdered infant formula.

The FSA are advising parents/carers to check that the temperature of the water used to prepare infant formula is at least 70˚C "regardless of the method used", and that if that is not the case for those using an infant formula preparation machine, that they should contact the manufacturer and their local Trading Standards Department or Citizens Advice.

The UK's product safety regulator, the Office for Product Safety and Standards has purchased examples of the infant formula preparation machines to assess compliance and have said that, if necessary, UK consumers will be informed of any actions they might need to take.

The safest way to prepare infant formula is using a kettle, following NHS guidance

If you use a formula preparation machine, we suggest: Check the temperature of the water dispensed using a food thermometer. Always do this separately to making a bottle as the thermometer can contaminate the water. If the temperature if below 70 degrees: - Use a kettle instead to make up bottles following NHS guidance - Report to your manufacturer. Scan QR code for NHS advice: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/making-up-baby-formula

Guide to bottle feeding:
How to prepare infant formula and sterilise bottles

Guide to Bottle Feeding by UNICEF Baby Friendly, Better Health Start for Life and the NHS provides information on safe preparation and storage of infant milks.

It is important that infant milks are made up safely. Powdered infant formula is not sterile and needs to be made up a temperature which will kill any potential bacteria present. All equipment needs to be sterilised, and it is important to know how to make up and store milk safely.

Making up bottles of infant formula from hot taps and baby kettles

More kitchens are now fitted with hot water taps dispensing boiling water directly. This statement provides some information to support families making up formula this way to do so safely.

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Making infant milk safely - First Steps Nutrition Trust

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It is important that infant milks are made up safely. Powdered infant formula is not sterile and needs to be made up at a temperature which will kill any potential bacteria present. All equipment needs to be sterilised, and it is important to know how to make up and store milk safely.

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Your baby wants to feed whenever they are hungry, thirsty, for a snack, or for comfort & security.

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A newborn baby spends most of their time sleeping and feeding but how often should a newborn feed? Should you wake a sleeping baby to feed? This article looks at how often babies need breast milk and how much, how to tell if a baby is breastfeeding well, and is a companion article to Breastfeeding a Sleepy Baby.

Find an IBCLC

Search for a breastfeeding expert near you

How often should a newborn feed?

Breast milk is easily and quickly digested-even as quickly as one hour-and babies have tiny tummies so they need to feed little and often. Typically a newborn baby will breastfeed at least 8-12 feeds in 24 hours ie breastfeeding every two to three hours from the start of one feed to the start of the next-which ties in with a newborn's sleep pattern. Some babies may feed more frequently e.g. every hour at first or they may cluster feed ie have lots of feeds close together at certain times of the day. Frequent breastfeeds will provide plenty of breastfeeding practice, provide baby with a steady supply of food and stimulate the breasts to make more milk.

Storage capacity

Another factor governing how often babies feed is the amount of breast milk a breast can store between feeds (storage capacity). Breasts have different amounts of glandular or "milk making" tissue regardless of the outward size or appearance. One mother may be able to store 90ml (3oz) or 150ml (5oz) in each breast whereas another might store considerably less. In an individual mother, one breast might store 60ml (2oz) and the other half this amount; or any combination between. Storage capacity will affect how often a baby will feed, because the smaller the amount of breast milk available, the more often a baby will want to breastfeed. Exactly how often or how much a baby is getting at each feed doesn't matter as long as that baby is able to breastfeed well and whenever he wants. For more information on storage capacity see One Breast or Two Per Feed?

Is colostrum enough for a newborn baby?

Colostrum is the name for the first breast milk that is present before and straight after the birth, it is low in volume but high in protective factors for the baby. Most healthy newborns arrive well nourished and only need small amounts of colostrum until a mother's milk volume increases (or "comes in") around the third day after birth. These small volumes are the perfect amount for a healthy newborn to practice breastfeeding. Although a newborn may sleep a lot (particularly in the first 24 hours) and may not need very much milk at a time in the first few days and nights of life, breast milk is quickly digested and babies still need to feed every two to three hours or more often.

How long will my baby sleep?

How long a newborn baby might sleep will depend on how much milk they can get during a breastfeed and how many feeds in total they get during any given 24 hour period. Babies tend to sleep for two or three hours at a time and then wake to breastfeed.

Sleepy baby

Some babies can be particularly sleepy and it's usually a good idea not to let your breastfed newborn sleep much longer than two to three hours between feeds in the day and four to five hours at night. If your baby is sleeping longer than this, is difficult to wake to feed or falling asleep as soon as they latch on, see Breastfeeding a Sleepy Baby.

When should I breastfeed my baby?

Babies can tell us when they are ready to feed by giving hunger or feeding cues. A baby's feeding cues can be quite subtle such as:

moving, fidgeting or fussing

sucking their fingers or fists

opening their mouths and turning their head to search for the breast (rooting)

crying (a late hunger cue).

Babies are more likely to breastfeed when they are in light sleep (eyes moving under their eyelids/or starting to fidget) and/or showing hunger cues.

How can I tell if my baby is feeding well?

Although babies can feed well in light sleep, just because a sleepy baby is attached to the breast ("latched") this is not a guarantee that they are drinking well. It's important to be able to distinguish active feeding from flutter sucking and comfort nursing. When a baby is feeding actively, even if they look like they are asleep, the baby's jaw will move as they suck and they will swallow regularly e.g. in a pattern of one or two sucks per swallow for 10-15 minutes or more at a time from one or both breasts. The length of time a baby is attached to the breast is not as important as how effectively that baby is feeding. Even if a baby is latched on for an hour, if he isn't feeding actively with plenty of swallows of milk he might not be getting enough milk. An IBCLC lactation consultant can help you assess how well your baby is feeding if you're not sure.

Latch is important

A baby's attachment at the breast (latch) affects how easily they can keep milk flowing during a breastfeed. If a baby is mostly sucking on the nipple without a big mouthful of breast tissue, he is more likely to fall asleep after the initial let-down when the flow slows, and breastfeeding is more likely to hurt. Flat, inverted or large nipples can make it more difficult for a baby to get a good latch and a baby with a tongue-tie might find it difficult to feed effectively. See Latching Tips for ideas to help your baby get a deeper latch and contact a breastfeeding specialist if you need help. Pain, sore nipples, and prolonged engorgement are signs that you may need help with breastfeeding.

How can I tell if my baby is getting enough milk?

Although we can't see how much breast milk a baby has taken from a breast, knowing how to spot active feeding, listening for swallows of milk, monitoring your baby's dirty nappies, and weighing your baby regularly will all help confirm they are getting enough milk. For more information on gauging your baby's milk intake see Is My Baby Getting Enough Milk? Breastfed Baby Poop and Understanding Your Baby's Weight Chart.

Listen for swallows. Is your baby feeding actively?

Check dirty nappies. Are you seeing at least three dirty nappies with soft mustard coloured poop by day four or five?

Weigh your baby. Check your baby's weight regularly. If they are not gaining appropriate amounts of weight they may need help to get the milk they need.

The following video from Global Health Media discusses how to tell your baby is getting enough milk including how to tell your baby is drinking well at the breast (skip to two minutes in to see effective sucking and swallowing).

Baby not gaining weight

Although many babies lose a little weight at first, normal weight gain after the first few days of life is 30-40g (1oz) per day. If your baby is finding breastfeeding difficult or is sleepy and not gaining weight-or very little-keeping him well fed is often the key to him getting better at breastfeeding and being less sleepy. An intense pumping routine will both protect your milk supply and provide a breast milk supplement to feed him. Urgent breastfeeding support from a breastfeeding specialist can check whether attachment, positioning, tongue function or other reasons for low milk supply are involved.

Take action sooner rather than later

The sooner you can turn things around the quicker breastfeeding can get back on track. If a baby is sleepy or not breastfeeding well, there is no advantage to just keep weighing him without taking action in the hope that their weight will miraculously pick up on its own. To get changes you will likely have to make changes. Sometimes simply improving the latch and position, using both breasts per feed, using breast compressions and reminding a sleepy baby to breastfeed every couple of hours will be enough. If this doesn't improve weight gain within 24-48 hours however, an intense routine of pumping and topping up to satiety after breastfeeds can turn things around quickly see Baby Not Gaining Weight and Supplementing an Underweight Baby for much more information.

How much milk do newborn babies need?

A rough guide to the amount of milk a newborn baby might need every two to three hours is copied below. The amounts change as baby grows and may fluctuate daily with growth spurts or periods of illness. Some babies may need more or less than these amounts. Although we can't see how much milk a breastfed baby is getting direct from the breast; feeding well on demand (at least 8-12 feeds in 24 hours), having plenty of wet and dirty nappies, and gaining 30-40g (1oz) per day in the first three months are good signs of getting plenty of milk.

First 24 hours: 2-10ml breast milk per feed

24-48 hours: 5-15ml breast milk per feed (ABM, 2017)

48-72 hours: 15-30ml (o.5-1oz) breast milk per feed (ABM, 2017)

72-96 hours: 30-60ml (1-2oz) breast milk per feed (ABM, 2017)

2-3 weeks: 60-90ml+ (2-3oz+) breast milk per feed

1-6 months: 90-150ml (3-5oz) breast milk per feed or a total of 750-1035ml per day (25-35oz) (Mohrbacher, 2010)

Summary

Babies feed frequently because they have small tummies, breast milk is quickly digested and they need to feed a lot in order to double their weight in the first four to six months of life. Exactly how often a baby breastfeeds doesn't matter as long as they are fed frequently on demand (at least 8-12 times in 24 hours) and they are getting the milk they need to grow. There are lots of ways to tell if a breastfed baby is getting enough milk without measuring the volume. A newborn baby should feed as often as they want to!

Footnotes & References

1. Normal Sleep Development, Baby Sleep Info Source (BASIS), 2019

2. Colson S et al, Biological nurturing increases duration of breastfeeding for a vulnerable cohort MIDIRS Midwifery Digest 13:1, 2003

3. Mohrbacher, Breastfeeding Answers Made Simple, 2010 p 237

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How often should a newborn feed? This article looks at how often babies need breast milk and how much, and how to tell if a baby is breastfeeding well.

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Does my baby need to feed at both breasts each time?

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Does my baby need to feed at both breasts each time?

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Offering both breasts at each feed in the early weeks is key to getting breastfeeding off to a great start. This article tells you to know when to switch and other tips to get the most out of a breast feed.

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Should a baby have one breast per feed or both sides? This article looks at how breastfeeding works to help understand whether a baby needs one breast or two per feed, how often a baby might want to breastfeed and what to do if a baby needs more milk.

Find an IBCLC

Search for a breastfeeding expert near you

Breasts make different amounts of milk

How much breast milk a breast can store varies from mother to mother and even from breast to breast within the same mother. How much breast milk a breast can store is known as the storage capacity. A mother with a small storage capacity can make just as much milk in 24 hours as one with a large storage capacity but she will need to feed her baby much more often.

Size doesn't matter

It's not possible to tell how much breast milk a mother's breasts can store by looking at purely the size of the breasts because the amount of fatty tissue will control the cup size. It is the amount of glandular tissue (milk making tissue) within the breast that controls the amount of milk stored between feeds. So how can a mother know what her storage capacity is and whether her baby needs one breast or two per feed?

One breast or two per feed?

Let your baby decide! The only person who can tell you how often he needs to feed is your baby. Only your baby knows when one breast is empty and whether he needs the milk from another breast straight away to fill him up or in half an hour or two hours. Put another way, if a mother can store 50ml in each breast her baby might want both breasts per feed. Whereas the baby of a mother who stores 120ml in each breast may only want one breast per feed. You don't need to know how much milk is stored so long as a baby is:

fed on demand

allowed to finish the first breast of his own accord before offering the second side (or third or fourth)

has plenty of dirty nappies and is gaining weight appropriately and thriving

All breast milk is good

You may come across the idea that there are two kinds of milk in a breast; low fat foremilk at the start of a feed and high fat hindmilk that arrives towards the end of a feed. Taken a step further you may have heard that the foremilk is like a drink or a soup starter but the hindmilk is the more important "meal" and "pudding". It can be confusing and unhelpful to think of breast milk in terms of two kinds of milk because all breast milk is good. See Forget About Foremilk and Hindmilk to explain why you don't need to worry about this. Confusion about foremilk and hindmilk can lead to harmful advice such as in the following example.

My health visitor told me to keep to one breast per feed to reach the hindmilk

Keeping to one breast "to reach the hindmilk" is a very common myth but is poor general advice because:

Staying on one breast can reduce a milk supply

Keeping a baby on one breast per feed-or for a specified block of time-is generally a way to decrease a breast milk supply. Offering the other breast after your baby has finished the first side, or switching between breasts (see box) is generally a way to increase a milk supply.

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

If you have a high storage capacity and an abundance of milk, keeping to one breast per feed, or for a block of time, may work well.

If you are not sure whether you have a low or high storage capacity, check with an IBCLC lactation consultant who will take a full history and check on your baby's weight gain and dirty nappies.

Switch nursing involves switching (changing) breasts a couple of times during a breastfeed to keep a sleepy baby feeding and can help to increase milk supply. Start by letting your baby feed on the first breast until their sucking slows right down or stops and then move him across to the other breast. The faster flow of another let down on the second side will keep him interested in feeding, then, once sucking slows on this breast, swap back to the first breast and so on. Switch nursing can be combined with breast compression; once sucking slows on each side try breast compression to keep your baby feeding actively before offering the next breast.

An underweight baby needs more milk

When weight gain is an issue, the answer is almost always that the baby needs more breast milk rather than a few more drops of higher fat milk from one breast:

When a baby isn't gaining weight they most likely need more milk, not more time on an already empty breast which will further reduce a mother's supply. An extra 7-8 ml of high fat milk from the same breast is no substitute for the extra 70-80 ml of fore-hind-and-in-the-middle-milk they might need from the other breast.

Making more milk

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

Whenever a breast is full, milk production slows down

Whenever a breast is emptied regularly, milk production increases

More frequent feeds, breast compressions, and using both breasts per feed are all strategies to make more milk and see How to Make More Milk on this website.

Sometimes one breast, sometimes two

Let your baby decide whether he wants one breast or two per feed and whether he wants to feed again in 30 minutes or two hours. Start each new feed with the breast that baby finished on last. Breastfeeding authors Mohrbacher and Kendall-Tackett explain:

Once your milk increases on the third or fourth day, most babies take one breast at some feedings and both breasts at others. This strategy relies on your baby's ability to tell you what he needs. As with us adults, some babies are fast eaters and some are slow eaters. So a clock will never tell you when your baby is done. (How would you feel if, in the middle of your meal, someone pulled your plate away?) Only your baby knows for sure when the flow on one breast has slowed down to the point where he is ready for the other side. Only he knows when he has had the right amount of milk for that feeding.

Lopsided?

It's very common for one breast to have more milk than another or for a baby to have a favourite side-perhaps they prefer one nipple over another or the flow of milk on one side feels just right. Over time the favourite side will usually compensate and produce more milk while the least favourite side will slow down production. This can cause breasts to be lopsided for a while but after breastfeeding ends they will even out again. If a mother is concerned about the size difference

Try to recreate the same position from the favourite side on the other breast. For example if baby prefers the cross cradle hold on the left side, try rugby hold on the right so that baby's body position on that side mimics their position on the favoured side.

Pumping with a good breast pump can help to increase the milk supply on the least favourite side-when there is more milk it is likely to be more desirable again to your baby.

What if my baby falls asleep at the breast? Is this a bad habit?

It is quite normal for a baby to enjoy sleeping in his mother's arms with the breast in his mouth, sometimes this is called comfort nursing. Breastfeeding your baby to sleep need not be a problem when coupled with good weight gain. However, watch for the baby who "hangs out at the bar without buying any drinks" i.e. he is latched on but actually he is barely swallowing anything before getting tired and falling asleep half way through the first side. Consult with your IBCLC if this is the case to get breastfeeding back on track with a care plan tailored for you and your baby and check out Breastfeeding a Sleepy Baby, Is My Baby Getting Enough Milk? or Baby Not Gaining Weight. For more information about comfort nursing see Flutter Sucking and Comfort Nursing.

I'm still not sure when to feed him!

When your baby shows early feeding cues such as sucking his fist or fingers, or moving his head side to side with an open mouth; offer him the breast. If you miss the early cues he may have to cry to get your attention, but you don't have to wait for crying; babies latch best when they are calm and before they get ravenous.

Breast milk is easily and quickly digested-even as quickly as one hour-and babies have tiny tummies so they need to feed little and often. It is usually recommended that a baby has at least 8-12 feeds in 24 hours i.e. that they breastfeed every two to three hours from the start of one feed to the start of the next and this ties in with a newborn's sleep patterns. Some babies may feed more frequently e.g. every hour at first. Frequent breastfeeds will provide plenty of breastfeeding practice, provide baby with a steady supply of food and stimulate the breasts to make more milk.

How can I tell my baby has finished feeding?

Check that your baby is feeding well by watching his jaw move and listening for swallows, there is more information in Is My Baby Getting Enough Milk? As the feed progresses his rhythmic sucking will slow down to flutter sucks with less frequent swallows; he may fall asleep and/or let go of the breast to signal he is finished. If you feel he hasn't drained the breast properly or has fallen asleep before he finished, you can try some breast compressions to get him sucking again, when he stops sucking with the compressions, offer the second side. Sometimes he may want the second side and sometimes he might not.

Offer the breast frequently

There is a lovely passage in the Womanly Art of Breastfeeding that helps explain how often to feed a baby by comparing the breast to a snack tray:

When you're at a party, the hostess doesn't usually ask if you're hungry before she passes the snack tray. She offers frequently, and you decide whether to eat or pass it on. You're the one with the breast "snack tray", why not be a good hostess and offer whenever your baby seems unsettled? No need to force the issue if you've guessed wrong. But your baby can't nurse if the offer isn't made.

Isn't he just using me as a pacifier?

Not at all! Nursing feeds him, pacifies him, puts him to sleep, comforts, reassures and relaxes him. If you offer your breast only as food and not as a "pacifier", you'll cut out all the calories he gets along with those other reasons, you're more likely to end up with supply problems, and you'll lose the pleasure of-literally-going with the flow. The phrase "he's just using you as a pacifier" works against confident, smooth-running breastfeeding. Nursing is how a baby grows; why hold back?

Summary

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

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One breast or two per feed? Let your baby decide! Only he can tell you when one breast is empty and whether he needs another straight away.

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How to know your baby is drinking well at your breast

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How to know your baby is drinking well at your breast

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Knowing how to tell your baby is swallowing milk is so reassuring - this video shows that in action.

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How to recognise when a  baby is drinking well

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How to contact the infant feeding teams for the hospital and health visiting, plus where to go for support in Hillingdon.

Please note: sometimes the groups cannot run - over Christmas for example. Check the Facebook page or ask your Midwife or Health Visitor for the changes over these times.

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July 2025 Hillingdon Infant Feeding Support A4

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Unicef UK Baby Friendly Initiative | Positioning and attachment

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If you are thinking of supplementing breastfeeds with formula

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If you are thinking of supplementing breastfeeds with formula

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Frequently asked questions about giving formula.

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With the right support and information, most mothers can make more than enough breast milk to keep their babies well fed. But what if breastfeeding is not going well or a baby seems hungry? What if there seems to be no breast milk after delivery or there are reasons for low milk supply? Or perhaps a mother is returning to work and is considering supplementing with formula. This article looks at parents' frequently asked questions and concerns about supplementing with formula or combination feeding when their baby is breastfed.

Find an IBCLC

Search for a breastfeeding expert near you

Do I really need to give supplements?

Exclusive breast milk is the biologically normal diet for a baby and many parents do not plan to use infant formula. When faced with a situation where a baby isn't gaining as much weight as expected or seems hungry or unsettled, it can be confusing to know whether supplements are needed. There are several ways to check whether a baby is getting enough breast milk before starting formula top ups and there are several ways to increase a breast milk supply too. See Is My Baby Getting Enough Breast Milk? and How to Make More Breast Milk for more information, and your health professional and IBCLC lactation consultant will guide you.

Baby not gaining weight

Up to 7% weight loss in the first few days is considered normal. But if your baby is not gaining weight within the normal range after this time, he may need more food. Your baby may become more and more sleepy and is in danger of becoming very weak, dehydrated or unresponsive unless he gets enough to eat. See Baby Not Gaining Weight, Understanding Your Baby's Weight Chart and Supplementing an Underweight Baby for more help.

Supplements may be needed

There are lots of ways to help your baby get more breast milk including more frequent feeds, using both breasts per feed, improving your baby's latch and positioning, or pumping your milk to provide a top up. An IBCLC lactation consultant can help you get breastfeeding back on track as soon as possible. Even so, building a very low milk supply can take time and a full supply may not always be possible. Until you have enough breast milk to keep your baby well fed, you may need to look at alternatives. Using donor breast milk is one possibility. If donor milk is unavailable you may need to consider using a commercial infant formula for a while. Babies can and do thrive on industrial baby formula despite its imperfections. It is important to keep your baby well fed.

What are the differences between breast milk and formula?

Breast milk is very different to formula. Breast milk is a natural complete food, made fresh in the breast from a mother's blood. It contains living cells to both protect a baby from illness and provides calories to grow. Breast milk includes friendly bacteria and enzymes to help the baby's digestion. In comparison, formula is a man-made processed food produced in a factory with a set shelf life. It doesn't have any living cells, immune factors or digestive enzymes and is therefore missing many ingredients compared to breast milk. The ingredients in formula compared to what has been found so far in breast milk are listed in What's In Breast Milk and What's In Formula? (Bellybelly, 2016) or as a poster here (pdf) and there is much more information in Is There a Difference Between Breast Milk and Formula? For more about how formula is made see Maureen Minchin's book Milk Matters: Infant Feeding and Immune Disorder.

How could supplementing with formula affect my baby?

Topping up with formula can mean:

A change to the balance of friendly bacteria (microbiome) living in the baby's gut. The microbiome will change from mostly friendly bifidus flora (bifidobacteria and lactobacilli) into the less desirable strains that are usually found in adult guts. This could reduce protection against infections and could influence long term health. Whether or not the microbiome can be reestablished with exclusive breastfeeding is not clear. Marsha Walker suggests it can return after two to four weeks of exclusive feeding while Linda Palmer questions whether this is possible if any formula is given in the first seven days of life . Sullivan et al call for more research on the health impact of introducing formula to a breastfed baby's gut microbiome, particularly when supplements are introduced later in life after the gut microbiome is established. Antibiotics also affect the microbiome.

