# data[].attributes.body
Find all your information on Formula and products with no biased information to help you make a choice.

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

Our Mission

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

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

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

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

Our Resources:

Are put together by nutrition experts and are regularly updated.

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

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

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

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

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

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

# data[].attributes.attachment_link.description
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.

# data[].attributes.body
Please see our Padlet for our referrals for Tongue tie or Feeding support.

We offer tongue tie divisions on babies around 36-37 weeks as we do need preterm babies to develop their tongue function and this can be delayed when born early. We will attend and see baby earlier for feeding support and plans and offer ongoing support. If they do need a division we can offer this on assessment.

https://padlet.com/roperzoe/the-specialist-infant-feeding-team-and-tongue-tie-service-mi-n9c05lrctc5noufs

# data[].attributes.body
Zoe Roper is the Infant Feeding Coordinator for the Neonatal and Transitional Care Unit. She can offer support to you and your babies whilst on the unit with breastfeeding support or advice around bottle feeding.

She can offer support with expression in the early days as as you progress on your journey.

She can assist with learning to breastfeed, attach and position baby.

She can help around bottles and teats and options for feeding

Her contact number is 07887993243. She works Tuesday - Thursday for the Neonatal Unit.

# data[].attributes.body
Nappy output for a term baby

# data[].attributes.body
Positions for breastfeeding

# data[].attributes.attachment_link.title
Breastfeeding positions - Best Start in Life - NHS

# data[].attributes.attachment_link.description
Find out about the different ways you can breastfeed with our step-by-step guide to breastfeeding positions.

# data[].attributes.body
Biological hold is really helpful like the Koala hold with a deeper latch and keeping baby on if they have any issues with latch / tongue function

# data[].attributes.body
Koala hold or biological hold is very good for small babies or babies with reduced oral function. Gravity helps baby to stay on and develop good sucking pattern.

# data[].attributes.attachment_link.title
Breastfeeding Holds: Koala (aka the Australian)

# data[].attributes.body
Cradle and cross cradle

# data[].attributes.attachment_link.title
Breastfeeding Holds: Cradle and Cross Cradle

# data[].attributes.body
Rugby hold can be used by many and can be helpful with preterm babies but they may need some assistance with pillows.

# data[].attributes.attachment_link.title
Breastfeeding Holds: Rugby (aka Football hold)

# data[].attributes.body
Welcome to Gate 19 Neonatal Unit at Mid Yorkshire Hospitals. You will have been sent this Padlet if your baby has been born early or is expected to arrive early. This padlet is aimed at parents needing further feeding information.

# data[].attributes.body
Learning how to attach your baby to the breast

# data[].attributes.body
How to make your bottles up safehttps://youtu.be/vazjsRRtmOo?si=jPmDjUpS_mTmz47ptly

# data[].attributes.headline
Feeding information if you are due to give birth early. 

# data[].attributes.subject
Feeding information if you are due to give birth early. 

# data[].attributes.body
You have been referred to the infant feeding team as your baby is expected to be born early. Here is a look at 24 hours on a Neonatal Unit

# data[].attributes.attachment_link.authors[].name
Y&H Neonatal Parent and Family Engagement 

# data[].attributes.body
Information on Responsive bottle feeding

# data[].attributes.body
Caring for your baby at Night

# data[].attributes.body
Neonatal Bonding Leaflet

# data[].attributes.body
The importance of skin to skin for your baby.

# data[].attributes.body
The benefits of skin to skin or Kangaroo Care for Preterm babies

# data[].attributes.attachment_link.title
Skin-to-skin kangaroo care and premature babies

# data[].attributes.headline
Helpful Information about expressing milk 

# data[].attributes.subject
Helpful Information about expressing milk 

# data[].attributes.attachment_link.authors[].name
Y&H Neonatal Parent and Family Engagement 

# data[].attributes.attachment_link.title
Helpful information about expressing milk

# data[].attributes.body
Please use the ARDO U TUBE channel for all your pumping needs.

# data[].attributes.attachment_link.description
Ardo is here to support you from conception, to pregnancy, birth and feeding. Ardo is a family-owned, award-winning company. We dedicate ourselves wholeheartedly to developing, producing and distributing highest-quality and best-functionality Ardo premium products. We support mums and families from conception, through to pregnancy, birth, breastfeeding and expressing breastmilk. The product range has been developed to continually meet both the personal requirements and individual needs of mums and their babies, and those who support them in their journey. The company philosophy complies with the WHO code (The International Code of Marketing of Breast-Milk Substitutes) and is uncompromisingly committed to this code. Hire or Buy a Breastpump from our website: www.ardomedical.co.uk

# data[].attributes.body
The Smaller breast pump is generally loaned by FAB, ARDO or Locala. Please ask your Midwife or Health visitor for more information. Please see the video above to learn about it.

If your baby is on our Neonatal Unit you can borrow a pump whilst your baby is on the unit. Please ask your babies nurse

# data[].attributes.attachment_link.title
How to Use the Ardo Carum True Hospital Breast Pump | Step-by-Step Guide

# data[].attributes.body
At Mid Yorkshire Teaching Hospitals we use the ARDO electric pumps and these should be available to use whilst you are an inpatient.