Your baby may have less protection from allergies, they could become sensitised to cows' milk or have an increase in atopic disease such as asthma or eczema (Walker, 2014). Inflammation, hypersensitivity or autoimmune disorder are also associated with allergy (Minchin, 2015).

Your baby may have an increased risk of developing diabetes and other health issues.

Your baby may begin to prefer a bottle if he realises a bottle gives him food yet he finds himself still hungry and frustrated at the breast. See ideas below for alternative feeding methods to try to prevent this.

Your milk supply could drop if you do not try to build your breast milk supply alongside using formula. With the help of a breastfeeding specialist and a care plan tailored to you and your baby, supplementing with formula does not have to mean the end of breastfeeding.

A baby will still get some of the advantages of breast milk and the benefits of correct formation of his mouth and airways by whatever amount of breast milk and breastfeeding a mother can manage.

What is the best formula for breastfed babies?

It's not possible to recommend one formula brand over another. Author Maureen Minchin has studied and compared the ingredients of many formula brands and found they all contain very different ingredients. Ingredients can also change within the same brand according to the cheapest available at a certain time. Formula labels can be very vague too-failing to include potential pollutants from the manufacturing processes or the risk of bacteria in a non sterile product . With no two formulas being the same, Minchin says that nobody knows which infant formula is "best". For further information on varieties of formula see Types of Formula, NHS, 2019 and Infant milks: A simple guide to infant formula, follow-on formula and other infant milks from First Steps Nutrition Trust. See below for notes and further reading on some of the alternatives to powdered cows' milk formula.

Ready to use liquid formulas

Powdered formula is not a sterile product. Wambach and Spencer say that ready-to-use preparations are the least risky option because they are sterile.

Low allergy formulas (hydrolysed)

Specially marketed low allergy brands of formula should not be assumed to be "safer" or "better" for general use. Some children still react to partially hydrolysed formula and there is no evidence that even extensively hydrolysed formula brands prevent allergies. In some cases, poor bone health has been associated with certain specialist formulas. For a full discussion and nutritional analysis of partially hydrolysed infant milks, extensively hydrolysed peptide-based milks and amino-acid based infant milks see Specialised Milks for Infants with Allergies in the UK Information for health professionals (January 2021) from First Steps Nutrition Trust.

Goats' milk formula

Goats' milk formulas are very similar to those based on cows' milk with the same digestibility and potential to create allergies:

Infant formula can be made from cows' milk, goats' milk, soya bean or hydrolysed proteins. Infant formula made from goats' milk has to have the same amino-acid composition as infant formula made from cows' milk and there is considered to be no difference between first infant formula made from cows' milk protein or goats' milk protein in terms of their allergenicity or their digestibility (EFSA, 2012). It is important that health professionals are aware that goats' milk-based infant formula are unsuitable for infants with cows' milk protein allergy.

Soy based formula not recommended

In UK, soya protein based formula is not recommended for general use under six months of age. First Steps Nutrition Trust explains:

The carbohydrate source in soya protein-based infant formula is maltodextrin rather than lactose, these milks therefore have a greater potential to cause dental caries than animal milk based infant formula.
Concerns have been raised over the potential allergenic effect of soya protein-based infant formula in infants at high risk of atopy and over the effects that the phyto-oestrogens present in soya protein-based formula might have on future reproductive health.

The UK government advises that soya protein-based infant formula should only ever be used if it has been recommended or prescribed by a health visitor or GP, and then only from 6 months.

What about homemade formula?

Industrially made formulas may not be perfect but homemade formula could present a greater health risk to a baby. The Department of Health for Western Australia discusses some of the potential dangers of homemade recipes in Risks to Your Baby of Home-Made Infant Formula. Maureen Minchin, Australian author and breastfeeding advocate, explains that homemade formulas do not come close to industrial versions and cautions:

No one can hope to mimic these complex foods by making homemade formulas. Yes, children will survive pretty much anything-but with consequences. This is a field in which a little knowledge misapplied could be a very dangerous thing.

Can you mix breast milk and formula?

Mixing breast milk and formula in the same container is not recommended because:

Formula can interfere with the antibacterial benefits of breast milk.

Mixing milk could mean wasted breast milk if baby doesn't finish the bottle.

Formula doesn't last as long as breast milk so mixing milk would shorten the time breast milk could be stored safely.

Because breast milk is so much more valuable to your baby, the recommendation is to feed expressed breast milk supplements first rather than mixing breast milk with formula. Pausing between giving formula after breast milk will allow time for the breast milk to start to leave the stomach (e.g. between 20 minutes and one hour). Waiting will not always be practical with a hungry baby.

The research on mixing breast milk and formula

Most of the studies looking at mixing breast milk and formula have been done by studying the effects of human milk fortifier (see below) added to expressed breast milk. Studies by Chan et al and Quan et al found that the cows' milk protein in human milk fortifier and normal formula can prevent some of the important anti-infective properties in human milk from working. Iron and iron-enriched formula were also found to affect the antimicrobial actions of breast milk.

What is human milk fortifier?

A human milk fortifier is an adapted cows' milk formula with extra nutrients which is added to breast milk and given to premature babies. Despite the misleading name this is not usually made from human milk (although versions are available in some areas). These human milk fortifiers (or more correctly bovine fortifiers) are intended to help premature babies grow faster which is seen as "better". However, there are several known links between these bovine fortifiers and serious health issues for premature babies. See Human Milk Fortifiers for more information.

Formula suppliers boast of faster weight gains when their fortifiers are used, and this is a consistent finding, but it is well shown that feeding of cow products is also consistently associated with greatly increased chances of necrotizing enterocolitis, respiratory infections, other infections (sepsis), and other health risks including reduced survival. Re-hospitalizations are also more frequent in preterm infants who had been receiving formulas.

Other options

Skin-to-skin contact and kangaroo mother care can significantly help a premature baby's rate of growth .

Increase the calories in breast milk by using 'breast milk cream', the fattier proportion of breast milk sometimes called hind milk.

Contact a milk bank. Milk banks usually give priority to premature or sick babies should a mother be struggling with her milk supply. Human milk is far superior for these vulnerable babies.

Preparing formula

Current guidelines for reconstituting powdered formula can be found in Safe preparation, storage and handling of powdered infant formula: guidelines from the World Health Organisation 2012 or the UK's National Health Service guidelines How to Make up Baby Formula, NHS, 2022.

Using water that has been boiled and cooled to 70°C will kill bacteria and making fresh bottles for each feed avoids bacterial contamination and potential oxidation of the reconstituted products (Minchin 2015). Cool to body temperature before feeding your baby.

It is important to add the correct amount of powder to the correct amount of water. Follow the manufacturers instructions carefully and use the scoop provided. Bottle gradations can vary greatly and may not be a reliable indicator of an accurate volume. You can test the accuracy of the measurements on your bottle or household jug by comparing it against the same volume measure by a large syringe (provided from your local chemist). Never dilute formula (or breast milk) with extra water.

Giving supplements

There are a number of ways to give your baby supplemental milk if needed, whether expressed breast milk, donor milk or formula. Each method has its own pros and cons and which to use will depend on your circumstances and personal choice. Additional milk can be offered by;

What are bottle preference and nipple confusion?

Sucking from a bottle teat is quite different to suckling on a breast; the size, shape and texture feels different in the mouth and the baby's tongue and jaw have to work in a different way to get milk.

Bottle preference. Just as sometimes a breastfed baby will refuse to take a bottle as they prefer the breast, sometimes introducing bottles can cause breast refusal or bottle preference (prefers a bottle). This can be a concern if you have low milk supply or you are using bottles before your baby has learned to breastfeed-some babies may begin to associate the bottle with their food source and the breast with hunger or frustration.

Nipple confusion. Many babies are very good at switching back and forth between breast and bottle and can handle the differences easily to get milk from both. However introducing alternative feeding methods such as teats could interfere with a baby's latch or feeding technique at the breast and this is often referred to as nipple confusion.

See Tips to Bottle Feed a Breastfed Baby and Best Bottle for a Breastfed Baby to minimise bottle preference or nipple confusion or consider trying one of the other feeding methods above.

Summary

Although ordinarily there are lots of ways to build a mother's milk supply before reaching for formula top ups, sometimes these can take time or not seem to help. If donor breast milk is not available, supplementing with formula may be a medical necessity-a baby needs to be fed. The health disadvantages of supplementing with formula must be weighed against the risks for a baby who is in danger of failing to thrive. Breast milk top ups are best given first and not physically mixed with formula. All formulas have different ingredients and it isn't clear which is 'best' for a breastfed baby. Ready made formulas are sterile while dehydrated powder isn't. There are several ways to give supplemental milk to your baby to help avoid nipple confusion.

Footnotes & References

See my review of Milk Matters Infant Feeding and Immune Disorder, Maureen Minchin, 2015 for a summary

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With the right support and information, most mothers can make more than enough breast milk to keep their babies well

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Why this is an amazing position for encouraging your baby to latch well.

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Learn how your baby's nappies help you know that they are getting plenty of milk.

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What colour is a breastfed baby's poop? How much poop should there be? Knowing the colour, consistency and amount of poop a breastfed baby produces in the early weeks can be very reassuring as it can provide clues about how breastfeeding is going and your baby's health. This article looks at what to expect in your exclusively breastfed baby's nappy during the first week of your baby's life, weeks one to six, and after the sixth week.

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Breastfed baby poop in the first week

Colour of poop in the first five days

The very first poop your baby passes on the first day of life is called meconium. Meconium is black, thick and sticky and will be passed in the first two days after birth. Over the next few days, breastfed baby poop tends to change through a predictable sequence of colours as the baby drinks more and more breast milk. The colour changes give a clue to how breastfeeding is going. When breastfeeding is going well, the colour of poop generally changes from black on the first day, to khaki green by the third day, then to brown and finally becomes yellow or mustard coloured poop by the fourth or fifth day. The stool consistency also becomes softer or more liquid and the number of poos per day gradually increases too.

Day one-black poo, thick and sticky

Day two-dark green/black poo

Day three-greeny-brown (khaki) poo, getting runnier

Day four-toffee brown poo

Day five-yellow/mustard poo: soft and plentiful, at least three or four poops per day.

If you are not seeing these colour changes on these days, asking for early support with breastfeeding will help to make sure your baby is getting enough breast milk.
Number of poos

Reference books vary slightly on the average number of dirty nappies to expect each day in the first week. Lactation consultant Marsha Walker says to expect one poop on day one, rising to three or four on day three, and around four large (or ten small) poops by day four or five . Authors Wambach and Spencer say to expect two to four dirty nappies each day in the first two days, two to five dirty nappies each day between days three and four and anything between two and six dirty nappies each day between days four and seven. If you are not seeing plenty of dirty nappies, asking for support with breastfeeding will help check if a baby is getting enough breast milk.

Plenty of milk = plenty of yellow poop

The colour changes towards yellow poop, along with plenty of dirty nappies are a guide that your breastfed baby is drinking plenty of colostrum (the first secretion from the breasts after giving birth) and breast milk. However the nappy output is only one factor in the assessment of a baby's calorie intake, health and well-being and it is important to have regular weight checks and be aware of all the ways to assess if a baby is getting enough milk (Wambach and Spencer, 2020).

Weight loss and poop

During the first five days some babies lose a little weight, newborns can lose up to 7% of their birth weight in the early days of life and this is considered "normal". When this happens, the daily colour changes in the nappy and the amount of poop can serve as reassurance that breast milk is being swallowed despite a little initial weight loss. However, if a baby continues to lose weight or is not gaining weight coupled with few or no poops, the most likely cause is they are not getting enough breast milk (Wambach and Spencer, 2020).

Breastfed baby not pooping?

If a baby is not pooping the most likely reason will be that he is not getting enough breast milk and this needs urgent attention. The idea that a breastfed baby has no waste and therefore doesn't poo very often in the first few days or weeks of life is not evidence-based. Wambach and Spencer recommend that if more than 24 hours pass without a stool in the first four to six weeks of life the baby should be seen by a health care provider and an assessment made of their milk intake (Wambach and Spencer, 2020).

Get breastfeeding help

Waiting around for poop without assessing how well a baby is breastfeeding can put a mother's milk supply and baby's health at risk. There are lots of reasons for a low milk supply and many ways to increase milk volume. If your baby isn't having any dirty nappies (or not many per day), and if the colour hasn't substantially changed by day four or five, check with your healthcare provider and call a breastfeeding specialist to check your baby's latch, position, how often you are feeding and whether you are using one breast or two per feed. Watch your baby feeding carefully. If he doesn't seem to be swallowing milk at the breast, expressing your milk will protect your milk supply and provide a supplement to feed your baby with until you can get help with breastfeeding.

Hold your baby

Kangaroo mother care and breastfeeding with skin to skin contact can help a baby breastfeed by optimising their feeding reflexes as well as encouraging frequent feeds. Keeping your newborn baby in your arms as much as possible may also help with more regular stooling. Nils and Jill Bergman explain that when separated from their mother, a baby's stress hormones are released with the effect of decreasing digestion (and therefore stooling) to prioritise heart rate and breathing in basic survival mode.

What about wet nappies?

When breastfeeding is going well you might expect to see at least one wet nappy on the first day of life followed by two to three on the second, three to four on the third, at least four to six wet nappies by the fourth day of life (Walker, 2017 p349) and at least five to six wet nappies per day by day five Plenty of wet nappies are important to show that a baby is well hydrated. Wet nappies, however, are not a substitute for dirty nappies which can help indicate whether a baby is getting enough milk to grow as well as to stay hydrated in the first few weeks of life.

How wet is a wet nappy?

It can be difficult to check for little wees in a disposable nappy as they are so absorbent. West and Marasco note clear urine usually means good hydration whereas more concentrated yellow urine may indicate dehydration.

Reddish marks in a dry nappy?

In the first couple of days after birth, before a mother's milk has come in, parents may spot orange or reddish "brick dust" marks in a baby's nappy. These are known as "urates" or urate crystals and may be mistaken for blood. Check with your midwife and breastfeeding specialist as they may be a sign your baby is not getting enough milk. A little blood in the nappy of a baby girl may also be "pseudomenstruation" due to hormonal changes. Jack Newman, a Canadian paediatrician and breastfeeding specialist, has a Facebook post with a photo and more information about urates.

Breastfed baby poop-weeks one to six

Colour and consistency of poop

There can be a wide range of normal when it comes to colour and consistency. Breast milk contains traces of the mother's diet. Therefore a mother's diet or any medications she (or her baby) are taking could affect the colour and form of her baby's poop.

Colour. The usual colour of a breastfed baby's poo by the end of the first week is yellow, mustard or light brown.

Consistency. A breastfed baby's stools are quite soft and unformed or runny and may contain small curds (Wambach and Spencer. 2021. p 263) that look like little lumps or seeds- see photo below. Authors Wilson-Clay and Hoover describe this as sometimes resembling mustard mixed with sesame seeds adding that occasionally stools may look watery.

Green poop

Green poo is also common, it could be normal for your baby or have one of a number of other explanations. A baby with green poo may have an intolerance to something in his mother's diet, be suffering from a lactose overload (green, frothy and foamy poop), not be getting enough milk or there may be another reason. See Why is My Breastfed Baby's Poo Green?, Lactose Intolerance in Babies and Milk Allergy in Babies for more information.

At least three or four poops per day

Expect frequent loose and copious bowel movements every day in the first four to six weeks (Wambach and Spencer, 2020) and five or six wet nappies per day. Frequency will vary between babies: The Womanly Art of Breastfeeding says to look for at least three poos each day in the first month the size of the circle made by touching the tip of your thumb and forefinger together. Shrago et al suggest that well-fed breastfed babies will have four or more poos a day by two weeks of age. Dr Jack Newman says to expect anything between three and ten dirty nappies per day. He explains:

Usually during the first few weeks, exclusively breastfed babies will have many bowel movements every day. Ten a day is not rare and if the baby is content, drinking well at the breast and gaining weight, there is no issue. Furthermore, the amounts of each bowel movement and the colour can be quite variable. One day a baby could have 3 bowel movements, the next day 10 and 5 the day after. What matters is whether the baby is content and drinking well at the breast, not the colour of the bowel movements. Of course, the very dark green, almost black, bowel movements that are meconium are not normal after three or four days of life.

Baby not pooing

As in the first week of life, if your baby is not pooping frequently and/or weight gain is poor it is important to check whether baby is getting enough milk: see Is My Baby Getting Enough Milk? and contact your breastfeeding helper for a breastfeeding assessment. If baby is getting plenty of milk and gaining weight normally, less frequent stools may just be your baby's rhythm-or see below for more possible reasons for infrequent stooling.

Breastfed baby poop-week six onwards

A breastfed baby's pattern of dirty nappies can change around six weeks of age and they may start having fewer dirty nappies or not pooping every single day. Wambach and Spencer explain that the ratio of whey to casein (milk proteins) in breast milk changes slightly around six weeks resulting in slightly thicker more formed stools that may be passed less often although many patterns of stooling are possible. Lactation consultant Robyn Noble says a breastfed baby over six weeks of age will typically have one copious mustard yellow poop per day with a consistency of toothpaste. Having fewer dirty nappies isn't usually a concern at this age as long as weight gain continues to be good with plenty of wet nappies as before.

Very infrequent poos

Some breastfed babies may only stool once every three to ten days or so and their poo may be light brown due to a longer time in the gut. The poop is usually soft and there's plenty of it when it comes, so doesn't fit the description of hard dry poop that may be described as constipation. However, although parents may be told that this interval between poops is normal in breastfed babies, it may not be ideal. A baby may be feeling uncomfortable after this period of time. Different authors have different explanations:

Author Linda Palmer proposes that a potential cause of infrequent stooling, despite a good breast milk intake and weight gain, could be a sensitivity to cows' milk products coming from the mother's diet-especially if accompanied with rashes and other symptoms of allergy. See below for more information on how allergy can influence poops and flatulence.

Lactation consultant Carol Smyth looks at a range of possible causes for infrequent stooling from medications to the microbiome in Should My Breastfed Baby Poo Every Day or is Breast Milk All Used Up?

Authors Wambach and Spencer point out that health issues such as Hirschsprung's disease, cystic fibrosis, infant botulism, cows' milk allergy and other bowel disorders can be associated with unusual patterns (Wambach and Spencer, 2020). Parents should check with a healthcare provider if they have any concerns over unusual stooling patterns.

Difficulty pooping?

Some babies who seem to be uncomfortable when due to open their bowels may be helped to poop by holding them in a more upright seated position e.g. over a toilet or potty. Baby can be held securely with their back supported against a parent's chest and with a thigh held in each hand in a supported squatting position. Gravity and freedom from a nappy can help a baby open his bowels.

Constipation?

An exclusively breastfed baby's poop is usually very soft and unformed. If stools are hard, dry and/or infrequent this may be diagnosed as constipation by your baby's doctor. Constipation is more likely with formula-fed or mixed-fed babies and a switch to infant formula could cause firmer stools (Palmer, 2015, p179). True constipation involves hard dry, infrequent stools and a baby's doctor will help to find the cause. Constipation can be associated with a food allergy or medical reasons such as a neurological disorder or even certain medication-reflux medication or iron supplements can cause constipation (Palmer, 2015; Smyth, 2016).

Food allergy and lots of poop

Situations that could be associated with food allergy described by author Robyn Noble in her book Breastfeeding Works! Even With Allergies include:

Very frequent poop. Beyond six weeks of age, an unexpectedly high number of copious runny poops per day could be an indication of a food allergy affecting the gut. Other symptoms might include reflux, mucus or blood in the stools, or poor weight gain despite lots of poop.

Smelly poop and/or flatulence (farts). Breastfed baby poop is usually described as inoffensive and has a characteristic sweet smell, sometimes described as yeasty or slightly cheesy (Wambach and Spencer, 2020). Unpleasant smelling poops, noisy bowel motions that are runny, frequent and gassy and/or excessive noisy flatulence (particularly after six weeks of age) can be associated with food allergy.

Nappy rash. Frequent nappy rash and perianal burns (despite regular nappy changes) may be seen alongside food allergy because runny, gassy stools are more acidic and can burn a baby's skin.

For more general information on food allergy see Milk Allergy in Babies.

The colour of poop

As with weeks one to six, the usual colour of breastfed baby poop before a baby starts solid food is yellow or mustard. Green coloured poop could be normal for an individual baby but there are also several other possible reasons, see Why is My Breastfed Baby's Poop Green? Any concerns about the colour of your baby's poop should be reported to your baby's doctor and especially in the following situations:

Black poop

Very dark or black poop (other than the first few days of black meconium) could be a result of digested blood due to bleeding somewhere in the gastrointestinal system and should be reported to your health professional urgently. If a baby drinks a lot of blood stained breast milk due to his mother's cracked nipples this may also cause very dark coloured poop, check with your health professional and see Blood in Breast Milk.

Red poop

If there is any bleeding lower down in your baby's gut it may show as red streaks in your baby's nappy as it won't have had time to be digested. Traces of blood may be seen if a baby has allergic proctocolitis but there are other possible medical causes of bleeding. Report all cases of blood in the nappy to your doctor.

Pale or white poop, greasy fatty poop

Very pale or chalky white stools or stools that appear "fatty" or "greasy" should always be reported to your health professional. See What are the Symptoms of Jaundice? for further information.

Mucous in poop

Small lumps or strings of clear mucous may be seen in your baby's nappy from time to time, mucous is produced in the bowel to lubricate the stool and is normal. But if there are frequent large amounts this may be due to some irritation in the intestines such as food allergy or sensitivity, an infection or it could be associated with other health issues-discuss with your doctor to rule out any concerns.

Unusual coloured poop

Unusual colours of an exclusively breastfed baby's poop can be due to artificial food colouring, natural food pigments or medications in his mother's diet.

After solids

Once solids are introduced, or formula, breastfed baby poop will change in appearance becoming browner, smellier and more like adult stools. Undigested food may sometimes be seen in the nappy (Wambach and Spencer, 2020). See Starting Solid Foods for more information.

Further reading

For a more in depth review of all the possible colours of baby poop and what they mean see Baby Poop: What Your Pediatrician May Not Tell You or visit the author's website here. For a review of the content of this book click here.

Summary

The contents of your baby's nappy can provide useful information about breast milk intake and your baby's health alongside other signs that your baby is receiving plenty of milk. See Is My Baby Getting Enough Milk? and Baby Not Gaining Weight if you have any worries about how much breast milk your baby is having and seek the help of an IBCLC lactation consultant or breastfeeding specialist. Always report unusual colours of poop or any other concerns to your health professionals.
*Excerpts reprinted by permission of Pinter and Martin

Footnotes & References

1. Walker. Breastfeeding Management for the Clinician, 2017, p 349

2. Wambach and Spencer. Breastfeeding and Human Lactation. 6e. 2020 p263

3. Mohrbacher. Breastfeeding Made Simple. 2010 p 36

4. Making More Milk 2e, Marasco and West, 2020 p30

5. Wilson-Clay and Hoover. The Breastfeeding Atlas. 6e. 2017. p29

6. Wambach and Spencer. Breastfeeding and Human Lactation. 6e. 2020 p263

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What colour is a breastfed baby's poop? How much poop should there be? Knowing the colour, consistency and amount of poop a breastfed baby produces in the early weeks can be very reassuring as it can provide clues about how breastfeeding is going and your baby's health.

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Click here to see our 'Multiple Pregnancy' padlet for feeding information

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If you are taking medicines, about to start treatment or want to know what is safe to take for common problems whilst breastfeeding - check here.

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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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Babies often want to stay close to you to help them feel safe and to sleep. Co-sleeping can help you manage this along with breastfeeding during the night. This video shows you how to do this comfortably and safely.

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Don't give up! Some babies take their sweet time - ask for support, come to the drop-in groups and follow these suggestions.

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Although babies have a strong instinct to breastfeed straight after birth, some babies may not seem interested in breastfeeding at first or may not seem able to attach to the breast. Some babies may still not be attaching to the breast (latching on) by the second or third day of life or even much longer. Why does this happen and how can a baby be helped to breastfeed? How often will a baby need to be fed if they can't breastfeed? Should a mother start expressing her milk? When and how often? This article answers frequently asked questions when a newborn baby won't breastfeed and is a companion article to How to Get Baby Back to Breast.

Why can't my baby breastfeed?

There are several reasons why a newborn may not be able or ready to breastfeed straight after birth. Despite this, babies have a strong instinct to latch for many weeks or months and most challenges can be overcome in time. Even if a mother has left the maternity hospital formula feeding her baby, and her baby is a few days old; there is still plenty of time to get breastfeeding established. Possible reasons for not latching include:

Birth drugs. Painkillers or other birth medications given to the mother during labour may make a baby very sleepy and/or less able to breastfeed. Over time the effects of any drugs will leave a baby's system.

A difficult birth. An instrumental birth (forceps or ventouse) or a birth injury may leave a baby feeling uncomfortable or in pain. They will need more time and support to get breastfeeding established.

Positioning. The way a baby is held to the breast can often make a big difference to how easily they can use their feeding reflexes to latch on. See Breastfeeding Positions for Newborns, Breastfeeding Videos and Latching Tips for ideas to help with positioning and attachment.

Separation after birth. Separation between mother and baby after birth can interfere with a baby's feeding instincts. However babies have a strong instinct to breastfeed once they are reunited with the breast, held in skin-to-skin contact and in helpful breastfeeding positions.

Prematurity or immaturity. Some babies who are born early may not be ready to latch on or breastfeed yet. But with the right support, even tiny babies can often get the hang of breastfeeding see Breastfeeding a Premature Baby and Kangaroo Care for Your Premature Baby.

Mucus and congestion. Some babies may have mucus congesting their airways after the birth and not seem interested in breastfeeding at first. This will resolve over time.

Feeding aversion. If a breastfeeding helper or parent has repeatedly pushed a baby's head into the breast to try and force them to breastfeed, the baby may come to associate breastfeeding with a scary or even painful experience. Refusing the breast due to a bad memory or painful association is sometimes called a feeding aversion. It's important to handle a baby gently at the breast and to remember that if they could breastfeed they would do so. For ideas to overcome a feeding aversion see below and see How to Get Baby Back to Breast.

Differences of anatomy. Sometimes a mother and baby may have anatomical challenges. For example some babies may struggle with a mother's flat or inverted nipples, large breasts or large nipples or have their own unique anatomy such as a cleft lip or palate, a small chin, high muscle tone or a tongue-tie that makes breastfeeding more challenging. Breastfeeding support from a specialist can be invaluable to help with anatomical challenges as they will know a range of latching techniques and ideas to try for each situation.

Allergies. In her book Breastfeeding Works! Even With Allergies author Robyn Noble notes that some babies born with food intolerances and allergies can seem incompetent at the breast.

What should I do when my baby won't breastfeed?

Until your baby can latch and breastfeed, it is very important to regularly express breast milk for your baby to stimulate your milk supply and to keep your baby (or babies) well fed. If breast milk isn't removed from the breast regularly a milk supply will begin to dry up. Some authors refer to this as the three keeps: keep milk flowing, keep baby fed, keep baby close.

Until your baby can breastfeed:

Express your breast milk regularly

Keep your baby well fed

Try lots of skin-to-skin contact

Find a breastfeeding specialist

Express breast milk regularly

The first days after birth are when the breasts gauge future milk production. The more often milk is removed at this time, the more likely there will continue to be plenty of milk for all your baby's needs as they continue to grow. Express breast milk regularly if a baby is unable to latch.

How can I express breast milk?

Colostrum can be thick and sticky and not much of it at first so it is usually easier to hand express this into a spoon or collect drops in a syringe at first, rather than use a breast pump. See Hand Expressing Breast Milk for help to do this.

When should I start hand expressing?

If your baby isn't breastfeeding, the sooner you can start hand expressing the better. Hand expressing in the first hour after birth is ideal and is discussed in Stanford University's video Successful Breastfeeding Begins at Birth.

How often should I express my breast milk?

Hand express and collect drops of colostrum as often as you can, at least every two hours during the day and every four hours at night. Or at least eight to twelve times in 24 hours. Once your milk volume increases sufficiently ("comes-in") some mothers find a breast pump is more efficient than hand expression. Breast milk generally increases in volume around the second or third day after birth -but it may be later than this (see below). Pumping both breasts every two to three hours in the day and every four hours at night, using massage and breast compression will help remove as much milk as possible. See What is Breast Compression? and How to Increase Milk Supply When Pumping.

How long should I pump for?

How long to pump at each session is quite individual to each mother because a mother with a small breast storage capacity will need to pump for a shorter time and more frequently, compared to a mother who stores more milk at one time. The topic is discussed in more detail in the following article:

Nancy Mohrbacher [lactation consultant and author] suggests pumping for twenty minutes for a few sessions while observing milk flow and then adjusting the time pumped as required: simply pumping for a longer or shorter time as needed to remove all the milk (Mohrbacher, 2020. p 490). The goal is to establish a full milk supply (750-1035 ml per day) by 10-14 days after the birth. Once the goal is met, pumping length may return to 10-15 minutes for some mothers.

Which pump shall I use?

Some hospitals or pump manufacturers hire out "hospital grade" pumps which are very efficient breast pumps that are ideal to get your milk supply off to a good start. For more information about types of pump see How to Increase Milk Supply When Pumping and Do I Need a Breast Pump?

Keep your baby well fed

A baby can't be forced to breastfeed just because they are hungry. In fact if they are not getting the frequent small feeds they need, they will be more likely to keep falling asleep and not have enough energy to breastfeed well. Although newborn babies only need small volumes, they do need small amounts of milk frequently or they could become dehydrated.

How often should I feed my baby?

Whether or not they are breastfeeding yet, a newborn baby needs frequent feeds to keep them well fed and hydrated. Feed your baby at least every two to three hours in the day and every four hours in the night (the same as the pumping schedule above) and see How Often Should a Newborn Feed? for more information.

How much milk will my newborn baby need?

The amount of breast milk each baby needs to stay hydrated and satisfied is quite variable for each baby and their age and bodyweight. A baby needs enough milk to ensure they are pooing and weeing and-after an initial weight loss typical of newborn babies-to start gaining 30-40g (1oz) per day in the first three months of life. The following excerpt gives an example of volumes of breast milk (or formula if needed) that may be required every two to three hours:

First 24 hours: 2-10ml breast milk per feed

24-48 hours: 5-15ml breast milk per feed (ABM, 2017)

48-72 hours: 15-30ml (o.5-1oz) breast milk per feed (ABM, 2017)

72-96 hours: 30-60ml (1-2oz) breast milk per feed (ABM, 2017)

2-3 weeks: 60-90ml+ (2-3oz+) breast milk per feed

1-6 months: 90-150ml (3-5oz) breast milk per feed or a total of 750-1035ml per day (25-35oz) (Mohrbacher, 2010)

What if my baby is very sleepy?

Try not to let your baby sleep too long as a newborn needs regular feeds. See Breastfeeding a Sleepy Baby for ideas to help wake a sleepy newborn.

How should I feed my baby?

Your baby can be fed all your expressed breast milk by spoon, syringe, feeding cup, feeding tube alongside a finger or bottle and teat. It can be helpful to avoid using a bottle at first unless large volumes are needed so that baby doesn't start to prefer the teat (nipple preference or nipple confusion) and be less keen to breastfeed. However if you want to use a bottle see our Tips to Bottle Feed a Breastfed Baby and Best Bottle for a Breastfed Baby. For information about cup feeding or finger feeding see Cup Feeding a Newborn and What is Finger Feeding?

Is my baby getting enough milk?

There are lots of ways to tell if your baby is getting enough milk including baby's weight gain, the colour and number of dirty nappies and whether they are swallowing milk and seem contented. See Is My Baby Getting Enough Milk? for much more information.

What if I don't have enough milk?

If you're still struggling to express any milk after the first few days your milk supply may be delayed or occasionally a medical condition can cause low milk supply. Contact your breastfeeding specialist and see No Breast Milk After Delivery and Reasons for Low Milk Supply. Sometimes a baby may need some donor milk or commercial infant milk until your milk supply increases, your health professional will normally advise you when this is needed. See Supplementing With Formula and How to Make More Breast Milk.

Skin-to-skin contact

Skin-to-skin contact-with no clothes between you and baby-helps breastfeeding in lots of ways. See Why Skin-to-Skin? for a full discussion and for several videos of babies attaching to the breast all on their own. Skin-to-skin contact helps:

Feeding reflexes. Skin-to-skin contact promotes your baby's feeding reflexes to encourage instinctive breastfeeding. Covering a baby's hands removes their sense of touch so remove any anti scratch mittens-see Scratch Mittens and Breastfeeding.

Milk supply. Skin-to-skin contact promotes the release of the hormones needed for milk production.

Comfort and calm a baby. Holding your baby comforts and calms him. Avoid passing your baby around friends and relatives so you can concentrate on getting breastfeeding established.

Regulate body systems. Skin-to-skin contact helps to regulate a baby's temperature, blood sugar levels, heart rate and breathing.

Feeding cues. When baby is in close contact and held skin-to-skin, it is easier to see the signs that a baby is getting ready to feed (early feeding cues). This is a good time to try to breastfeed. Early feeding cues include a baby starting to fuss and fidget, searching for the breast with a wide open mouth and sucking on fists or fingers.

This short film from the Global Health Media Project shows how skin-to-skin contact helps babies use their feeding reflexes to latch to the breast straight after birth.

Find a breastfeeding specialist

A breastfeeding specialist such as an International Board Certified Lactation Consultant (IBCLC) can be invaluable to help you and your baby start breastfeeding. The article Why Hire an IBCLC? on this website describes the different forms of support available. A breastfeeding specialist can help with:

Positioning and attachment. A breastfeeding specialist will be able to suggest helpful positions and techniques to help your baby latch. They will have lots of experience of latching babies. Sometimes some experienced hands to guide you and your baby are all that are needed.

Anatomical differences. A breastfeeding specialist will often know little tricks and tips to get around many challenges or know when to suggest a referral to a health professional for further assessment.

Maximising milk supply. A breastfeeding specialist can help you devise the best plan to protect and maintain your milk supply.

Tips to help a baby breastfeed

Skin-to-skin contact

Skin-to-skin contact can help breastfeeding get started (see above) and help you find comfortable Breastfeeding Positions for Newborns.

Not too hungry

A baby will have more energy to breastfeed if they are not too hungry when they have a breastfeeding practice session. Keep your baby well fed.

Avoid bottle teats

It is a good idea to avoid bottle teats if possible to prevent a baby becoming imprinted on a firm silicone teat as their preferred feeding method. Babies can be fed small volumes by a spoon, syringe or feeding cup. If a baby needs larger volumes of milk after the first few days however, a bottle may be more practical than the alternatives. Tips to Bottle Feed a Breastfed Baby and Best Bottle for a Breastfed Baby can help to minimise nipple confusion or nipple preference.

Avoid pacifiers or dummies

A dummy can cause missed feeding cues and may interfere with getting breastfeeding established. See Pacifier, Dummy or Soother-Yes or No? for more reading about dummies.

Stay calm, be patient

It is natural to become very frustrated and upset if your baby can't breastfeed and you don't know how to help him. But a baby is very in tune with his mother and if he senses you are anxious whenever the breast appears, he will also feel more anxious. A baby will be more likely to focus on learning to breastfeed when they are calm, not too hungry and when they can sense you are calm too.

Look for early feeding cues

It is helpful to practise breastfeeding as soon as a baby shows really early feeding cues such as starting to move in light sleep, moving their head from side-to-side to search with an open mouth, or sucking their fingers or fists. Crying is a late feeding cue and a baby is less able to organise themselves to breastfeed if they are crying and upset.

Engorgement

Engorgement can make latching more difficult see Engorged Breasts for tips to help with this including massage and something called reverse pressure softening which is a technique to temporarily push fluid away from behind the nipple to make latching easier.

Shaping the breast

Sometimes a baby can find it hard to grasp a mouthful of breast tissue along with the nipple. Supporting and shaping the breast-flattening it slightly-to fit your baby's mouth can be helpful, see Latching Tips.

Nipple shield

In some situations a nipple shield may help a baby to latch and breastfeed e.g. if a mother has very flat nipples or a baby is premature. A nipple shield is a thin, flexible silicone cover with holes that is placed over your nipple during a breastfeed. Read more in Nipple Shields Good or Bad? and discuss using one with your breastfeeding helper.0

Troubleshooting

Baby cries at the breast

If your baby cries as soon as they are held to the breast, they may be feeling frustrated with trying to breastfeed. They may associate breastfeeding attempts with being forced onto the breast, being hungry without reward or perhaps they sense that their mother is anxious about what is about to happen making them feel anxious too. If your baby has made this type of negative association (feeding aversion) try some of the following ideas to help them overcome this:

Rescue your baby from their trauma rather than reinforcing their discomfort by repeatedly trying to breastfeed again and again against their wishes. Hold a distressed baby upright against your shoulder or between your breasts, walk around with them, talk or sing to them and calm them down before trying again.

Stay calm. Try to stay calm, positive and patient at each breastfeeding practice session. Relax your shoulders and smile, talk to, sing or praise your baby.

Not too hungry. Make sure to feed your baby a little expressed milk so they are not too hungry before they try to breastfeed.

Happy place. Try to make the breast a happy relaxed place without pressure to latch in between feeding attempts or even take a short break from trying to breastfeed altogether-Time off to "Reboot" the Baby and Get Over Breast Distress discusses this.

Try different positions. If breastfeeding isn't working something may need to change. Try holding your baby in a different position that they don't associate with previous breastfeeding attempts. If you usually use a cradle or cross cradle hold, try standing up to feed, lying down, reclining or rugby hold. See Breastfeeding Positions for Newborns for images of these positions.

Seek support. Find a breastfeeding specialist to help you and see How to Get Baby Back to Breast for more ideas.

Baby prefers a bottle

If your baby has already become imprinted on a bottle teat as their preferred way of feeding see How to Get Baby Back to Breast, Tips to Bottle Feed a Breastfed Baby and Best Bottle for a Breastfed Baby.

Baby latches then pulls away/loses the latch

Occasionally a baby may latch on but then quickly let go of the breast again either before the milk flows or just after the milk begins to flow. Possibilities include:

Nipple/breast shapes and sizes. Some babies may find challenges with certain shapes or sizes of nipple or breast which other babies would not find a problem. A very soft flat nipple can be harder for a baby to find and a baby may find it hard to keep hold of a heavy breast in their mouth. See Breastfeeding With Inverted Nipples and Flat Nipples and Breastfeeding With Large Breasts for breastfeeding tips and check in with your breastfeeding helper.

Milk too slow. Some babies may need a little encouragement to stay at the breast to wait for the let-down (milk release). Hand expressing to ensure your milk is already flowing to instantly reward your baby's latching attempts with milk can be helpful, and breast compressions and massage can keep the flow going until your baby realises how to control the flow.

Milk too fast. Sometimes a baby can find it difficult to coordinate sucking with swallowing and breathing when milk begins to flow. And sometimes milk may be seen spurting and gushing like a hose causing a baby to cough and splutter. Most babies can cope better with the flow of milk if they are in a deep latch with plenty of breast tissue as well as the nipple in their mouth. See What is a Fast Let-Down? if you feel there is a challenge associated with flow.

Pain or discomfort. A baby who is in pain from a difficult birth or discomfort from food intolerances may find it difficult to stay at the breast.

Problems once baby starts to breastfeed

Breastfeeding hurts

It will be a relief once your baby begins to latch on and stay at the breast but what if breastfeeding hurts? It will be tempting to put up with the pain because you're just happy that baby is latched on. But doing so can quickly make your nipples sore and a baby will also find it more difficult to get the milk he needs. There are several reasons why feeding could be painful. It is usually because the baby doesn't have enough breast tissue as well as the nipple in their mouth. See Causes of Sore Nipples, and Why Does Breastfeeding Hurt? and check in with your breastfeeding specialist as soon as possible.

Baby not getting enough milk

There are several ways to tell if your baby is getting enough milk and sometimes more may be needed than a mother can pump. Or there may be plenty of milk but once your baby starts to latch on they may not be very efficient at breastfeeding at first and may still need supplementary feeds for a while to ensure they are getting enough milk. The following links have more information:

Summary

There are various reasons why a baby can't breastfeed when they are first born. Until your baby can get the hang of breastfeeding it's important to (1) express your breast milk and (2) keep your baby well fed. Expressing breast milk frequently will protect and stimulate your milk supply and provide a milk supplement for your baby. And keeping your baby well fed ensures they are contented and have the energy to learn to breastfeed. Keeping your baby close to you in skin-to-skin contact where possible will help promote your baby's feeding reflexes until your baby is ready to feed, or until you can find a breastfeeding specialist to help you. Most of the challenges that prevent a baby breastfeeding can be overcome with time, patience and skilled help.

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This article answers frequently asked questions when a newborn baby won't breastfeed and is a companion article to How to Get Baby Back to Breast.

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Hillingdon Breastfeeding on Facebook

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Hillingdon Breastfeeding. 575 likes. Hillingdon's NHS Breastfeeding Support Team provide breastfeeding support and information in hospital, the community and online via this page. Please like our...

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You should have the opportunity to chat with a midwife throughout your pregnancy about:

Building a relationship with your baby during your pregnancy,

Why skin to skin contact is amazing and helps with feeding and comforting your baby

Why keeping your baby close by to you helps them feel secure, plus helps you quickly recognise when they need something

Learning to feed your baby whenever they need it and for as long as they need it

How building a close and loving relationship with your baby helps their brain to develop

The value of breastfeeding

Useful tips on how your milk supply works and how to help breastfeeding be successful

Please ask for a midwife appointment to talk about these and other questions you might have about feeding your baby, or contact the infant feeding team - thh.infantfeeding@nhs.net

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Unicef UK Baby Friendly Initiative | Breastfeeding problems

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Video - how to clean and sterilise baby bottles

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Video - how to clean and sterilise baby bottles

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A short video on how to clean and sterilise baby feeding bottles.

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The Hillingdon Hospitals NHS Foundation Trust

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How to clean and sterilise your baby's bottles

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Video - how to safely make up a formula feed

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Video - how to safely make up a formula feed

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A short video on how to prepare a feed using powdered formula

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The Hillingdon Hospitals NHS Foundation Trust

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How to safely make up infant formula for your baby

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If you've decided to bottle feed, you may be worried about what formula to buy, what equipment you'll need and how to get the hang of feeding your baby when everything is so new.

We're here to provide lots of helpful information and advice on bottle feeding. If you have any worries or concerns, the best thing to do is speak to your midwife or health visitor.

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From making formula feeds to how to bottle feed your baby, we have lots of useful advice and tips.

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Responsive bottle feeding & a basic guide to choosing formula

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Responsive bottle feeding & a basic guide to choosing formula

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Weaning from Supplements - La Leche League GB

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Making the transition from using bottles, cups etc., to feeding at the breast There are lots of reasons babies might need more milk than they can get directly at the breast: They don't have enough energy to do all the work of feeding. They may have been born early or small-for-dates, or are unwell, or [...]

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How to tell if your baby needs more milk

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How to tell if your baby needs more milk

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how to keep breastfeeding on track if your baby needs more milk

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Does your baby need more milk?
How to know your baby is getting enough breastmilk
Increasing your milk production
If supplements are needed
Feeding methods
Expressing your milk

Does your baby need more milk?

Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk production. Perhaps you and your baby had a difficult start, or were not given the support you needed to establish breastfeeding. Or maybe things were going well until your baby's weight gain faltered.

If others question your milk production and your baby is fussy, wants to feed much of the time, seems small, or gains weight slowly, you may be wondering whether you have enough milk.

Follow your baby not the book

Young babies need to nurse frequently to get enough milk and establish their mother's milk production. Following feeding schedules, using regular supplements, nipple shields, or a dummy can really reduce your milk production.

Breastmilk is also a drink and frequent nursing is normal. Adults rarely go longer than two hours without a drink, snack or meal. Your baby's tummy is tiny and breastmilk is quickly digested, so they need frequent feeds to help them grow. It is recommended that your baby is weighed no more than once a month for the first six months, unless there are concerns.

Sleepy Baby
A baby who sleeps a lot rather than waking to feed every 2-3 hours may need to be woken up to nurse, particularly if they have jaundice or aren't gaining enough weight. If this is difficult or your baby is lethargic, ask your midwife, health visitor or GP to check that all is well.

See our article Sleepy Baby - why and what to do for more information.

How to know your baby is getting enough breastmilk

Weight gain
It is normal for newborns to lose up to 7% of their birth weight in the first few days. Once your milk production increases, usually on day 3-4, expect your baby to begin gaining weight. Most babies regain their birth weight by the age of 10-14 days. You may also find it helpful to see Is my baby getting enough milk?

Plot your baby's weight gain on a UK-WHO growth chart based on the growth rates of breastfed babies (see examples below and Further Reading). Although they will be growing at their own individual rate, it will give you an indication of how they are doing.

Monitor your baby's weight over a period of time rather than week by week. Your baby's weight may generally follow the chart, or climb up, crossing the percentile lines. A gradual drop from one percentile line to the next (or the equivalent distance) is unlikely to be a problem unless their weight is low for their age. Heavier newborns often show 'catch-down' growth - they gain weight steadily but drop gradually against the chart lines.

Dropping against the chart is more of a worry for lower weight babies
If your baby's growth curve drops across two lines of the chart (or the equivalent distance), or if their weight is below the lowest line of the chart:

Follow the suggestions here to ensure they get more milk.

Seek help from your GP to rule out an underlying medical reason for your baby's slow weight gain.

If you have doubts about your baby's growth, you may find it reassuring to talk to an LLL Leader.

Wet and dirty nappies
If your baby receives enough milk, the thick and sticky black meconium poos will be passed within three days of birth, followed by at least 6-8 wet and 3-5 dirty nappies in each 24 hours. Expect yellow, loose, unformed poos at least the size of a 2p coin. From about six weeks, some babies have abundant poos once every few days. This isn't a problem when a baby has plenty of wet nappies.

Look at your baby
You may instinctively know how your baby is doing. Are they nursing vigorously? Is their skin firm? Do they look healthy and seem active and alert? Are they meeting developmental milestones?

Remember
Even if your breasts feel empty, there's always some milk there. Full breasts and engorgement slow milk production - you may need to nurse more often. Removing even small amounts of milk from soft breasts increases milk production.

Babies nurse for comfort as well as for food. Those little 'snack' comfort feeds can really increase your milk production and their calorie intake.

Expect your baby to want to breastfeed very often from time to time. Your breasts will quickly adjust to making more milk if you follow your baby's cues.

Every baby has a unique feeding pattern. If your baby is gaining weight adequately, following their own feeding pattern is the best way of ensuring you are meeting their needs. It's rare that a mother cannot produce enough milk for her baby, and there are lots of ways to increase the amount of breastmilk your baby gets.

Increasing your milk production

After the first few weeks, supply and demand drives milk production. To increase your milk supply, focus on feeding more often and getting more milk out at each feed. For more information about how breasts make milk, see our article How milk production works and also How to increase your milk supply.
Breastfeeding basics

Breastfeed as often as possible - at least 10 times in 24 hours. Wake your baby if necessary.

Switch sides when your baby's suck-swallow pattern starts to slow. Continue to switch sides (four times or more) until they reject the breast.

Use breast compression (see below).

Instead of breastfeeding at set intervals, encourage 'cluster feeding' - breastfeeding very often at times when your baby is willing to.

Encourage breastfeeding for comfort as well as for food. It can really help your milk production. Stop using dummies - breastfeed instead.

Ensure you are meeting your baby's needs for milk during the night, feeding at least once every four hours.

Cut back a little on your baby's solid foods if your milk production is dropping (see below).

An effective latch
A baby may spend a long time at the breast but not get very much milk if they are not latched on effectively. Check your baby is well attached - watch and listen for swallowing which is frequent at the start and then slows down.

Contact an LLL Leader for one-to-one support and see Further Reading for more information. It's important to seek skilled help early on if you are finding breastfeeding difficult, uncomfortable or painful.

Take a 'baby moon'
Get some help with the housework and eat simple, easily-prepared meals for a week or two so you can concentrate on breastfeeding your baby. A couple of days' bed rest together, feeding your baby on demand can really boost your milk production. Or at least take some time each day to rest with them and concentrate on breastfeeding.

Try laid-back breastfeeding
Many babies instinctively seek the breast and feed frequently if they can snuggle up close to their mother's chest.

Try letting your baby lie on your body, skin to skin (with a blanket if needed) as you recline, so both their chest and tummy are against you. This close body contact gives your baby lots of opportunity to breastfeed, even in a light sleep, and boosts levels of the hormones that increase your milk. A soft carrier or sling helps to keep your baby close and encourages breastfeeding. (see Positioning and Attachment for more on laid back breastfeeding)

Breast compression
This technique puts pressure on the milk ducts and can help to make feeding more efficient:

1. Support your breast with one hand - thumb on one side, fingers on the other.

2. Wait while your baby breastfeeds actively, their jaw moving all the way to their ear. When their swallowing slows, compress your breast firmly to increase milk flow and encourage swallowing. Hold it squeezed while they continue nursing actively, then release your hand.

3. Rotate your hand around the breast and repeat step 2 on different areas of the breast.

Go gently - this should not hurt.

Other foods
Babies need only human milk for the first six months (human milk is higher in calories than many weaning foods). Too much solid food replacing human milk can affect weight gain in older babies. Breastfeed before offering solid foods if your baby is under 12 months old. Even at 12 months, both human milk and solids are equally important. Breastfeed frequently and, rather than spoon-feeding, offer your baby a variety of foods, letting them feed themselves to ensure they take only what they need.

Continued low milk production
If you've tried all these suggestions and your milk production has not increased enough, there may be a medical reason. Some medical conditions can lead to low milk production, though appropriate treatment can reduce the impact. These situations are rare, but you can discuss possibilities with an LLL Leader. For more information see our article How to increase your milk supply and Further Reading.

Signs your milk is increasing
Watch for weight gain and an increase in your baby's wet and dirty nappies. Your breasts may feel fuller before feeds and begin to leak.

Looking after yourself
Don't forget to be kind to yourself, especially if you're feeling under pressure. Now is the time to call in favours from friends and relatives so you can concentrate on your baby. If your baby needs more milk, talking to your local LLL Leader will help. You can share your concerns with other mothers at an LLL meeting, who will be able to give you encouragement and support.

If supplements are needed

It can be a challenge fitting in breastfeeding, supplementing and expressing. You could try the following approach, aiming for at least 8 feeds in 24 hours. At each feed:

1. Start with breastfeeding, observing your baby's swallowing pattern. Use breast compressions to maximise the flow. When swallowing slows, switch sides and repeat. If your baby has enough energy, you can repeat this process (known as 'switch nursing'). This part of the feed might take 10-30 minutes, but use swallowing as your guide. A baby who is not swallowing isn't taking in any milk so move to step 2.

2. Give your supplement with a spoon, syringe, nursing supplementer, finger feeding tube, or bottle. Give stored breastmilk first, then supplement with other milk. Follow your baby's lead until they are satisfied. A baby who is underweight may become extra hungry for a while. By giving them extra milk, you will help them gain weight and get the energy they need to breastfeed better. To save time, this step could be done by your support person while you express. For more on ways to give your baby more milk, see our article on Bottles and other tools.

3. Express both breasts using a combination of pumping and hand expression, switching back and forth as milk flow slows. Store this milk in the fridge ready for the next feed. By removing the milk your baby couldn't, you build your future milk production and have milk to supplement the next feed. This is an important step, especially if you are working to eliminate formula supplements.

4. Finish at the breast. The whole feed may take 60-90 minutes. If it works for you, you might offer the breast at the end of the feed so your baby associates the breast with being calm, happy and satisfied. Suckling can help them settle to sleep, too.

Keep a record of the amounts of each supplement your baby takes at each feed and also what you express. This can help you see your progress and maybe useful for anyone supporting you with breastfeeding.

Feeding methods

Cup, spoon and syringe feeding can work when small amounts are needed.

A nursing supplementer can be used to give larger amounts while your baby is at the breast. Another option is finger feeding, using an infant feeding tube. One end of the tube is taped to your finger. As your baby sucks on your finger, milk flows along the tube from a container which can be raised or lowered to change flow. An LLL Leader can help you find out more and choose an option that works best for you.

If using a bottle, paced bottle feeding can help ensure your baby doesn't take more milk than they need.

A smaller teat hole prevents a baby taking milk too quickly.

Hold them in an upright position, using your hand to support their neck and head.

To encourage your baby to open wide, place the teat across their lips with the tip between the upper lip and nose.

Allow your baby some control. Let them take the bottle teat into their mouth themself. Avoid pushing the teat into their mouth.

Tilt the bottle just enough to fill the tip of the teat and give a gentle flow so your baby isn't overwhelmed with milk. As the bottle empties, gradually tilt the bottle more and lean your baby back.

Encourage frequent pauses to mimic breastfeeding, and allow your baby to decide when they have had enough.

For more information see Bottles and other tools.

Expressing your milk

A baby nursing well at the breast is more effective than any pump. But while your baby isn't breastfeeding well or you're giving supplements, expressing your milk will stimulate milk production. Give any expressed milk before you give infant formula, so none of your precious breastmilk is wasted.

Nurse your baby frequently so they get the extra milk you make. An increase in the amount you can express is a sign that you can reduce supplements if your baby is nursing well and often.

Hospital-grade pumps are the most effective for mothers needing to increase their milk, but any pump that works well for you is fine.

Try hands-on pumping: use breast massage and breast compressions while pumping, then hand express afterwards to get the last few drops of milk. For more on hand expressing see our article: Hand expression

Pumping on both sides at the same time boosts milk-producing hormones. When pumping one side at a time, switch back and forth several times as milk flow slows.

Consider power pumping: experiment with pumping very frequently for short periods to mimic cluster feeding.

Wash your pump with hot soapy water, or sterilise it once a day. Pump equipment can be left at room temperature for short periods, or stored in the fridge for longer periods. For more information, see our article Expressing Your Milk.
Good times to express milk

After feeds while your baby sleeps - 'putting in an order' for more milk later. Milk expressed after a feed may be small in quantity, but is high in calories.

Between feeds if your baby is too sleepy to nurse frequently.

While holding your baby, or with them nearby. Expressing little and often can be better than long sessions. Try some 'power pumping' during the evening, or fit in some extra pumping sessions one day. You should notice an increase in milk production a couple of days later.

Using donor milk and formula to support breastfeeding
The use of donor milk or infant formula is sometimes essential to meet a baby's nutritional needs. You may need to use donor milk or formula as a short-term measure while you work to increase your milk production. See our article Using donor milk & formula to support breastfeeding for more information.

Supplementing with donor milk or formula without protecting your milk supply may reduce the duration of your breastfeeding journey.

Powdered infant formula is not a sterile product. To reduce health risks associated with using infant formula, carefully follow the NHS guidelines for preparing it. La Leche League does not recommend the use of homemade formula. The NHS guide to bottle feeding is available online (see Further Reading).

Written by Karen Butler and mothers of LLLGB

Further Reading

How to increase your milk supply
How milk production works
Using donor milk and formula to support breastfeeding
Dummies and Breastfeeding
Hand expressing of breastmilk
Comfortable Breastfeeding
Is my baby getting enough milk?
Nursing Supplementers
Positioning & Attachment
Rhythms and Routines
Safe sleep and the Breastfed Baby
Sleep baby - why and what to do
Storing your milk
After a difficult start

Books
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Making more milk, second edition, Marasco, L. and West, D. New York: McGraw-Hill Education, 2019.
Other websites
Natural (laid-back) breastfeeding naturalbreastfeeding.com
Biological nurturing™ www.biologicalnurturing.com
Maximising milk production when expressing https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html
UK-WHO Growth Charts These charts are based on the growth rates of breastfed babies and can be found in your baby's Personal Child Health Record (red book). Further copies, the more detailed hospital 0-4 charts and specialised charts for low weight babies can all be downloaded from: www.rcpch.ac.uk/growthcharts
NHS guide to bottle feeding

This information is available to buy in printed form from our shop.

Copyright LLLGB 2022

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My baby needs more milk - La Leche League GB

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Does your baby need more milk? How to know your baby is getting enough breastmilk Increasing your milk production If supplements are needed Feeding methods Expressing your milk Does your baby need more milk? Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk [...]

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If you are not breastfeeding, a first infant formula is suitable for the first year of your baby's life. All first infant milks available meet your baby's nutritional needs. This link takes you to an unbiased, evidence based guide on choosing an infant milk.

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Infant milks for parents & carers — First Steps Nutrition Trust

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

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We are working to provide support in Hillingdon in line with the Baby Friendly standards - read about those here.

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This link answers some of the questions you might have whilst learning to feed your baby.

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Is breastfeeding good for my baby?
Breastfeeding not only provides food in the most natural form for babies, but also provides comfort, pain relief and the natural nurturing that babies need for development. Breast milk contains everything that a baby needs for growth in the first six months of life in exactly the right amounts and in the best form for his body to use. Breast milk satisfies a baby's hunger and thirst. No other foods or drinks are necessary, provided a baby is allowed to feed at the breast whenever he wishes.

Breast milk increases a baby's resistance to many infections and diseases, and reduces his risk of developing allergies, diabetes and childhood cancers. Breast milk is free, fast and convenient. It is always available and is fresh, clean and served at the right temperature. There's no sterilising to worry about, no mixing, heating, refrigerating and no bottles to take out and about. Babies can be breastfed discreetly anywhere.

Is breastfeeding good for me?
Breastfeeding reduces the risk of breast and ovarian cancers and helps your uterus to return to its pre-pregnancy size, so you regain your figure more quickly. Breastfeeding also uses up excess fat stores from pregnancy.

Breastfeeding gives you a chance to sit down and relax during a busy day and so helps you cope with the demands of motherhood. It gives you confidence as you know you are giving your baby the best possible start in life. It can be a rewarding and satisfying experience for you and your baby.

How soon can I breastfeed my baby?
You can usually start breastfeeding immediately after birth. A baby's suckling instinct is strongest in the first hour after birth, so putting your baby to the breast as soon as possible will get you off to a good start.

How do I put my baby to the breast?
Make yourself comfortable. (For night-time feeding or if you have stitches, lying on your side may be the best option for you.) Your baby should be held close to your body, facing your breast with his head, shoulders and body in a straight line, and your hand supporting his neck so he can move his head to latch on. He should be able to reach the breast easily without having to stretch or twist.

Hold your baby with his nose opposite your nipple, allowing his head to be able to flex. Brush your nipple against his lips or nose to encourage him to open his mouth and reach for your breast. Wait for the 'gape' (his mouth opening like a yawn).

Bring him to the breast with his chin touching the breast first, then his bottom lip and tongue near the outer edge of the areola, and bringing his top lip to latch over the nipple as far as possible on to the other side of the areola. Make sure he takes a good mouthful of the areola (the dark area surrounding the nipple) and not just the nipple itself. He should have more areola in his mouth on the side of his bottom lip than his top lip.

Babies breastfeed - they don't nipple feed. Allowing your baby to suck on just the nipples will make them extremely sore, and can lead to cracking and bleeding. Remember to always bring your baby to your breast rather than trying to move your breast to your baby. Tummy to Mummy, Nose to Nipple,and Baby to Breast.

You may prefer to use a more reclined position and encourage baby to self-attach. Your midwife can support you with this after the birth.

How can I avoid sore nipples?
Some nipple tenderness is common during the first few days due to hormonal changes in your body but this will soon pass. If it is painful when you first put your baby to the breast, gently insert your clean little finger between your baby's mouth and your breast to break the suction and try again. If the discomfort persists, seek help from a breastfeeding counsellor or midwife to check your baby is correctly positioned at your breast.

Breast milk is a natural antiseptic - if your nipples are sore, express a little milk after a feed and allow the milk to dry on the nipple. It will help them heal. If your nipples are cracked, you may need more than breastmilk. A breastfeeding counsellor can talk to you about 'moist wound healing'.

When your baby is correctly positioned and feeding well, breastfeeding shouldn't be at all
painful - if it is, some adjustments will be required. Don't be afraid to ask for help.
A plentiful milk supply is also dependent on correct positioning. It's important thing to get this right.
How long should I feed my baby for?
Always let your baby determine the length of the feed. Your baby knows when he has had enough, and will take himself off the breast. If you take him from the breast before he is ready, he may not have received as much of your milk as he needs, and he may not gain weight and thrive as he should. Taking your baby off the breast too soon may also reduce the amount of milk you produce.

How often should I feed my baby? \
Breastfed babies need to feed frequently. Young babies will generally need at least 8 feeds and may have as many as 12 or more feeds in 24 hours. Your baby may also 'cluster' feed, having a few of his breastfeeds close together then the rest spaced out a little more - this is normal. The important thing to remember is that the more often a baby suckles at the breast, the more milk is produced.

At times during the early weeks your baby may appear to be more hungry than usual - he will be "asking" to build up your supply in preparation for a spurt of growing and developing. Occasionally a very placid baby, who regularly sleeps for long stretches, may need to be woken to be fed. Don't be tempted to make comparisons between how often your baby feeds and a bottlefed baby's patterns. Breastfed babies have a totally different pattern of feeding.

How can I increase my milk supply?
If you feel that your supply is low, encourage your baby to feed more often. Put your own and your baby's needs first. Babies do have 'growth spurts' and at these times they will need to feed more often to stimulate milk production. Good positioning at the breast is also important for a good milk supply.

Can I have too much milk?
Colostrum (the 'first' milk) begins to change to mature milk during the first week and this is often referred to as the milk 'coming in'. Your breasts will be swollen with extra fluids and, initially, you may be making more milk than your baby takes.

At this time your breasts may become hard, lumpy and painful. Frequent feeding helps to avoid this, and expressing a little milk before putting the baby to the breast can also help. A warm bath or warm flannel held to the breast will help the milk to flow easily and make expressing easier.

Will breastfeeding spoil my figure?
No, it's pregnancy and birth that affect your figure, along with your lifestyle and eating habits. You may find your breasts change in appearance slightly after giving birth whether or not you breastfeed, but breastfeeding may actually help them to remain firmer than they otherwise would. A well-fitting nursing bra will support your breasts, and keep you comfortable during the day. A bra that is too tight can lead to blocked milk ducts and mastitis.

Do I have to eat a special diet?
No. A normal, balanced diet will provide your body with all the nutrients necessary to make plenty of milk for your baby's needs without depleting your own stores of nutrients or energy. Occasionally a baby may take exception to something you have eaten or drunk, but this is unusual. Moderation in all foods is normally all that is required. Drink when you feel thirsty.

How do I know if my baby is getting enough milk?
If your newborn baby is feeding whenever he asks to, is gaining weight steadily, has plenty of pale, wet nappies (provided no other fluids are given), has several poos a day (in the first six weeks) and seems contented, then relax - he's getting enough. He will enjoy the cuddling and the close contact with you, so don't be afraid of "spoiling" him by breastfeeding frequently.

What about night feeds?
Almost every baby wakes at night needing to be fed. A baby's tummy cannot hold huge amounts of milk and, as breast milk is very easily digested, your baby will ask to breastfeed often. Night feeds help boost your milk supply and prevent engorged breasts. Night feeds may continue for some time: there is no set age at which a breastfed baby will give up wanting to feed at night. Each baby is an individual with individual needs.

What if I need more help?
The ABM has volunteer breastfeeding counsellors who give free information and support by phone, in person or via email. Follow us on Facebook, Twitter, Pinterest and Instagram. Become an ABM member to receive regular breastfeeding information and our members' magazine.

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Is breastfeeding good for my baby? Breastfeeding not only provides food in the most natural form for babies, but also provides comfort, pain relief and the natural nurturing that babies need for development. Breast milk contains everything that a baby needs for growth in the first six months of life in exactly the right amounts and in the best form for his body to use.

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Breastfeeding and bottle feeding information sheets

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Breastfeeding and bottle feeding information sheets

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Available in Arabic, Bengali, Hindi, Lithuanian, Mandarin, Polish, Romanian, Slovak, Turkish and Urdu

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

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

Breastfeeding guidance: English (for reference)

Bottle feeding guidance: English (for reference)

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Foreign language resources - Baby Friendly Initiative

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

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Being able to express your milk with your hands is a very useful skill to have- to relieve full areas, as well as provide milk for your baby if you are apart.

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Unicef UK Baby Friendly Initiative | Hand expression

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Breastfeeding, attachment, positioning and complications in various languages

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Breastfeeding, attachment, positioning and complications in various languages

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Select the language required to view relevant videos

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Mothers and caregivers Videos - Global Health Media Project

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© 2022 Global Health Media Project | a 501(c)(3) nonprofit

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How to increase your supply, *includes where to hire hospital-grade breastpumps*

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Maximising Breastmilk  - with QR codes 2605

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Frequently asked questions in various languages

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Frequently asked questions in various languages

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Available in Bengali, Polish, Punjabi, Urdu and Welsh

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Is breastfeeding good for my baby?
Breastfeeding not only provides food in the most natural form for babies, but also provides comfort, pain relief and the natural nurturing that babies need for development. Breast milk contains everything that a baby needs for growth in the first six months of life in exactly the right amounts and in the best form for his body to use. Breast milk satisfies a baby's hunger and thirst. No other foods or drinks are necessary, provided a baby is allowed to feed at the breast whenever he wishes.

Breast milk increases a baby's resistance to many infections and diseases, and reduces his risk of developing allergies, diabetes and childhood cancers. Breast milk is free, fast and convenient. It is always available and is fresh, clean and served at the right temperature. There's no sterilising to worry about, no mixing, heating, refrigerating and no bottles to take out and about. Babies can be breastfed discreetly anywhere.

Is breastfeeding good for me?
Breastfeeding reduces the risk of breast and ovarian cancers and helps your uterus to return to its pre-pregnancy size, so you regain your figure more quickly. Breastfeeding also uses up excess fat stores from pregnancy.

Breastfeeding gives you a chance to sit down and relax during a busy day and so helps you cope with the demands of motherhood. It gives you confidence as you know you are giving your baby the best possible start in life. It can be a rewarding and satisfying experience for you and your baby.

How soon can I breastfeed my baby?
You can usually start breastfeeding immediately after birth. A baby's suckling instinct is strongest in the first hour after birth, so putting your baby to the breast as soon as possible will get you off to a good start.

How do I put my baby to the breast?
Make yourself comfortable. (For night-time feeding or if you have stitches, lying on your side may be the best option for you.) Your baby should be held close to your body, facing your breast with his head, shoulders and body in a straight line, and your hand supporting his neck so he can move his head to latch on. He should be able to reach the breast easily without having to stretch or twist.

Hold your baby with his nose opposite your nipple, allowing his head to be able to flex. Brush your nipple against his lips or nose to encourage him to open his mouth and reach for your breast. Wait for the 'gape' (his mouth opening like a yawn).

Bring him to the breast with his chin touching the breast first, then his bottom lip and tongue near the outer edge of the areola, and bringing his top lip to latch over the nipple as far as possible on to the other side of the areola. Make sure he takes a good mouthful of the areola (the dark area surrounding the nipple) and not just the nipple itself. He should have more areola in his mouth on the side of his bottom lip than his top lip.

Babies breastfeed - they don't nipple feed. Allowing your baby to suck on just the nipples will make them extremely sore, and can lead to cracking and bleeding. Remember to always bring your baby to your breast rather than trying to move your breast to your baby. Tummy to Mummy, Nose to Nipple,and Baby to Breast.

You may prefer to use a more reclined position and encourage baby to self-attach. Your midwife can support you with this after the birth.

How can I avoid sore nipples?
Some nipple tenderness is common during the first few days due to hormonal changes in your body but this will soon pass. If it is painful when you first put your baby to the breast, gently insert your clean little finger between your baby's mouth and your breast to break the suction and try again. If the discomfort persists, seek help from a breastfeeding counsellor or midwife to check your baby is correctly positioned at your breast.

Breast milk is a natural antiseptic - if your nipples are sore, express a little milk after a feed and allow the milk to dry on the nipple. It will help them heal. If your nipples are cracked, you may need more than breastmilk. A breastfeeding counsellor can talk to you about 'moist wound healing'.

When your baby is correctly positioned and feeding well, breastfeeding shouldn't be at all
painful - if it is, some adjustments will be required. Don't be afraid to ask for help.
A plentiful milk supply is also dependent on correct positioning. It's important thing to get this right.
How long should I feed my baby for?
Always let your baby determine the length of the feed. Your baby knows when he has had enough, and will take himself off the breast. If you take him from the breast before he is ready, he may not have received as much of your milk as he needs, and he may not gain weight and thrive as he should. Taking your baby off the breast too soon may also reduce the amount of milk you produce.

How often should I feed my baby? \
Breastfed babies need to feed frequently. Young babies will generally need at least 8 feeds and may have as many as 12 or more feeds in 24 hours. Your baby may also 'cluster' feed, having a few of his breastfeeds close together then the rest spaced out a little more - this is normal. The important thing to remember is that the more often a baby suckles at the breast, the more milk is produced.

At times during the early weeks your baby may appear to be more hungry than usual - he will be "asking" to build up your supply in preparation for a spurt of growing and developing. Occasionally a very placid baby, who regularly sleeps for long stretches, may need to be woken to be fed. Don't be tempted to make comparisons between how often your baby feeds and a bottlefed baby's patterns. Breastfed babies have a totally different pattern of feeding.

How can I increase my milk supply?
If you feel that your supply is low, encourage your baby to feed more often. Put your own and your baby's needs first. Babies do have 'growth spurts' and at these times they will need to feed more often to stimulate milk production. Good positioning at the breast is also important for a good milk supply.

Can I have too much milk?
Colostrum (the 'first' milk) begins to change to mature milk during the first week and this is often referred to as the milk 'coming in'. Your breasts will be swollen with extra fluids and, initially, you may be making more milk than your baby takes.

At this time your breasts may become hard, lumpy and painful. Frequent feeding helps to avoid this, and expressing a little milk before putting the baby to the breast can also help. A warm bath or warm flannel held to the breast will help the milk to flow easily and make expressing easier.

Will breastfeeding spoil my figure?
No, it's pregnancy and birth that affect your figure, along with your lifestyle and eating habits. You may find your breasts change in appearance slightly after giving birth whether or not you breastfeed, but breastfeeding may actually help them to remain firmer than they otherwise would. A well-fitting nursing bra will support your breasts, and keep you comfortable during the day. A bra that is too tight can lead to blocked milk ducts and mastitis.

Do I have to eat a special diet?
No. A normal, balanced diet will provide your body with all the nutrients necessary to make plenty of milk for your baby's needs without depleting your own stores of nutrients or energy. Occasionally a baby may take exception to something you have eaten or drunk, but this is unusual. Moderation in all foods is normally all that is required. Drink when you feel thirsty.

How do I know if my baby is getting enough milk?
If your newborn baby is feeding whenever he asks to, is gaining weight steadily, has plenty of pale, wet nappies (provided no other fluids are given), has several poos a day (in the first six weeks) and seems contented, then relax - he's getting enough. He will enjoy the cuddling and the close contact with you, so don't be afraid of "spoiling" him by breastfeeding frequently.

What about night feeds?
Almost every baby wakes at night needing to be fed. A baby's tummy cannot hold huge amounts of milk and, as breast milk is very easily digested, your baby will ask to breastfeed often. Night feeds help boost your milk supply and prevent engorged breasts. Night feeds may continue for some time: there is no set age at which a breastfed baby will give up wanting to feed at night. Each baby is an individual with individual needs.

What if I need more help?
The ABM has volunteer breastfeeding counsellors who give free information and support by phone, in person or via email. Follow us on Facebook, Twitter, Pinterest and Instagram. Become an ABM member to receive regular breastfeeding information and our members' magazine.

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Is breastfeeding good for my baby? Breastfeeding not only provides food in the most natural form for babies, but also provides comfort, pain relief and the natural nurturing that babies need for development. Breast milk contains everything that a baby needs for growth in the first six months of life in exactly the right amounts and in the best form for his body to use.

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Getting the Best Fit for Your Breastpump

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Getting the Best Fit for Your Breastpump

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How well your breastpump fits you, can make a big difference to how much milk you can pump. See this leaflet to guide you.

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Available in Bengali, Polish, Punjabi, Urdu and Welsh

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By choosing to make your baby a breastfed baby, you and your partner are giving your baby the very best start. USeful information for partners.

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The most common reason for a lower milk supply is a baby not feeding well, or frequently enough.

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

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Read more about common breastfeeding issues that can affect your breast milk supply. If you have any concerns, it’s important to talk to your health visitor.

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If your baby is very sleepy, or has problems with weight gain, your infant feeding specialist may recommend you try this technique.

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Breastfeeding Tips: When do I switch breasts?

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Babies can seem unsettled and cry for many reasons - if it is colic, here is what might help.

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There are other reasons why your baby may be crying, it's a good idea to check if they:

are hungry

have a dirty or wet nappy

have wind

are too hot or too cold

are bored or overstimulated

If your baby tends to cry during or after feeds, it's worth checking whether this could be reflux. Our guide to reflux in breastfed babies has information on the signs and symptoms.

What causes colic?

There are no known reasons why some babies get colic &ndash some doctors think it's a type of stomach cramp. But it may happen because babies find it harder to digest food when they are really young.

Constant crying could also be due to food allergies, such as cow's milk allergy. If you think this is the case, talk to your GP before making any changes to your baby's diet.

Colic remedies for breastfed babies

Sadly, there is no actual cure for baby colic, only methods to provide relief and soothe them. These are some of the tried and tested techniques that other parents use to relieve colic symptoms in breastfed babies:

Burping

Burp (or wind) your baby during and after every feed - have a look at burping your baby for techniques.

Sit your baby up

When breast or bottle feeding, sit your baby up as straight as possible. This will help minimise the amount of air they swallow. If you are bottle feeding, try to make sure the milk fills the teat and there are no air pockets - you could try using an anti-colic bottle to see if that helps.

Attachment

Check that your baby is attached (latching on) properly as this may help reduce colic symptoms. If you are unsure that your baby is attaching properly while breastfeeding, have a look at our guide to latching on.

Diet

There is no evidence that changing your diet will help &ndash however some people say that cutting down on spicy foods, caffeine and acohol has made a difference for them.

If you are mixed feeding (combining breast and bottle feeding), have a look at our guide to colic when bottle feeding.

Other ways to soothe your baby

Hold them

During bouts of crying, hold your baby to your chest so they can feel and hear your heartbeat.

Rock your baby

Sometimes the swaying motion of rocking your baby in your arms can help.

Warm bath and a massage

A warm bath can be soothing, followed by a gentle tummy massage (with gentle, circular strokes on the tummy).

Create a calming atmosphere

Babies can become overstimulated with lots of noise and activity around them. Try to quieten your surroundings, switch the TV off, dim the lights, and try to take some deep breaths yourself.

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There are other reasons why your baby may be crying, it's a good idea to check if they: are hungry have a dirty or wet nappy have wind are too hot or too cold are bored or overstimulated If your baby tends to cry during or after feeds, it's worth checking whether this could be reflux.

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All babies spit up milk - that is normal. Come along to a drop-in group if you think it is more than that.

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Reflux, spitting up or possetting are all names used to describe babies bringing back some of the milk that they swallowed earlier. Some spitting up is

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If you think your baby has tongue tie, come to a drop-in support group and we can help.

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Tongue-tie can make it difficult for your baby to latch on properly. Find out about the symptoms and how to treat it

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Read more about common breastfeeding issues such as tongue-tie. If you have any concerns, it’s important to talk to your health visitor.

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Lots of tips and tricks for increasing your supply.

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With the right information and support, most breastfeeding mothers will make plenty of breast milk and their babies will be contented and thrive. However, good breastfeeding support is not always available and there can be a variety of factors that might lead to a mother finding she has a low milk supply. If a mother doesn't have enough milk to satisfy her baby, there are several ways to make more breast milk. A breastfeeding specialist can be a helpful partner to identify the most likely reasons for a low milk supply and to discuss a personalised care plan to maximise a mother's breast milk.

This article

This article looks at how milk production works and how to use this information to increase breast milk. If your baby is not getting enough milk or not gaining enough weight, supplements may be needed to keep your baby well fed until your milk supply increases.

How milk production works

Breast milk is made "on demand". As long as milk is taken from the breasts (by a baby or a pump) more milk will be made in the breast to replace it.

A full breast has slower milk production. As soon as a breast is full it sends a message to the breast or "milk making factory" to slow production.

An empty breast has faster milk production. As soon as a breast is empty, the milk factory speeds up production.

It follows that MORE BREASTFEEDS equal MORE MILK because the more often the breasts are emptied the more milk will be made. A lactating breast is never truly empty so in practice this means regularly removing or "draining" most of the available milk. This process depends on effective milk removal through a good latch (the way baby attaches to the breast), good positioning and plenty of frequent feeds. If your baby isn't emptying or draining the breasts thoroughly, your milk supply will not be fully stimulated. A good breast pump can help with milk removal if you are exclusively pumping for your baby or while you work on improving latch and positioning with the help of a lactation consultant.

How to make more breast milk

Sometimes making more breast milk is just a matter of improving positioning or offering both breasts per feed instead of one. Sometimes it is not quite as straightforward. If your milk supply doesn't improve after trying the suggestions below, contact your IBCLC lactation consultant for more personalised information based on your medical history.

#1 A good latch and position

With a good latch your baby can stimulate the breast properly to release milk, and the more milk that is released, the more will be made to replace it. A good latch is one that has lots of breast tissue in the mouth not just a nipple. Positioning is also important so that your baby can get a good mouthful of breast, be comfortable at the breast and feel stable. When your baby is latched well and getting breast milk you will either hear him swallowing, or see the pause in his suck while he swallows. Breastfeeding is not supposed to hurt and pain or sore nipples indicate something is wrong. See Latching Tips and Why Does Breastfeeding Hurt? for further tips to improve latch and an explanation of how latching can help with increasing milk supply.

#2 Frequent feeds

Removing milk from the breast frequently is another key to stimulating your milk supply. Conversely, waiting a set time so that your breasts "fill up" between feeds will NOT be helpful for your milk supply. Healthy newborn babies typically want to feed every couple of hours or more-see How Often Should a Newborn Feed? S ucking fists or fingers, moving their head from side to side with an open mouth or starting to fuss are all signs that a baby is hungry (hunger cues). Encouraging your baby to feed as often as they need will help your milk supply. Breastfeeding in clusters i.e. more frequent breastfeeds at certain times of the day are perfectly normal. The closer together breastfeeds are, the higher the fat content of all the breast milk and the more milk your breasts will make.

Sleepy baby or ineffective feeds

If your baby is very sleepy or has not been getting enough milk for a while, it may be necessary to wake your baby to remind him to feed. Remind a sleepy baby to feed at least every two hours during the day and every four hours at night. Watch for the baby who looks as if they are breastfeeding but closer inspection reveals they are asleep at the breast, or making light fluttery jaw movements as if they are dreaming about breastfeeding but without swallowing-see #3 and #4 below and read more in Flutter Sucking and Comfort Nursing and Breastfeeding a Sleepy Baby.

Night feeds are important

Night feeds are very important for milk supply because:

Frequent breast emptying increases the rate of milk production

Levels of prolactin (an important hormone for milk production) are naturally higher at night

Milk can flow more easily when a mother is sleepy and relaxed

A baby can take as much as 20-30% of their calories at night so night feeds are especially important if your baby is not gaining weight. Some mothers whose babies sleep through the night early-yet who don't gain much weight have found it can help to set an alarm to schedule a feed in the night.

#3 Monitor swallowing and active feeding

Letting your baby be the one to end the feed normally ensures he has had enough milk. If he has filled his tummy, he may fall asleep after 10-30 minutes of active sucking and swallowing (rough guide). His hands and face will be relaxed and he will let go of the breast himself. However, watch for the baby who is "hanging out at the bar but not buying any drinks". He may stay latched for an hour or more but close inspection shows he is not actively sucking and not swallowing milk. This baby may fall asleep with his hands clenched in tight fists and may have a worried expression. In this case, after breastfeeding from both breasts for 20-30 minutes with breast compressions (#4), your time will be better managed by pumping and topping him up with breast milk (or formula if needed), rather than sitting on the sofa for long periods with a baby who isn't drinking and isn't gaining weight.

#4 Use breast compressions

Breast compression is the name given for applying gentle massage and steady pressure to the breast during a breastfeed to simulate another let-down (release) of milk. If your baby falls asleep after less than ten minutes swallowing, or, when your baby stops actively sucking and swallowing, gentle breast compressions can increase milk flow which starts baby sucking again and so further stimulate the milk supply. This usually works better to keep a baby actively sucking than blowing on baby's face or tickling their toes. For more information see What is Breast Compression?

#5 Offer both breasts per feed

Letting your baby finish each side at his own pace and offering both breasts at each feed is a way to increase a milk supply. After your baby has finished the first breast with breast compressions, offer the second breast and repeat, using breast compressions again when sucking slows on this breast. Keeping to one breast per feed is a way to reduce a milk supply.

Switch nursing

If your baby keeps falling asleep while feeding, a technique called "switch nursing" may help keep his interest and encourage active feeding. Change (or switch!) breasts when baby's sucking slows down and he swallows less often. Switch nursing is also explained in One Breast or Two Per Feed?

Foremilk and hindmilk

One common cause of a low milk supply is when a mother has been told to stay on one breast for blocks of time to "get to the hindmilk". Hindmilk is the name for the milk towards the end of a feed which has a higher fat content. This is very poor advice for the mother who doesn't have much milk. Keeping to one breast per feed or for a period of time is a way to reduce your milk supply. See Forget about Foremilk and Hindmilk for more information.

#6 Pumping or hand expressing

Pumping or hand expression will be invaluable if your baby is not latching at all, if you want to pump so you can store breast milk, or if your baby is not emptying the breasts properly. A good pump can increase a milk supply by thoroughly draining the breasts at each pumping session. For many pumping tips, including how often to pump and how long to pump for, see How to Increase Milk Supply When Pumping. Research has shown that breast massage during pumping and hand expressing after a pumping session to remove the remaining milk can help milk supply significantly.

It may not always be necessary to pump, especially if you are working with a lactation consultant and have improved positioning and feed frequency and are now using breast compressions. Every mother-baby pair is different so be guided by your IBCLC's individualised care plan.

#7 Skin-to-skin

Spending time holding your baby skin-to-skin or with you both lightly dressed has many benefits for you and your breastfed baby. Benefits include spotting early feeding cues, stimulating hormones needed to make milk and helping your baby gain weight simply by your baby being where he feels safest and expends least energy-in your arms.

#8 Avoid pacifiers (dummies) and delaying feeds

Dummies can cause a baby to miss feeds or go longer between feeds if their hunger cues are stifled with an empty teat. A pacifier can also affect a baby's latch and suck because a pacifier teat is very different to a breast. See Pacifier, Dummy or Soother-Yes or No? for more information. When all your baby's sucking is at the breast it will help to boost his milk intake. Scheduling feeds or delaying feeds because you think a baby can't be hungry again yet can prevent a baby from getting all the milk they need. See He Can't be Hungry. He Just Ate! to understand how babies gain weight.

#9 Diet

For some mothers diet can play a role in achieving a full milk supply. Some nutrients are particularly important for breast milk production and if there are not enough in the diet milk production could be affected. See Best Breastfeeding Diet and Foods to Avoid and Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production, Second Edition for more information.

#10 Galactagogues

A galactagogue is something that is said to increase the production of breast milk such as certain herbs e.g. fenugreek, foods e.g. oatmeal and a few prescription medicines e.g. domperidone.

For a summary of popular galactagogues see What is a Galactagogue? And for more reading see Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production.

galactagogues can't take the place of frequent milk removal. Take the time to identify and address whatever is tanking your supply first. Then galactagogues may help speed up the process. Putting the cart before the horse rarely gets you very far.

#11 Body work

If any of the important nerves involved in milk let down are functionally impaired, or if any of the mother's spinal vertebrae are misaligned, body work or manual therapy may be of interest to some mothers with milk production issues.

Acupuncture or acupressure

Acupuncture has been used in China for low milk supply for two thousand years with specific acupuncture points reputed to be associated with raising prolactin levels so increasing milk supply. (Marasco and West, 2020).

#12 Medical investigation

If working through the ideas above don't help baby get more breast milk there may be other reasons why a milk supply is low. Certain medical conditions such as hormone or endocrine issues or medications can reduce a milk supply. See Reasons for Low Milk Supply and No Breast Milk After Delivery for more information.

Supplementing your baby

If your baby's weight is a concern, it is important to keep your baby well fed until your milk supply improves and your little one is able to take enough breast milk. Topping up with expressed breast milk or formula if needed before or after several day time breastfeeds will have less impact on your breastfeeding relationship than replacing whole breastfeeds with bottles. The volume of supplement used each day is an indication of how much more breast milk is needed to establish a full milk supply. You can work towards making this amount of breast milk with the ideas above.

Top-ups can be fed by a cup (baby must be awake and alert), using a supplemental system at the breast or by a bottle-use paced bottle feeding to mimic breastfeeding. For much more information around topping up a very underweight baby while protecting breastfeeding see Supplementing an Underweight Baby.

Should I offer solids early?

In most cases the answer to poor weight gain is not to start solids early but to work on your breast milk supply with a breastfeeding specialist using the ideas above. If additional calories are still needed, donor milk or formula may be indicated. However, after four to five months of age, Canadian paediatrician Jack Newman and breastfeeding author Maureen Minchin have written about how starting selected high quality solids may be preferable to topping up with formula, since formula and using a bottle have their own downside and risk such as an early end to breastfeeding and implications for long term health. Working with your IBCLC lactation consultant and health professionals will help you decide on the best course of action for your baby. See Starting Solid Foods for more information.

FAQs on milk supply

Will drinking loads of water help my milk supply?

It is important to stay hydrated but drinking excess water above levels needed to quench thirst and give clear urine has not been shown to increase milk supply. For more information see Best Breastfeeding Diet and Foods to Avoid.

Will sports drinks help my supply?

Drinking specific branded sports drinks (e.g. Gatorade or Body Armor) is often suggested in forums as a way to increase milk supply. Although some mothers feel it worked for them, there is no scientific evidence that drinks containing sugar, salt (electrolytes), additives, colours, flavourings and genetically modified ingredients can help with milk production. It is possible that if a mother believes it will work there may be a placebo effect. Authors Marasco and West say:

Have you heard that Gatorade or similar sports drinks-blue is often specified-are lactogenic? Personal testimonies abound, though there is nothing special about the ingredients that stand out except maybe potassium, which is important for dehydration. Myth or fact, there are healthier drinks [...] that both contribute to your health and your milk supply.

Is breastfeeding better than pumping for milk supply?

In many cases breastfeeding is better at stimulating a milk supply than a pump. But not always. For the mother with an underweight baby or a baby with a poor latch it is likely that pumping with a good pump will drain the breasts more thoroughly after a breastfeed and help promote milk supply. Always be guided by your IBCLC lactation consultant for the best ideas to boost your milk supply in your own unique situation.

Summary

Breast milk is made by supply and demand. When a pump or baby removes milk from a breast, more breast milk is made. This principle depends on good breast drainage which in turn depends on a good latch, frequent breastfeeds or a good pump. There are many ways that a mother can increase her milk supply but sometimes there can be medical causes hindering a full milk supply. An IBCLC lactation consultant can help a mother identify the reasons for her low milk supply and suggest a care plan tailored for her and her baby to make more breast milk.

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How to make more breast milk; tips, tricks and ideas to increase a breast milk supply from breast compressions to pumping and more.

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In addition.... did you know that you can store freshly expressed breastmilk at room temperature for up to 6 hours.

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There may be times when you need to express your breast milk. Have a look through our guide to expressing breast milk and bottle feeding.

Storing breast milk

Breast milk can be stored in a sterilised container, or special storage bags - remember to label and date it.

Store it in small quantities to avoid wasting any. Your breast milk can then be kept:

at the back of the fridge, not the door, for up to 8 days (at 4C or lower)

in the ice compartment of the fridge for up to 2 weeks

in the freezer for up to 6 months (at -18C or lower)

The best way to defrost frozen breast milk is by leaving it in the fridge to thaw out completely. But if you need it straightaway, you can defrost it by placing the bag or container in a jug of warm water, or by holding it under running warm water.

Whichever way you defrost the milk, it must be used immediately (never re-freeze it).

Breastfeeding Friend from Start4life

The Breastfeeding Friend, a digital tool from Start4Life, has lots of useful information and expert advice to share with you - and because it's a digital tool, you can access it 24 / 7.

For confidential breastfeeding information and support, call the National Breastfeeding Helpline on 0300 100 0212. Lines are open 9:30am to 9:30pm every day.

Sign up now for our pregnancy, baby and toddler guide

Get personalised emails for trusted NHS advice, videos and tips on your pregnancy week by week, birth and parenthood.
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Read about expressing your breast milk and how to store it safely.

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Skip to main content There may be times when you need to express your breast milk. Have a look through our guide to expressing breast milk and bottle feeding. Breast milk can be stored in a sterilised container, or special storage bags - remember to label and date it.

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Also available in several languages.

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Positions for Breastfeeding - Breastfeeding Series

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Breastfeeding takes practice. It takes time to work out which positions feel best - try them all out to see which feels best.

Breastfeeding positions

Before you breastfeed your baby, have a drink beside you - something thirst quenching like a big glass of water. There are a few different breastfeeding positions you can try, these are 3 of the most popular:

Cradle hold

This is the probably the most popular breastfeeding position. However, if you've had a caesarean, this may be uncomfortable as your baby lies across your tummy near the scar (try lying on your side or the rugby hold instead). For the cradle hold, sit in a comfy chair with arm rests, or a bed with cushions or pillows around you.

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

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

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

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

Here is a top tip...

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

Lying on your side

This is a good position if you've had a caesarean or difficult delivery, or if you're breastfeeding in the middle of the night.

1. Start by getting comfy lying on your side. Your baby lies facing you, so you are tummy to tummy. Check to make sure your baby's ear, shoulder and hip are in a straight line - not twisted.

2. Put some cushions or pillows behind you for support. A rolled up baby blanket placed behind your baby will help support them - remember to remove it after you have finished feeding. If you've got a pillow under your head, make sure it's not too close to your baby's head or face.

3. Tuck the arm you're lying on under your head or pillow (ensuring your baby's position isn't altered by the pillow) and use your free arm to support and guide your baby's head to your breast.

Laid-back nursing

Laid-back breastfeeding, also known as "biological nursing", is when you lie back in a comfortable semi-reclined position on a comfy sofa or bed. If you have had a caesarean section (c-section), your baby can lie across you and away from your incision.

1. Lean back (but not flat) on a sofa or bed.

2. Prop yourself up with cushions or pillows so your back, shoulders and neck feel supported.

3. When you are comfortable, place your baby on your front. Their tummy should be resting on your tummy - but if this is uncomfortable, lie them to one side.

4. Make sure you are upright enough to look into your baby's eyes

5. While supporting your baby, gently guide your baby to your nipple. For more information, have a look at this video on laid back nursing..

Rugby hold (or the 'clutch')

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

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

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

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

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

5. Gently guide them to your nipple.

Breastfeeding Friend from Start4life

The Breastfeeding Friend, a digital tool from Start4Life, has lots of useful information and expert advice to share with you - and because it's a digital tool, you can access it 24 / 7.

For confidential breastfeeding information and support, call the National Breastfeeding Helpline on 0300 100 0212. Lines are open 9:30am to 9:30pm every day.

Sign up now for our pregnancy, baby and toddler guide

Get personalised emails for trusted NHS advice, videos and tips on your pregnancy week by week, birth and parenthood.
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Find out about the different ways you can breastfeed with our step-by-step guide on breastfeeding positions

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Skip to main content Breastfeeding takes practice. It takes time to work out which positions feel best - try them all out to see which feels best. Before you breastfeed your baby, have a drink beside you - something thirst quenching like a big glass of water.

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Skin to skin/Kangaroo care for premature babies

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Skin to skin/Kangaroo care for premature babies

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Mums expecting twins aren't always encouraged to consider breastfeeding; but twins, and even triplets, can be breastfed exclusively. Only a few women won't have enough milk for their babies. Milk supply works on the principle of supply and demand. Breastfeeding tells a mother's body to produce more milk in response to her baby's (or babies') needs. With two babies, more milk is removed from the breasts, so more milk is made. The best way to make sure you establish a good supply is to feed your babies often in the early weeks and to ask someone knowledgeable to help you check that they are attached and breastfeeding correctly.

During the first few days and weeks, babies send signals to your milk supply and may sometimes feed more frequently. This frequent feeding is sometimes perceived as a sign of a lack of milk but, if feeds happen responsively, milk supply will swiftly increase, and feeding will settle into a pattern again. Your babies' weight gain and their nappies will reassure you that they are getting the milk they need.

"I found out at an antenatal scan that I was expecting twins. I asked if I could breastfeed them and was told that I would have to give bottles as well. This upset me as I'd really enjoyed breastfeeding my other two children. The twins were born at 36 weeks (though I nearly had them earlier than that). They never had bottles. I'm glad I found out in advance that it's possible to breastfeed twins."
How can I breastfeed two babies?
Confidence and the belief that it can be done are important. Attend a breastfeeding support group or workshop while you're pregnant to increase your confidence and find out where to get support locally. If you have any questions after your babies are born, you'll know who to ask. Perhaps you can be put in touch with someone who has breastfed twins (or see the Facebook group mentioned below).

"The twins were our first children and I thought I'd like to try to breastfeed. I read a little and a friend invited me to watch her breastfeed her baby. Most of the mums I met at a twins' club hadn't tried, but I decided to give it a go. Our babies were born at 37 weeks after a straightforward labour and the hospital staff were generally encouraging. I wish I'd known a bit more about growth spurts though and how to let the babies increase my milk supply at these times. I also wish I had known about antenatal hand expressing."

Twins can be fed separately or together. Many mums find that they do both in different situations and when their twins are at different stages of development. Feeding babies together can be a good way to establish a plentiful milk supply quickly and can save time. While mum and each baby are still learning about breastfeeding, it may be easier to spend some time feeding separately. As the babies grow and their head control develops, it will be easier to breastfeed them together. Later still, the babies will be able to position themselves. Decisions like when to swap breasts and which positions work best, will vary from family to family.

"Don't be afraid to ask for help positioning the second twin in the early days, so you can have a go at feeding two babies together."

Rugby hold, Parallel and Crossover holds
Breastfeeding cushions designed with twins in mind are more likely to enable a mum to tandem feed and even feed hands-free. However, some mums find they prefer to use V-shaped or normal pillows or cushions or use positions where no cushions are needed. If you have someone to assist you in the early days, they can help you position a second baby after the first one has started feeding.

"After a couple of weeks, I got the hang of feeding lying down and that made things a lot easier at night. When they were a little older, I managed to find a way of feeding both lying down. You get inventive about using different positions and doing things like answering the phone while breastfeeding."

"Our girls are now 17 months old and I'm still enjoying breastfeeding them. Now they are toddlers, I tend to feed them separately, but I used to do a mixture of breastfeeding separately and together."

What if my babies are born early?
Twins are more likely to be born early than single babies. If babies are born early, their mother's milk will be different to full-term milk and have specific advantages for pre-term babies. Breastmilk reduces a baby's chances of becoming ill and some conditions can be particularly serious in a pre-term baby. If twins are born very early, they may need to be fed by tube or special cup until they are able to breastfeed. Expressing breastmilk for premature babies will mean a mother is making a valuable contribution to her children's welfare, especially as hospital staff are responsible for other aspects of their care. Donor milk can also be an option.
Won't I be too tired to breastfeed?
Tiredness is sometimes given as a reason not to breastfeed twins, but there's no evidence that breastfeeding in itself is tiring. In fact, breastfeeding mums can make the most of opportunities to sit or lie down. It's important to eat a balanced diet and to rest when your babies sleep.

Once breastfeeding is established, it gets easier to go out or travel with twins, because breastmilk is available immediately and at the right temperature. Imagine the sheer number of bottles to be washed, sterilised, made up with hot water then cooled down for bottle-fed twins, and the cost of formula.

Breastfeeding involves the release of specific hormones that help a mother to feel relaxed. This is particularly beneficial for mums of twins who are likely to have an even busier time than other mothers. Also breastfeeding will help your uterus (particularly enlarged after having twins) to contract back to its pre-pregnancy shape and size and will help you lose weight more quickly.

If families feed their babies at the same time, they may choose to wake the other twin at night to minimise the number of night feeds. Breastfeeding at night can be done lying down and can help to establish a good supply of milk.
But my family and friends want to help
Grandparents or others might ask if they can help by giving a baby a bottle, but if bottles are introduced early on, this may make breastfeeding more difficult to establish and reduce a mother's milk supply. Dummies may also mean the demand on your milk is reduced so the supply reduces. However, some mothers of twins do find that expressing breastmilk can be useful and allows someone else to feed the babies occasionally.

There are lots of other things that family and friends can offer to do to help parents of newborn twins e.g. cuddling a baby, changing a nappy, offering mum a drink or sandwich, helping at bath time if needed, or hanging out washing. The support and encouragement of friends and family is an important aspect to breastfeeding twins successfully.
More information:

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Many new mums worry about whether they will have enough milk, but in fact there are very few women who don't have enough.

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Breastfeeding Support – Breastfeeding Twins and Triplets

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Many twin mums stop breastfeeding before they’re ready because of a lack of support and knowledge. We provide evidence-based advice to expectant and new mums through our popular Facebook group. We also provide discounted pump hire and one-to-one support sessions which can save a family’s breastfeeding journey.

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Monitoring blood sugar levels in pre-term babies

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Monitoring blood sugar levels in pre-term babies

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Breastfeeding support line in Bengali and Sylheti

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Breastfeeding support line in Bengali and Sylheti

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0300 456 2421

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Having the support of your partner goes a long way in helping you to work out breastfeeding. This link helps them to find out how best to support the both of you.

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By choosing to make your baby a breastfed baby, you and your partner are giving your baby the very best start. USeful information for partners.

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Breastfeeding will still protect your baby even if you or someone in your household smoke. Here is some guidance you on how to reduce your baby's exposure to smoke.

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This information can also be viewed as a PDF by clicking here
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.
Smoking whilst breastfeeding is not advised. However the benefits of breastfeeding and smoking are still greater than formula feeding. Smoking only after feeding and away from the baby is recommended to limit the baby's exposure.

Nicotine is found in breastmilk.

The flavour of breastmilk collected 30-60 minutes after smoking was identified as tasting more like cigarettes than samples taken at any other time.

The levels of cotinine (the chemical into which nicotine is changed in the body) in the urine of breastfed babies whose mothers smoked were ten times higher than those of formula fed babies of smoking mothers. It appears that this is due to passage through breastmilk and not through exposure to smoke in a room.

Babies of mothers who smoke appear to be more likely to suffer from colic.

Smoking appears to lower breastmilk production - more women who smoke believe that they have insufficient milk

Mothers who smoke are likely to breastfeed for a shorter length of time

Many women continue to smoke whilst breastfeeding perceiving that it is the only time that they have for themselves, to overcome tiredness or to reduce their appetite.

Passive smoking is related to early onset of wheezing - breastfeeding may reduce the severity of bronchial asthma.

Research shows exposure to smoke increases the risk of cot death in babies.

There have been recent reports linking smoking during breastfeeding with risk of obesity and endocrine dysfunction in the baby in later life (Lisboa 2012, 2015)

Mothers and fathers should stop smoking - or not restart after pregnancy

The use of nicotine replacement therapy exposes the baby to less nicotine than smoking does

There appears to be no current research on "e cigarettes". Although there is some vapour release the risk would probably be less than with smoking.

It is safer to use nicotine replacement therapy whilst breastfeeding than to smoke.

NRT products are not licensed to be used by breastfeeding mothers. This means that the manufacturers have not included a statement on their use when they first made the product available. It does not mean they are not safe.

Babies will be exposed to less nicotine through NRT than through smoking. Smoking produces blood levels of nicotine of 44ng/ml whilst NRT patches produce around 17 ng/ml

NRT avoids exposure to the other chemical compounds in tobacco smoke.

Mothers should not use NRT and continue to smoke

Patches applied over a 24 hour period may produce vivid dreams in the mother; it might be advisable to remove the patch overnight so that the baby is exposed to less during night time feeds.

NRT products do not cause breastmilk to smell of cigarettes.

Nicotine gum produces large variations in nicotine levels whilst patches produce a sustained but lower level. If gum is used it should be chewed immediately after feeds to reduce the baby's exposure. NRT nasal sprays similarly produce rapid high levels and may best be used after feeds.

Exposure of the baby to NRT products is safer than exposure to cigarettes and with appropriate support may help the mother (and ideally her partner) to quit smoking permanently.

NB - Research shows exposure to smoke increases the risk of cot death in babies.

Oral medication to help with smoking cessation Varenicline (Champix ®) and Bupropion (Zyban ®) should be avoided during breastfeeding.

These suggestions are based on my experience of running a smoking cessation clinic as in independent prescribing pharmacist.

Think about why you want to stop smoking - is it for you, for your baby or older children, because somebody says you OUGHT to? If the latter you are unlikely to succeed long term, you need to decide that it is what YOU want to do and have a clear reason to do so.

Set a date when you plan to stop smoking and work towards that date.

Decide on what NRT you wish to use - it is much easier than trying to go cold-turkey. Can you get support from your local community pharmacy, practice nurse or smoking cessation service? They may well prescribe for you so the NRT is free if your baby is under 12 months of age. They will also monitor your carbon monoxide level in your breath showing you how your lungs clear quickly.

Think about when you smoke - is it a routine e.g. after a meal, with a cup of coffee, when you are tired or hungry? Think about each cigarette you have over several days - what made you decide to light this cigarette? Do you really want it?

Think about where you smoke - is it always in the same place e.g. a chair you sit in, outside the kitchen door so in sight or sound of your baby but not with him/her.

Decide how you can change each time you smoke - can you distract yourself for 20 minutes? This is the time it usually takes a craving to subside. Could you wash the floor, sing a song to your baby, make everything ready for the next meal, paint your nails or something else that works for you? Can you change where you sit?

On the day you decide to stop you may want to tell everyone so that you elicit their support or you may want to keep quiet so no-one tries to tempt you because they haven't made their own decision.

Put away the cash you would have spent on the cigarettes and spend it after 6 weeks of being cigarette free on a treat for YOU - not the family, not the baby, this is YOUR celebration of overcoming the addictive habit called smoking.

If you smoke to give yourself "5 minutes peace" think about how else you could spend that time.

Have strong tasting sweets around to suck - traditionally these are mints but could be anything you like. Also have lots of healthy snacks so you don't resort to chocolate instead.

Be proud of yourself - stopping smoking is not easy! Take every day as it comes and celebrate. If you have one cigarette it doesn't mean you failed, think why it happened and plan how to avoid that situation again. Do not give up giving up!

Amir LH, Donath SM. Does maternal smoking have a negative physiological effect on breastfeeding? The epidemiological evidence. Breastfeed Rev. 2003 Jul; 11(2):19-29. www.ncbi.nlm.nih.gov/pubmed/14768313?dopt=Abstract

British National Formulary

Dahlström A, Ebersjö C, Lundell B Nicotine exposure in breastfed infants. Acta Paediatr. 2004 Jun;93(6):810-6 .www.ncbi.nlm.nih.gov/pubmed/15244232?dopt=Abstract

Hale T. W Medications in Mothers Milk

Ilett KF, Hale TW, Page-Sharp M, Kristensen JH, Kohan R, Hackett LP. Use of nicotine patches in breast-feeding mothers: transfer of nicotine and cotinine into human milk. Clin Pharmacol Ther. 2003 Dec; 74(6):516-24. www.ncbi.nlm.nih.gov/pubmed/14663454?dopt=Abstract

Jones W Breastfeeding and Medication 2018 Routledge

Lactmed website http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Lisboa PC et al Effects of maternal nicotine exposure on thyroid hormone metabolism and function in adult rat. J Endocrinology posted online 4 February 2015 http://joe.endocrinology-journals.org/content/early/2015/02/04/JOE-14-0473.abstract?sid=6e1733c0-0501-4c8f-ad40-d4f493cfafc2

Lisboa PC, Elaine de Oliveira E, and de Moura E G Obesity and Endocrine Dysfunction Programmed by Maternal Smoking in Pregnancy and Lactation. Front Physiol. 2012; 3: 437 www.ncbi.nlm.nih.gov/pmc/articles/PMC3500832/

NICE Smoking Cessation services PH10 2008 http://publications.nice.org.uk/smoking-cessation-services-in-primary-care-pharmacies-local-authorities-and-workplaces-ph10

Reijneveld SA ,Brugman E , Hirasing RA Infantile colic: maternal smoking as potential risk Factor Arch Dis Child 2000;83:302-303

Shenassa ED, Brown MJ. Maternal smoking and infantile gastrointestinal dysregulation: the case of colic. Pediatrics. 2004 Oct; 114(4):e497-505. http://pediatrics.aappublications.org/content/114/4/e497.full

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019

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Smoking, Smoking Cessation and Breastfeeding - The Breastfeeding Network

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This information can also be viewed as a PDF by clicking here The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.

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@hillingdonmaternity on Instagram

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Please use the website links if you have any questions. For clinical help, please contact maternity triage. This page is for information only.

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@Hillingdonhospitalmaternity on Facebook

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This is the official Facebook page of the Maternity Department at Hillingdon Hospital to give you... Pield Heath Road, UB8 3NN Uxbridge, UK

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Local peer support:

Kerrie: 02085 789403
Weekdays 10am-3pm and weekday evenings

Louise: 07980 855126
Text to arrange a call back

National support: 03451 202918
8am to 11pm daily

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Available in Welsh, Spanish, French, Italian, German, Dutch, Turkish, Russian, Hebrew, Japanese and Chinese

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LLLGB resources

LLLGB breastfeeding information in Welsh is now available on our website.
Bwydo ar y fron
Hanfodion bwydo ar y fron
A yw fy mabi'n cael digon o laeth?

Our Leaders offer support to Mums in the following languages:
Afrikaans, Bemba, British sign language, Croatian, English, French, German, Gujarati, Hebrew, Hungarian, Italian, Polish, Portuguese, Spanish, Swahili, Welsh.

We are in contact with LLL Leaders around the world, and can access online support in many languages.
If you would like to access support in a language other than English, please contact our Administration Department and we will try to help you.

LLL Europe resources

You can also find articles, information and support on the LLL Europe website - it has contact details and links to LLL in 21 countries.

LLLI resources

LLLI's international online magazine Breastfeeding Today has translations of many articles in Spanish, German, French and Russian with articles in other languages coming soon.

For more information about LLLI click here.

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Support in languages other than English - La Leche League GB

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LLLGB resources LLLGB breastfeeding information in Welsh is now available on our website. Bwydo ar y fron Hanfodion bwydo ar y fron A yw fy mabi'n cael digon o laeth? Our Leaders offer support to Mums in the following languages: Afrikaans, Bemba, British sign language, Croatian, English, French, German, Gujarati, Hebrew, Hungarian, Italian, Polish, Portuguese, Spanish, Swahili, [...]

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0300 330 0700
8am - midnight daily

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Many mums struggle with breastfeeding in the early weeks, but support can make all the difference. Watch this video as two mums share their experiences.

Feeding support from NCT

Our breastfeeding counsellors are here to help you on your feeding journey. They'll offer relevant information and suggestions - whether you're breastfeeding, formula feeding or mixed feeding. You can access their support in the following ways:

Call the NCT Infant Feeding Line

If you have any questions, concerns or need support - however you're feeding your baby - you can speak to our friendly breastfeeding counsellors free of charge by calling our support line on 0300 330 0700. The line is open every day from 8am to midnight, including bank holidays.

Online breastfeeding support - chat/social media

It's always helpful to talk to other women who are breastfeeding for support, tips and company. Peer support can be found on most social media platforms online, like this one.

As well as support from our breastfeeding counsellors and your health care providers, our breastfeeding commissioned services are offering virtual breastfeeding support via zoom groups, text messaging and one- to-one calls.

If you live in any of these areas and would like some support from a breastfeeding peer supporter, please get in touch:

Many of our local NCT branches are also providing online breastfeeding peer support via closed Facebook groups. Get in touch to find out more - search on your postcode and message your closest branch to see if they have any online peer support.

Visit a local NCT Baby Cafe - supporting you to feed your baby

Put your postcode in our local activity finder to see if there's an NCT Baby Cafe near you. You can expect support, encouragement and reliable information - whether getting ready to breastfeed, establishing breastfeeding, continuing breastfeeding, expressing, mixed feeding, formula feeding, introducing solids or stopping breastfeeding.

These groups are run by qualified NCT Breastfeeding Counsellors but you may also receive support from a trained peer supporter or volunteer. They are free of charge and you are welcome to drop-in - there's no need to be an NCT member or have done an NCT antenatal course in order to attend.
Free one-to-one support from a volunteer
Some NCT Breastfeeding Counsellors are able to provide one-to-one support on a voluntary basis. This could be over the phone, online or in-person. Call the Infant Feeding Line on 0300 330 0700 to find out if this support is available in your area. We can put you in touch with your friendly local breastfeeding counsellor if there is one offering voluntary support near you.

We would be interested to hear any feedback that you have following support from one of our breastfeeding counsellors. Please fill in our survey.

Our courses

All of our courses are led by specially trained and experienced practitioners who understand what matters to you. Choose from our range of classes whether you're preparing for birth or need support postnatally.

What can you expect from NCT support?

Breastfeeding Counsellor

Our Breastfeeding Counsellors are here to support you on your feeding journey. They have undertaken an extensive two-year university accredited training course in counselling, listening skills and research-based breastfeeding knowledge.

You will be offered the opportunity to be listened to without judgement and without being pushed in any one direction. Our Breastfeeding Counsellors will discuss your options and explore what would work for you, alongside offering relevant information for you to achieve your feeding goals.

They will continue to support you however you feed your baby. Breastfeeding Counsellors attend regular continuous professional development days to update knowledge and skills. They are also supported by receiving supervision to explore and reflect upon their counselling practice.

Breastfeeding Peer Supporter

Our Breastfeeding Peer Supporters are mothers who are trained to support other mothers in their feeding journeys. Their six-week training course includes listening skills and straightforward breastfeeding knowledge.

They support mothers in the community both in breastfeeding support groups and by phone or social media contact. They will also signpost mothers to information and specialist support if this exceeds the limit of their knowledge or skills.

All NCT Breastfeeding Peer Supporters receive ongoing training and support from specialist breastfeeding counsellors, helping them to reflect and learn from their experiences and maintain the boundaries of their role.

All of our Breastfeeding Counsellors and Breastfeeding Peer Supporters are mothers who have the lived experience of breastfeeding their own babies.

Practical and emotional support

Your breastfeeding counsellor will make use of person-centred counselling skills, bringing thoughtful and empathetic support to you and your family. This includes listening to you without judging or criticising and offering information and suggestions. She will provide relevant information to help you make informed decisions about feeding your baby.

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Breastfeeding support from NCT | Baby & toddler, Feeding articles & support | NCT

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Breastfeeding isn't always straightforward, but there is lots of information and help to support you - wherever you are in your feeding journey.

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📞 The Infant Feeding Team at Hillingdon Hospital:  01895 279 723

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📞 The Infant Feeding Team at Hillingdon Hospital:  01895 279 723

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Email: thh.infantfeeding@nhs.net

Julia Masdin - Infant feeding co-ordinator

Abbie Bedwell & Maria Kirby - Infant Feeding Support Workers for maternity
Louise Moran & Sarah Wells- Infant Feeding Support Workers for the Neonatal & Transitional Care Units.

This number is not 24/7, but you can leave always leave us a message and we will get back to you. For urgent enquiries please contact Triage.  You can also contact the National Breastfeeding Helpline on 0300 1000212

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This service is open 24 hours a day but mainly for out of hours advice and support

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This phone line is not 24/7. For urgent enquires, please contact Triage

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One to one feeding support is available from the health visiting team for babies over 10 days old. Call the number above or speak to your Health Visitor.

The Health Visiting Infant Feeding Team is also available to see you if you have more complex feeding problems. Contact them by emailing: cnwl.hillingdonbreastfeedingsupport@nhs.net

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How the community can support breastfeeding

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How the community can support breastfeeding

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How the community can support breastfeeding - The Hillingdon Hospitals’ Podcast

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In this episode we are joined by Julia Masdin the Trust’s Infant Feeding Coordinator to talk about breastfeeding - including the benefits for the mum and the baby, how soon after delivery should mums breastfeed, how can a mum tell if a baby is get…

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How to know if your baby might be constipated and what to do.

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Skip to main content

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

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

Constipation

Constipation makes it more difficult for your baby to have a poo. It's often caused by their diet and is easy to treat from home.

Symptoms of constipation

The symptoms of constipation in your baby can include:

pooing fewer than 3 times in a week

finding it difficult to poo, and poos that are larger than usual

dry, hard, lumpy or pellet-like poos

unusually smelly wind and poo

your baby may be less hungry than usual

their tummy might feel firm

Other signs of constipation can include your baby lacking energy and being a bit grizzly.

How often should my breastfed baby poo?

There's no 'normal' when it comes to how often babies poo - breastfed babies will sometimes go several days, or even a week without having a poo (this is more common in babies aged 6 weeks or older). You'll quickly get used to your baby's bowel movements, so you'll be able to tell what's normal for them.

Breastfeeding Friend from Start4life

The Breastfeeding Friend, a digital tool from Start4Life, has lots of useful information and expert advice to share with you - and because it's a digital tool, you can access it 24 / 7.

What causes constipation?

Change in diet

It's quite common for your baby to become constipated when they start taking first infant formula (which is harder to digest than breast milk), or eating processed foods. That's just because their body is learning how to cope with digesting new things.

Dehydration

Constipation can be caused by a lack of fluids. There are various reasons why your baby may not be getting enough fluids - they may be teething and finding it uncomfortable, it could be down to illness (a cold, a throat or ear infection, etc), or if they are older, not drinking enough fluids with their food. Lack of fluids can make your baby's poo harder and more difficult to push out.

Lack of fibre

In older babies, it can also be caused by not getting enough fibre, (such as fruit, vegetables and cereals) in their diet. For advice on which foods to include in your baby's diet, have a look at our guide to What to feed your baby.

Treating constipation

Here are some tips on helping relieve constipation at home:

lie your baby down and gently move their legs like they're riding a bicycle - this can help get things moving. If your baby is happy lying down, give them a gentle tummy massage

if your baby is bottle-fed, try giving them extra water between some feeds

if your baby is on solids, make sure they're getting enough fibre. Apples, pears and prunes are particularly good for constipation. Find out more about foods with plenty of fibre.

It may take a few days to get things moving again, but if things do not improve, speak to your health visitor or doctor. Your doctor may prescribe a laxative, or want to double check that it's not being caused by any underlying medical conditions.

For confidential breastfeeding information and support, call the National Breastfeeding Helpline on 0300 100 0212. Lines are open 9:30am to 9:30pm every day.

Sign up now for our pregnancy, baby and toddler guide

Get personalised emails for trusted NHS advice, videos and tips on your pregnancy week by week, birth and parenthood.
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Do you think your baby could be constipated? Find out what causes constipation and how to treat it

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

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Come along to an antenatal breastfeeding workshop

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Come along to an antenatal breastfeeding workshop

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No prior booking needed. Everyone welcome - we suggest you join when you are about 34 weeks pregnant

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Ideas for connecting with your baby in pregnancy and as a newborn

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Ideas for connecting with your baby in pregnancy and as a newborn

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Getting to know your baby during pregnancy helps their development, and helps you to naturally be more responsive to them when they are born.

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It is well known that breastfeeding is the healthiest choice for you and your baby.  This leaflet helps you find out more about that, and gives tips to help breastfeeding get off to a good start.

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Ho to help your baby get a deep latch on the breast

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Ho to help your baby get a deep latch on the breast

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Bringing your baby to your breast with a wide open mouth so their chin touches your breast well below your nipple, means that the nipple is aimed towards the perfect place - at the back of the roof of your baby's mouth.

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Various things can cause you to become sore when breastfeeding. Ask for help and come to our drop-in groups for support.

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There are several possible causes of sore nipples when a mother is breastfeeding. The most common reason is a baby who is not latched (attached) to the breast properly. To avoid sore nipples a baby needs plenty of breast tissue as well as the nipple in his mouth when he breastfeeds. However sometimes, positioning and attachment may look good yet a mother may still have very painful sore nipples. This article provides a brief guide to some common causes of sore nipples when breastfeeding.

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Causes of sore nipples

#1 Position and attachment

When a baby breastfeeds with a big or deep mouthful of breast tissue as well as the nipple in their mouth it is often called a deep latch. Conversely, if a baby is mostly attached to the nipple with very little breast tissue this is known as a shallow latch. A shallow latch can cause painful feeds and blistered, cracked, grazed or bleeding nipples. Once a baby is helped to latch more deeply; sore or cracked nipples can usually heal quickly on their own. See Why Does Breastfeeding Hurt?, Breastfeeding Positions for Newborns, Latching Tips and Breastfeeding Videos for more information on position and attachment or contact a breastfeeding specialist to help you find a comfortable position to prevent sore nipples.

#2 Variations in anatomy (mother)

Sometimes a baby's latch can "look" good but the mother complains of severe discomfort or one or both of her nipples are sore and damaged. If there is pain, something is not quite right whatever the latch looks like. Variations in the particular anatomy of mother or baby can sometimes make it harder to get comfortable. In these cases, an assessment by an IBCLC lactation consultant can be really helpful. Challenges can include:

Nipple size and shape. Nipples come in many shapes and sizes and a mother can have two very differently shaped nipples. Very large, flat, inverted or unusually shaped nipples can sometimes rub in an infants mouth despite paying careful attention to positioning and attachment. See Breastfeeding With Inverted Nipples and Flat Nipples for help with flatter nipples and ask your breastfeeding specialist to assist with finding the best position for you and your baby. In some situations nipple shields may be helpful (silicone nipple covers with holes for milk to flow). Dimpled or folded nipples may tend to trap moisture after a feed and become sore, but patting them dry after a feed can avoid this.

Large breasts. A larger cup size can sometimes make positioning more challenging see Breastfeeding With Large Breasts for more ideas.

#3 Variations in anatomy (baby)

Just as mothers are all different, so are babies. Examples of variations in anatomy that could be causes of sore nipples include:

Small mouth

Sometimes a baby may seem too small for the size of the nipple or breast they are paired with making it more difficult for them to get a deeper latch. Sometimes a baby may not seem to be able to open their mouth wide enough. Positioning help from a breastfeeding specialist can often help mother and baby find a position that works for them and in a short period of time baby will grow in size.

Receding chin

A receding chin describes a small chin set back a little into the face and is quite normal in babies. However if the lower jaw is very much shorter than usual this can sometimes make it more difficult to get a deeper latch. Cathy Watson Genna explains that a small lower jaw (micrognathia) can give a baby less strength in the jaw and restricted tongue movements. Small jaws tend to grow forward in time, often by around 12 weeks of age. In the mean time, mothers can explore:

Paying careful attention to latch and positioning. Reclining or side-lying positions can be helpful

A nipple shield may be useful short term

Finger-feeding may help to strengthen tongue movements (Watson Genna, 2017)

Tongue function

Sometimes a baby pinches or grazes his mother's nipples even though the latch "looks" good to an onlooker. This could have various causes including:

Poor attachment-a deeper latch with more breast tissue in the mouth will stabilise the tongue and ensure the nipple is in a comfortable position in baby's mouth.

Tension-a baby may have high muscle tone e.g. tension in the neck, jaw or muscles controlling the tongue preventing a full range of movement.

Nipple confusion-a baby who is used to a bottle teat may be using a bottle feeding technique at the breast-sometimes called nipple confusion-see Tips to Bottle Feed a Breastfed Baby for more reading.

Pinching to control fast flow-if milk flow is very fast or there is frequently too much milk available, a baby may also learn to pinch the nipples to stem the flow of breast milk. See What is a Fast Let-Down? and Oversupply of Breast Milk for more reading.

Tongue-tie-when a baby has restricted tongue movements due to the anatomy under their tongue. See What is a Tongue-Tie? for more information.

An IBCLC lactation consultant can help to find solutions if you feel your baby's sucking technique is a cause of sore nipples.

#4 Vasopasm of the nipple

A vasospasm is a sudden constriction (vasoconstriction) or narrowing of the blood vessels. When it happens in the nipple, it can be extremely painful. If you have a nipple vasospasm you may notice blanching of the nipples (when the tips of the nipples look white after a feed) and the pain may be felt a short time after breastfeeding or in between feeds. Possible causes of nipple vasospasm include;

A shallow latch-getting your baby latched deeply at the breast will be helpful.

Raynaud's phenomenon-this is a condition where the mother may experience similar symptoms in her fingers and toes, often triggered by feeling cold.

Stress, or exposure to cigarette smoke and certain medical conditions.

Vasopasm or vasoconstriction of the nipple can also cause Mammary Constriction Syndrome (deep breast and muscle pain). See Vasospasm Symptoms for more information on causes, symptoms and treatments for nipple blanching and vasospasm.

#5 Bacterial infection

Another possible cause of sore nipples that are not healing could be a bacterial infection, eg by Staphylococcus aureus ( S. aureus); a bacteria commonly found on skin. Lactation consultant Marsha Walker explains:

Once the integrity of the nipple skin has been breached, it becomes highly susceptible to colonization and infection by bacteria such as S. aureus. This can lead to prolonged nipple pain, delayed healing, complications, and the need for more aggressive interventions.

Wash damaged nipples daily with plain soap

Walker says that washing damaged nipples daily with ordinary mild soap (not antibacterial) reduces the number of bacteria present and breaks down their protective shield (Walker 2013). Note, there's no need to wash healthy nipples with soap. See Treatments for Sore Nipples for treatment options if you have a bacterial infection or Staph, MRSA and Breastfeeding for more information about S aureus infections.

#6 Fungal infection (thrush)

Thrush is a fungal infection caused by an overgrowth of Candida albicans. Thrush is thought to be normally kept in check by friendly bacteria in our bodies but a mother may be susceptible to thrush if she has cracked or damaged nipples or if mother or baby are on antibiotics (antibiotics kill the friendly bacteria that keep thrush in check). A baby can get a thrush overgrowth inside his mouth (often seen as white patches that can't be scraped away inside the cheeks). Many authors state that a breastfeeding mother can get a thrush infection on her nipples, but there is controversy over the condition. Symptoms often cited include itching or burning pain after a breastfeed and sharp pains deep in the breast in between feeds. These symptoms are similar to those experienced when a baby is not latched correctly causing vasospasm of the nipple (#4 above) and also if a bacterial infection of the nipples is present (#5) making diagnosis difficult. For a full description of causes, symptoms and the latest treatment recommendations see Thrush on Nipples.

#7 Sensitivity to topical creams or food allergens

Nipples may be sore due to an allergy to a cream or remedy that mothers may be using on their nipples. Even purified lanolin-a popular choice for soothing nipples-can cause a reaction in some mothers, either as an allergy or by causing moisture associated skin damage. If there is an overgrowth of bacteria or fungi on the nipples this can increase the sensitisation of skin to food allergens. See Treatments for Sore Nipples for more information.

#8 If baby has a food allergy/pain

When a baby is uncomfortable or has a pain e.g. when they have tummy ache or an inflamed food pipe (gullet or oesophagus) as can be seen with food allergies, they may find it hard to breastfeed comfortably. Lactation consultant and author Robyn Noble explains that as a result of their discomfort a baby can tend to clamp down or "bite" at the breast. This can compress the nipple causing soreness and often a marked ridge or crease will be seen across the nipple after the feed. Noble calls this a hypertonic bite response and makes suggestions to improve comfort and positioning for these babies in her book Breastfeeding Works! Even With Allergies, 2015. Babies with food allergy will usually have other symptoms, see Milk Allergy in Babies for more information.

#9 Milk blisters or blebs

White or yellow spots on the nipple that cause pinpoint soreness and pain during a breastfeed may be blocked nipple pores. Nipple pores are the little openings in the nipple through which milk is released. Thickened waxy milk may seem to be blocking the pore causing the white spot or it may look like a blister filled with milk when a thin layer of skin is covering the nipple pore. The white spots are called milk blisters or blebs and one explanation is that they are an inflammatory response to trauma to the nipple. See Blisters on Nipples for more discussion on causes and ideas to free the blockage.

Other blisters

Friction blisters-clear or blood filled-on the nipple may be caused by your baby feeding in a shallow latch if this causes your nipple to be pinched between their tongue and hard palate. See Blisters on Nipples for more information.

Herpes or chicken pox. Painful blisters may also be viral in origin e.g. caused by herpes simplex or the varicella-zoster virus see Herpes and Breastfeeding for further reading.

#10 Pumping equipment

The part of the pump that rests against the breast is called a flange and includes a narrow nipple tunnel which is held over your nipple. If the nipple tunnel is too small or too large this can cause sore or damaged nipples. If the pump vacuum is too high this can also cause trauma to the nipples. See How to Increase Milk Supply When Pumping or the Flange FITS™ Guide from Babies in Common for help in choosing the right sized nipple tunnel. Some mothers have found moulded silicone breast pumps to be a comfortable alternative to a regular manual or electric pump when they have damaged nipples.

#11 Breastfeeding gadgets

Occasionally the very products that are supposed to prevent sore nipples can be the cause of them:

Nipple shields. Although these can be a great help in many cases, if they are not a good fit and are rubbing the nipple these can worsen sore nipples. See Nipple Shields Good or Bad?

Silver cups. Small silver cups are sold to wear over sore nipples and are said to help with healing owing to the antibacterial and antifungal properties of silver. Some mothers find them helpful, others find these cups keep nipples wet and soggy all day long promoting breakdown of skin and preventing healing. Lactation consultant and doctor Pamela Douglas states that silver dressings or topical agents have not been shown to improve wound healing or prevent infection (Douglas, Vol 18: 1-29 2022).

Bras and breast pads. Bras and breast pads prevent exchange of gases and affect local humidity inside the bra. The additional moisture, particularly if pads are frequently damp or wet, can interfere with healing by over hydrating the nipple leading to moisture-associated skin damage (Douglas, Vol 18: 1-29 2022). Continuous exposure to moisture can be a cause of mild dermatitis or eczema (#12). See Nursing Bras FAQ for further information.

#12 Eczema, dermatitis and psoriasis

Other causes of sore nipples include the skin conditions; eczema, dermatitis and psoriasis. Contact your health professional for diagnosis and medication compatible with breastfeeding.

#13 Paget's disease (rare)

Paget's disease of the nipple is a skin condition that looks like eczema but is due to an underlying cancer. Dr Jack Newman says:

It is quite uncommon in women of childbearing age but it can occur. Paget's disease is easily mistaken for eczema because of the flaking skin and itching. Most mothers with eczema get it on both breasts though, while Paget's disease usually involves only one. If treatment with a steroid ointment does not result in rapid resolution (within a week) of the problem, the mother should see her doctor. The diagnosis is made by biopsy of the nipple. This does not mean the mother should stop breastfeeding on that side-she cannot transfer cancer to the baby by breastfeeding.

#14 Complicated cases

Sometimes it can be very difficult to determine the root cause of sore nipples because several factors may be involved at the same time. An IBCLC lactation consultant can be a valuable member of your healthcare team to help to identify likely causes and management strategies .

Sore nipples and an older baby

If breastfeeding becomes painful when your baby is a little older it can sometimes be a mystery to find the reason why you suddenly have sore nipples. Why Does Breastfeeding Hurt? has a section with ideas for this situation.

What can I put on sore nipples?

Marsha Walker, IBCLC (breastfeeding advocate and author) and Jack Newman, MD (Canadian paediatrician and breastfeeding expert) favour combination treatments of antibacterial, antifungal and anti-inflammatory ingredients to quickly deal with the problem, irrespective of the cause. However there is insufficient evidence to recommend any particular treatment over another. See Treatments for Sore Nipples for more information about all the treatment options for sore nipples that aren't healing.

Summary

Sore nipples are most commonly associated with poor positioning or latch. It doesn't take many feeds in a shallow latch before nipples become sore, grazed, blistered or deeply cracked and, once damaged, there is a risk of bacterial or fungal infection as well. Breastfeeding is not supposed to hurt-if it is painful, seek urgent help from your breastfeeding specialist or IBCLC lactation consultant to find the cause of your sore nipples. Correcting the latch or your baby's sucking technique is a priority to prevent repeated damage. Your health care provider will advise on the most appropriate treatment for your sore nipples.

Footnotes & References

1. Supporting Sucking Skills, Watson Genna, 2017

2. O'Hara M. Bleb histology reveals inflammatory infiltrate that regresses with topic steroids: a case series. Breastfeed Med 2012; 7(Suppl. 1): S2.

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Causes of sore nipples and breast pain can include poor positioning of your baby, bacterial infection, fungal infection (thrush) and vasospasm.

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If your baby is not feeding so well or so often, you may become super full (engorged) - here is how to deal with that quickly and keep breastfeeding.

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When a breast becomes overfull it is said to be “engorged”. Engorgement is very common in the early weeks after

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If you have an area of your breast that is inflamed and sore, here is what to do.

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Breast inflammation is a relatively common condition affecting breastfeeding women encompassing a range of conditions such as engorgement, a blocked duct, mastitis or abscess. Mastitis is associated with a range of distinctive symptoms from a sore, painful breast to feeling unwell or having a fever (rise in body temperature). Breast inflammation is thought to be due to the body's reaction to a build up of breast milk in the breast. It is thought that when breasts are over full or engorged, high pressures on the delicate milk ducts in the breast can trigger inflammation.

This article

This article looks at the symptoms and causes of breastfeeding related mastitis, and ways to prevent and treat it. Related articles include Engorged Breasts, Blocked Milk Duct, Breast Lumps and Do I Have a Breast Abscess?

Symptoms of mastitis

The symptoms of mastitis can include:

Soreness, pain, heat and swelling (inflammation) in the breast

A sore lump or tender spot inside the breast

Colour changes to the skin. In lighter skin tones there may be areas of red or pink skin on the surface of the breast which may include red streaks or lines. In darker skin tones areas of skin with mastitis may look brown or purple as well as red or changes in skin tone may not be visible.

Flu-like symptoms such as feeling achey, shivery or run down, headache.

Bacterial infection

Mastitis is not always associated with a bacterial infection. Mastitis symptoms often clear on their own after a day or two of careful preventative treatment-see below. If a bacterial infection is present, this is usually due to Staphylococcus aureus (Staph) or Streptococcus (Strep) but breastfeeding can continue. The US based Academy of Breastfeeding Medicine (ABM) explains:

Bacterial mastitis is not a contagious entity and does not pose a risk to the infant nor require an interruption in breastfeeding.

What causes mastitis?

Different authors have different opinions on the causes of inflammation of the breast. One explanation is that high pressures in the milk making tissue and ducts cause mechanical strain which can rupture cell membranes and lead to inflammation. Causes of such a high pressure under this model include:

Poor position and attachment

Poor positioning (the way baby is held to breastfeed) or a suboptimal latch (the way a baby attaches to the breast) can make it more difficult to drain or "milk" the breast. During breastfeeding a baby needs a big mouthful of breast tissue as well as the nipple in their mouth, see our Latching Tips. Incorrect positioning and attachment, including a poorly fitted nipple shield, could lead to sore or cracked nipples, engorgement, blocked milk ducts or mastitis.

Infrequent feeds

A baby who is not breastfeeding often enough, perhaps due to scheduled feeds, separation from mother, frequent use of a pacifier to delay feeds, busy holiday/stressful periods or a mother or baby who is feeding less due to illness.

Massage and vibration

Vigorous massage, vibration, or something pressing firmly into the breast throughout a feed could interfere with milk flow such as a finger, a tight bra or other clothing, the straps of a heavy bag, mother's sleeping position or a poorly fitted breast pump.

Additional risk factors that have been highlighted by other authors include:

Smoking increases the risk of breast abscess and inflammation in the ducts behind the nipple (breast periductal inflammation).

Breast trauma for example a toddler knocking the breast, or any scarring within the breast or nipple including previous breast or nipple surgery; breast implants, reduction surgery, nipple piercing or skin infection.

Diet and inflammation. Eating a high proportion of inflammatory omega-6 polyunsaturated fatty acids (PUFAs) while having very few anti-inflammatory omega-3 PUFAs may promote inflammation in the body including breast tissue. In addition, a diet high in refined sugar discourages a healthy microbiome (friendly bacteria within our bodies) favouring bacteria that may contribute to inflammation and disease instead. One study found that eating traditional fermented foods such as kefir or homemade yoghurt may be protective against mastitis.

A mother who does a lot of vigorous exercise especially using the upper arms and chest (Wambach and Spencer, 2021 p 285).

Preventing and managing mastitis

New insights into traditional ways of preventing and managing inflammatory conditions of the breast continue to evolve. Recent publications to guide us include The Academy of Breastfeeding Medicine's Protocol #36 The Mastitis Spectrum (2022) and a series of papers by Australian doctor and breastfeeding specialist Pamela Douglas. The following is a summary of recommendations for preventing and managing breast inflammation taking new and previous information into account.

#1 Breastfeed often on demand

Breastfeeding frequently on demand with your baby in a deep, comfortable latch (see #2) will help prevent and manage mastitis. If your baby is not breastfeeding, or not able to breastfeed well yet, frequent hand expressing or pumping can be used to regularly remove breast milk instead (see #3). It is important that your baby, hands or your pump remove enough milk from your breasts to stay comfortable at the first sign of engorgement or a blocked duct. Strategies to support frequent feeds include maximising skin-to-skin contact between mother and baby after birth, offering each breast about 12 times in a 24 hour period (no need to watch the clock) and letting baby suckle for comfort as well as nutrition (Douglas, Vol 18: 1-29 2022).

#2 Good position and attachment

A good position and latch helps prevent or resolve breast inflammation. See Breastfeeding Positions for Newborns, Breastfeeding Videos and Latching Tips or seek help from your IBCLC lactation consultant or breastfeeding specialist to check your baby's latch. Douglas writes that prolonged or unequal pressures on the breast could exacerbate breast inflammation and cautions against deep massage, firmly shaping or compressing the breast during feeds, tight or overly supportive bras or using a pump that is poorly fitted (Douglas, Vol 18: 1-20 2022).

Although nipple shields may have a helpful role for some mothers (Douglas, Vol 18: 1-29 2022) the Academy of Breastfeeding Medicine protocol #36 recommends avoiding shields although this is based on consensus or opinion rather than high quality research (Mitchell et al, 2022) .

#3 Hand express or pump to comfort

During bouts of breast inflammation, frequent breastfeeds and/or expressing enough milk to stay comfortable is recommended to reduce inflammation and so that the milk volume will naturally adjust to your baby's needs (Mitchell et al, 2022; Douglas, Vol 18: 1-20 2022). If your baby can't breastfeed, isn't feeding well yet or can't keep up with the volume of milk, you may need to hand express or use a breast pump for a while. Bear in mind pumping with a poorly fitted flange can cause breast inflammation see Do I Need a Breast Pump? and How to Increase Milk Supply When Pumping for tips on finding the right fit.

Don't over pump

Excess milk removal (regularly pumping more milk than your baby can drink) could be counter productive by stimulating milk supply further and perpetuating a cycle of too much milk and inflammation. It is therefore not necessary to over pump to try to empty the breasts, or to reach the hind milk as a general breastfeeding strategy.

#4 Reduce a milk supply gradually

To avoid or manage engorgement it is important to remove milk frequently. It is not a good time to feed less often, try to reduce a milk supply or stop breastfeeding while a breast is painfully engorged and inflamed. Where needed, down regulating a milk supply slowly will protect against engorgement and similarly if you want to stop breastfeeding this is best done gradually (Douglas, Vol 18: 1-20 2022), see How to Stop Breastfeeding.

#5 Breast movement but no deep massage

Breast massage may worsen inflammation. There is some disagreement between practitioners on whether massaging a lactating breast can help or hinder inflammation. One study found careful use of very gentle light touch massage combined with hand expression may help to drain an engorged breast thoroughly to prevent mastitis developing. Newer thinking cautions that a deep or vigorous massage could traumatise a breast and worsen engorgement and inflammation (Douglas, Vol 18: 1-20 2022, Mitchell et al, 2022). If considered, any massage technique should use no more pressure than applying cream to the skin or stroking a pet, see Engorged Breasts, and Blocked Milk Duct.

Breast gymnastics. Natural breast movement may prevent breast inflammation yet bras and sedentary lifestyles can restrict breast movement (Douglas, Vol 18: 1-20 2022). Douglas says the type of breast massage sometimes called breast gymnastics may have a role in preventing breast inflammation (Douglas, Vol 18: 1-20 2022). Douglas explains that breast gymnastics involve lifting and gently moving the breasts in various directions, often with circular movements using the whole of the hand or palm laid gently over the breast. For more information on bras see Nursing Bras FAQ on this website.

#6 Pain relief

Warm compress? Some mothers may find a warm compress on the breast is soothing and helps with pain relief. Warmth across the nipple can help release hormones to trigger the let-down before you breastfeed or express. However warm compresses or showers could cause blood vessels to widen (dilate) and bring even more fluid to the area adding to any engorgement. Warmth has not been shown to help mastitis in studies (Mitchell et al, 2022; Douglas, Vol 18: 1-20 2022).

Traditional remedies. Around the world there may betraditional local remedies for breast inflammation. In France some mothers use a green clay poultice as a topical remedy to soothe breast inflammation. One traditional remedy of using a poultice of grated raw potato or carrot to reduce pain and discomfort is mentioned in The Nursing Mother's Herbal 2003, p.149 by Sheila Humphrey.

#7 Self care

Rest, remember to eat and drink plenty of fluids. Lawrence and Lawrence state bed rest is recommended during mastitis. What we eat can influence the levels of inflammation in the body (see above) (Hurd, 2015; Hurd-Reeves, 2019; Basim, 2020).

Medication or supplements for mastitis

If you are not starting to feel better after 12-24 hours of treatment, contact your health care professional for advice in case medication is required (NICE, 2021; ABM 2022).

Antibiotics

Most women with inflammatory mastitis recover without antibiotics or interventions other than control of symptoms, knowledge of the physiological anti-inflammatory response, and regular communication with their health professional (Mitchell et al, 2022). The Academy of Breastfeeding Medicine says it is important to reserve antibiotics for bacterial mastitis and explains:

Use of antibiotics for inflammatory mastitis disrupts the breast microbiome and increases the risk of progression to bacterial mastitis. Furthermore, nonselective use of antibiotics promotes development of resistant pathogens. Prophylactic antibiotics have not been shown to be effective in the prevention of mastitis. It should be noted that many antibiotics and antifungal medications have anti-inflammatory properties, and this may explain why women experience relief when taking these.

A health care professional will prescribe compatible antibiotics if a bacterial infection is suspected after 24 hours of a mastitis action plan, or if the mother is very poorly(Mitchell et al, 2022) . The organisations below discuss specific antibiotic choices and doses and currently recommend a 10-14 day course of antibiotics:

Nisin is an antibacterial peptide produced by the bacterium Lactococcus lactis that kills other bacteria and is used as a food preservative. One study found swabbing nipples with a nisin solution was an effective alternative to antibiotics in treating mastitis due to stahylococcus.

Probiotics?

The results of studies on the use of probiotics to prevent or treat mastitis are not clear. Arroyo et al compared giving mothers strains of Lactobacillus species isolated from breast milk with conventional antibiotic treatment. They found that women who took the probiotics improved more and had lower recurrence of mastitis than those who took antibiotics. Another industry funded study found improvement in the risk of mastitis after giving the mothers a probiotic. However, Amir et al describe a number of concerns about the validity of Arroyo's study, and similar trials, and call for high quality randomised control trials to establish whether probiotics are an effective treatment for mastitis. Douglas states that there is little evidence to justify use of probiotics for prevention of mastitis (Douglas, Vol 18: 1-20 2022).

Lecithin?

The food supplement lecithin is sometimes suggested to help reduce the constituency (thickness) of breast milk so reducing the risk of blocked ducts and associated mastitis. However not everyone agrees with the idea of thickened milk causing obstructions and Douglas says that current studies don't support the ingestion of lecithin to thin breast milk (Douglas, Vol 18: 1-20 2022). Dr Tom Hale of Hale's Medications and Mothers' Milk [paywall] says lecithin would be broken down in the stomach and intestines long before being absorbed and there isn't any evidence for its use. See Blocked Milk Duct for more information.

Vitamin C

Some practitioners recommend a mother ensures she is taking plenty of vitamin C during mastitis see Vitamin C and Breastfeeding for more information.

Recurrent Mastitis

If you keep getting episodes of mastitis or blocked ducts an IBCLC lactation consultant or breastfeeding specialist can be very helpful to identify the most likely reasons why. They will review your history fully, and check whether your or breastfeeding management could be the underlying cause for mastitis to keep returning. Other risk factors for recurring mastitis include:

Breastfeeding on a schedule instead of whenever baby wants (on demand)

Stopping breastfeeding abruptly on the affected side during an episode of mastitis.

Deep or vigorous massage could traumatise delicate breast tissue and may cause more inflammation (Morgensen et al, 2020; Mitchell et al, 2022; Douglas, 2022).

Diet and inflammation. Recurrent blocked ducts and associated mastitis may be linked with a diet that is high in refined carbohydrates (sugar) and/or a high proportion of inflammatory omega-6 PUFAs coupled with few anti-inflammatory omega-3 PUFAs (Hurd, 2015).

Preventing recurrent mastitis

In most cases, addressing the above causes will resolve repeated mastitis. Additional clinical guidance includes:

Culture specimens from breast milk and send nasal swabs from both the mother and baby for culture (NICE, 2021).

Consider chronic bacterial infection, pseudomonas infection, secondary fungal infection, underlying breast disease such as a cyst, tumour or other medical cause.

Pay attention to hygiene eg discard any potentially contaminated nipple creams or ointments, wash pump equipment thoroughly (NICE, 2021). Note: The Academy of Breastfeeding Medicine says there is no evidence to support poor hygiene as a cause of bacterial mastitis (Mitchell et al, 2022).

Other causes of breast inflammation

If mastitis does not seem to respond to treatment or keeps recurring there may be something else happening. For a review of other causes of deep breast pain associated with breastfeeding see Why Does Breastfeeding Hurt? and see below:

Thrush. Fungal infection has historically been described as a cause of deep breast pain however more recent research highlights multiple other conditions to explain these symptoms casting doubt on breast thrush.

Not mastitis? Check with your health professional if mastitis does not improve with treatment. Although rare, other conditions such as cellulitis or inflammatory breast cancer can be mistaken for mastitis.

Frequently asked questions

#1 Can I continue breastfeeding my baby if I have mastitis?

Yes, even if antibiotics are needed, breastfeeding can continue during mastitis (Mitchell et al, 2022). Antibodies in breast milk will help protect the baby from any infection and stopping breastfeeding abruptly could cause more problems. Breast milk is sometimes said to taste slightly salty from a breast with mastitis but this doesn't usually pose a problem to the baby.

Most cases of infection based mastitis are caused by Staphylococcus aureus bacteria (staph). For more information about breastfeeding and staph infections including infection by methicillin-resistant Staphylococcus aureus (MRSA) see Staph, MRSA and Breastfeeding.

#2 What can I do if my baby can't latch or my milk won't flow?

Sometimes engorgement behind the nipple can change the nipple shape making it difficult for your baby to latch and having the effect of someone stepping on a hose, stopping the flow of liquid (i.e. breast milk!). If you're struggling to express any milk at all or your baby can't seem to latch due to engorgement, have a look at Engorgement Relief When Milk Won't Flow for ideas to help you.

#3 What is the treatment for blocked milk ducts?

An untreated blocked duct (local build up of breast milk) can lead to mastitis. Treatment for a blocked duct is the same protocol for relieving engorgement or mastitis, see Blocked Milk Duct for more information.

#4 What does a white spot on my nipple mean?

If you have a small white spot on your nipple alongside symptoms of mastitis, this could be a "bleb"; a small blockage to one of the nipple pores. See the section about milk blisters or blebs in Blisters on Nipples for more information.

#5 Bra or no bra?

It's important to ensure a tight fitting bra is not the cause of the mastitis. NICE (National Institute of Health and Care Excellence) guidance recommends avoiding wearing a bra, especially at night ( NICE, 2021) whereas Lawrence and Lawrence say to wear a supportive bra during mastitis that doesn't cause painful pressure (Lawrence, 2016). For more in depth discussion on the pros and cons see Nursing Bras FAQ.

#6 Why is my breast milk thick or lumpy?

Some mothers notice their pumped breast milk can be lumpy or clumpy If milk has a thick or clotted consistency within the breast this has often been assumed to be a risk factor for breast inflammation, however Douglas says there is no evidence that sticky or clumped milk could block ducts (Douglas, Vol 18: 1-20 2022). Unless a mother expresses her milk, the presence of thicker or lumpy breast milk and whether it could sometimes be a variation of normal would not be apparent. Theories for causes of thickened milk include mastitis and diet.

Mastitis. Some mothers may notice their expressed breast milk has lumps or clots forming in the collection container just after pumping, or seem to come directly from the nipple. In The Breastfeeding Atlas, 6e, p97 authors Wilson-Clay and Hoover share that clumpy, lumpy milk is an indication of early mastitis in the dairy industry and could also be linked to breast inflammation in humans as some women have reported clumpy milk during mastitis episodes. The cause of the lumpy milk may be a result of coagulase, a protein made by Staphylococcus microorganisms that produce fibrin; a substance that causes clotting. A culture of the lumpy milk may locate a particular organism for treatment.

Summary

Mastitis is the name for an inflammation in the breast thought to be due to a high pressure volume of milk in the breast. Mastitis can be very painful and a mother may have general symptoms similar to flu (shivers, temperature, feeling unwell) as well as a very painful sore breast (or two). At the first sign of engorgement or early mastitis-frequent breastfeeding, or hand expressing/pumping just enough so that the breast is comfortable again can help relieve symptoms. Sometimes mastitis is associated with a bacterial breast infection and may require antibiotics. There are several antibiotics for treating mastitis that are compatible with breastfeeding-there is no need to stop breastfeeding or stop frequent milk removal during an episode of mastitis. Stopping breastfeeding/removing milk when the breast is inflamed could lead to a breast abscess. If mastitis keeps coming back, check your baby's latch and positioning with your breastfeeding specialist or IBCLC lactation consultant and stay in touch with your medical professional.

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Breast inflammation is a relatively common condition affecting breastfeeding women encompassing a range of conditions such as engorgement, a blocked duct, mastitis or abscess. Mastitis is associated with a range of distinctive symptoms from a sore, painful breast to feeling unwell or having a fever (rise in body temperature).

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Sometimes, a baby who is not attached well can trigger symptoms such as nipple or deep breast pain. Research shows us it is very unlikely to be thrush. For any nipple or breast pain come in to one of our drop-in groups for support.

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

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

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How grandparents can support breastfeeding.

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How grandparents can support breastfeeding.

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You can share this link with your baby's grandparents, to help them know how best to support you with breastfeeding.

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Naturally, you want the very best for your new grandchild. You would like to pass on advice and the benefit of your wisdom to the new mum. Mum is going to breastfeed and perhaps you don't know an awful lot about it - when your children were small most mums bottle-fed. This leaflet will give you the latest information on breastfeeding so you can feel more confident in supporting mum in her decision to breastfeed your grandchild.

Lots of babies are bottle-fed and turn out OK. What's so good about breastfeeding?

It's true that artificial milk (formula) is adequate ― but it has lots of disadvantages compared with mum's breast milk.

Babies fed formula milk are at greater risk of developing eczema, asthma and other allergies, and are more likely to suffer with ear infections and diarrhoea.

Formula feeding increases baby's risk of more serious illnesses like diabetes and some cancers.

Formula-fed babies are more likely to be obese as they get older.

Formula-fed babies may have an increased risk of cot death.

Formula milk is harder to digest and gives baby foul smelling bowel movements. Baby is more likely to suffer constipation.

Bottle-feeding is expensive ― milk, bottles and teats, steriliser, bottle bag ― they all add up.

Breastfeeding requires no special equipment and costs nothing.

Advantages for baby

Breast milk has exactly the right amount of each nutrient baby needs. Research finds new nutrients in breast milk all the time, and then manufacturers try to add some of these to the artificial milks on the market.

Breast milk is produced on a demand and supply system. There is always milk ready when baby is hungry or thirsty. Breast milk, and especially the first milk, colostrum, has lots of infection-fighting agents to help baby's immune system.

Advantages for mum

Breastfeeding is free and it is convenient. No need to pack bottles or find somewhere to warm them whilst out. Breastfeeding can quickly calm a fussy or crying baby.

Breastfeeding helps mum and baby bond and is enjoyable. There is the sense of satisfaction in mum feeding baby from her own body.

Breastfeeding makes the womb return to its normal size quickly. Mum gets her figure back faster and can lose the weight she put on in pregnancy without dieting.

Breastfeeding reduces mum's risk of getting breast cancer, ovarian cancer and osteoporosis.

Breastfeeding delays the return of mum's periods. Breastfeeding is the perfect way for mum to relax. Sitting or lying down to breastfeed ensures she gets enough rest.

How long should feeds last?

Feeds don't need to be timed. Baby should be left at the breast until he comes off himself. Then he can be winded and offered the other breast (some babies want to feed on both sides at each feed, others don't).

Long feeds will not hurt mum's nipples if baby is attached properly. Baby suckles on the breast itself and breastfeeding shouldn't hurt.

Why are babies demand fed instead of being fed four-hourly?

Breast milk is easily digested so baby will need to feed quite often ― usually at least 8 to 12 times a day in the early weeks.

Less frequent feeding can decrease mum's milk supply, impact on baby's weight gain and hydration and increase mum's risk of blocked ducts and mastitis.

Baby needs to feed when he shows hunger signs (rooting, finger sucking). Crying is a last resort. The feeding action causes mum's body to make more milk. The more baby feeds, the more milk will be on tap.

Shouldn't baby be starting solids soon?

Breast milk is all the food baby needs in his first six months. Baby will be getting ready for first tastes of solid foods once he is sitting unsupported, taking food from your plate and feeding himself. This usually happens around six months or later.

Giving any solids or drinks (including formula milk) before six months is linked with later health problems. Introducing solid food early will result in breast milk being replaced by less nutritious first foods and baby gets fewer of mum's antibodies.

Can I give a bottle so mum can rest?

Baby should not be given a bottle or a dummy in the first few weeks while breastfeeding is being established. Sucking on a plastic teat is a very different action to breastfeeding. Baby could get nipple confusion and have problems breastfeeding. There are some suggestions for other ways of helping mum below.
How can I help with my grandchild?
There are lots of ways you can help with your grandchild: cuddling, winding, bathing, and taking him out for a short walk. Any offers of help with housework, making a cup of tea or a meal will probably be gratefully accepted. Perhaps ask mum what she thinks might help.

Encourage mum to be comfortable feeding her baby in your company. Don't make her sit in a bedroom or other private place for feeding ― it will make her feel left out of things. Mum will be able to breastfeed without 'exposing herself'.

One of the best ways to help is to support mum in her decision to breastfeed. If mum has a problem, help her to solve it (if necessary with help from a breastfeeding counsellor, midwife or health visitor).
Nearly all women are physically capable of breastfeeding but breastfeeding can sometimes be a struggle without accurate information and without support from close family.
Be careful not to undermine mum's decision to breastfeed by suggesting that she gives her baby a bottle. If you can support mum and help her self-confidence, she will be able to give your grandchild the love and care he needs and give him the best possible start by breastfeeding.
You might like to show your support for mum by giving her a gift subscription to the ABM. Her welcome pack will contain all our ABM breastfeeding leaflets and she'll receive our ABM magazine (published three times a year).

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Congratulations, you're going to be a grandparent - ABM

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Naturally, you want the very best for your new grandchild. You would like to pass on advice and the benefit of your wisdom to the new mum. Mum is going to breastfeed and perhaps you don't know an awful lot about it - when your children were small most mums bottle-fed.

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Please read this information if you are considering of consuming alcohol. You can have occasional, small amounts of alcohol but should not drink regularly or heavily (e.g. binge drinking) without considering how to limit your baby’s exposure.

If you drink any alcohol DO NOT bed share with your baby or fall asleep in the sofa/chair

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This information can also be viewed as a PDF by clicking here.
Breastfeeding mothers can have occasional, small amounts of alcohol but should not drink regularly or heavily (e.g. binge drinking) without considering how to limit the baby's exposure. If you drink any alcohol DO NOT bed share with your baby or fall asleep in the sofa/chair. If you do binge drink, your baby should be cared for by an adult who has not had any alcohol. It is not necessary to express breastmilk to clear it of alcohol.

Never share a bed or sofa with your baby if you have drunk any alcohol. Doing this has an increased association with sudden infant death syndrome (SIDS).

Alcohol passes freely into breastmilk reaching approximately maternal levels BUT maternal blood levels have to reach 300mg/100ml before mild sedation is reached in the baby (this compares with a level of 80mg/100ml needed to fail the police breath test in England, Wales and N. Ireland; 50mg/100ml Scotland.

To reduce exposure of the baby to alcohol, avoid breastfeeding for 2-3 hours after drinking.

Peak levels in the milk appear after 30-90 minutes but this does not mean that social drinking of small amounts of alcohol mean that you cannot breastfeed.

Excess levels of alcohol in milk may lead to drowsiness, deep sleep, weakness and decreased growth in the infant. Reduction of let-down is reported when the mother drinks heavily. Alcohol may reduce the baby's sucking time at the breast but not the volume of milk consumed.

It is not necessary to express breastmilk to clear it of alcohol; as the mother's blood levels fall, the level of alcohol in the breastmilk will decrease.

Binge drinking (more than 6 units of alcohol in one period), may make you less aware of your baby's needs. If you have drunk enough alcohol to make you feel disorientated or cause vomiting you should not be caring for your baby without supervision from a sober adult. You should ideally express for comfort and to maintain your supply - although this may be the last thing on your mind!

Chronic consumption of alcohol is more likely to cause harm than occasional social drinking.

NB It is vital that mothers who have been drinking alcohol should never let themselves be in a situation where they might fall asleep with the baby; on a bed, chair or settee (this would also apply to other carers who have been drinking alcohol). The place of sleep is a bigger risk than the fact that the mother has been drinking unless her consumption has been very high.

Drinking alcohol reduces the ability of the mother to be aware of her baby's needs, whether she is breastfeeding or not. It is safest to ask someone else to care for the baby.

Other websites

NHS Breastfeeding and drinking alcohol. - Your pregnancy and baby guide www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-alcohol/

Guidelines from the NHS

Anything you eat or drink while you're breastfeeding can find its way into your breast milk, and that includes alcohol.

If you regularly drink as much as 14 units per week, it's best to spread your drinking evenly over 3 or more days.

If you wish to cut down the amount you drink, a good way to help achieve this is to have several drink-free days each week.

Fourteen units is equivalent to: 6 pints of average-strength beer, 10 small glasses of low-strength wine

Use Alcohol Change's alcohol calculator to check your units: https://alcoholchange.org.uk/alcohol-facts/interactive-tools/unit-calculator
©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network March 2021

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Alcohol and Breastfeeding - The Breastfeeding Network

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This information can also be viewed as a PDF by clicking here. Breastfeeding mothers can have occasional, small amounts of alcohol but should not drink regularly or heavily (e.g. binge drinking) without considering how to limit the baby's exposure. If you drink any alcohol DO NOT bed share with your baby or fall asleep in [...]

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Not all babies need winding - especially when they are breastfed. If you feel your baby might need to burp, here are some suggestions on how to do that gently.

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What's the best position to burp my baby?

Support your baby's head and neck, make sure their tummy and back is nice and straight (not curled up), and rub or pat their back gently.

You don't need to spend ages burping your baby, a couple of minutes should be enough.

There are a few ways to burp your baby. Try them all out and see which works best - or use a combination.

1. Over your shoulder

With your baby's chin resting on your shoulder, support the head and shoulder area with one hand, and gently rub and pat your baby's back.

It might help to walk around as you are doing this.

2. Sitting on your lap

Sit your baby on your lap facing away from you.

Place the palm of your hand flat against their chest and support their chin and jaw (do not put any pressure on the throat area).

Lean your baby forwards slightly and with your free hand, gently rub or pat your baby's back.

3. Lying across your lap

Lie your baby across your lap face down.

Supporting their chin (do not put any pressure on the throat area), use your free hand to gently rub or pat your baby's back.

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Burping your baby will get rid of the air they have swallowed while drinking milk. See our guide for burping tips and best positions.