# data[].attributes.body
ARDO Fitting and using the pump

# data[].attributes.attachment_link.authors[].name
Y&H Neonatal Parent and Family Engagement 

# data[].attributes.attachment_link.authors[].name
Y&H Neonatal Parent and Family Engagement 

# data[].attributes.attachment_link.title
Pump parts and putting the pump together -Ardo

# data[].attributes.body
Hand Expression

# data[].attributes.attachment_link.authors[].name
Y&H Neonatal Parent and Family Engagement 

# data[].attributes.body
Please access the Breastfeeding Network for factsheets on medications and breastfeeding.

# data[].attributes.attachment_link.title
Drugs in Breastmilk factsheets - The Breastfeeding Network

# data[].attributes.attachment_link.description
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 […]

# data[].attributes.body
https://www.breastfeedingnetwork.org.uk/factsheet/antidepressants/Most antidepressants are safe to take whilst breastfeeding but please check with the breastfeeding network.

# data[].attributes.attachment_link.readable_text
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.

Sertraline has the lowest passage of SSRI drugs into breastmilk. Citalopram also passes into breastmilk in low levels. If a breastfeeding mother has found an antidepressant previously prescribed of benefit, that may influence the choice of drug prescribed

It is important that post-natal depression is recognised and treated effectively as it may impair bonding between mother and child and enjoyment of an important period in the relationship. Approximately 80% of women experience post-natal blues but some 10-15% experience more severe symptoms and need medication and or counselling and cognitive behavioural therapy. Some mothers may not immediately recognise or accept that they are depressed. Some fathers may recognise the difference in their partners. Others will deny the possibility.

The symptoms of post-natal depression may include obsessive thoughts often concerning harm to the baby, hyperactivity or lethargy, weight loss, volatility of behaviour and restlessness. Some women will express suicidal tendencies. But many symptoms are non-specific e.g. feeling of tiredness and not wanting to get up, not being able to cope as the day goes on and needing to go to bed early - could describe the natural effects of caring for a new baby 24 hours a day. Some women, particularly those who are normally natural leaders, may express concern over loss of confidence.

Most anti-depressants take three to four weeks to exert maximal efficacy and it is important that the woman is informed of this. Many patients stop taking anti-depressant medication within the first four weeks having found no benefit. Initially some medicines may also make symptoms appear worse and patients need to be aware of this to ensure concordance with the drug regime.

For information on anxiety and breastfeeding see bfn.local/anxiety/

For information on OCD and breastfeeding see bfn.local/ocd/

The treatment for depression usually involves SSRIs which act by inhibiting re-uptake of serotonin into neurones in the central nervous system. The majority of manufacturers have not conducted clinical trials on the use in lactation and in the Summary of Product characteristics recommend that they are not used by breastfeeding mothers. Their use is therefore off-licence and at the discretion and responsibility of the prescribing physician.

Side effects include nausea which may be particularly marked in the early weeks of therapy, diarrhoea, headache, insomnia and agitation. It may be difficult to differentiate the side effects of the drugs from the symptoms of depression so it may seem that the drugs are not being effective in the early weeks of therapy.

Sertraline (Lustral®) - has a shorter half-life. The long half-life metabolite is only marginally active, unlike that in fluoxetine and hence is unlikely to cause accumulation in the baby. There are published studies on more than 30 infants with no untoward effects noted. In almost all cases none of the drug has been detected in the infant plasma. Reported but anecdotal, evaluation of an infant exposed to 100milligrammes daily was that the child reached normal developmental milestones and weight at 3 months. There is one report of an infant developing benign neonatal sleep at 4 months, which resolved at 6 months, it is unclear whether this bears any relationship with the maternal use of sertraline. It is normally seen as the SSRI of choice for a breastfeeding mother if she has not had a previous antidepressant which was effective for her - this would then be the drug of choice.

Citalopram (Cipramil®) - There is one report of an infant exhibiting "uneasy" sleep patterns on a maternal dose of 40milligrammes/day. This resolved when the mother's dose was reduced. There are also two reports of excessive somnolence, decreased feeding and weight loss in breastfed infants. In studies no adverse effects on the babies were noted. If the baby shows less than expected weight gain it might be prudent to discontinue the drug and change to another SSRI. It should not be given concomitantly with erythromycin or fluconazole. However, the majority of breastfed babies tolerate it well.

The milk plasma ratio has been estimated to be 1.16-3, suggesting that the drug concentrates in milk. The metabolite enters breastmilk in low levels and at a normal daily intake would produce 14.6 microgrammes/Kg/day (0.7-5.9% of the maternal dose) a very low level.

Paroxetine (Seroxat®) - One case reports levels in breast milk below the level of detection in 16 infants exposed to levels up to 50milligrammes per day (dose normally 20-30milligrammes daily) through their mother's breastmilk. There are reports of neonatal withdrawal syndrome in newborns exposed to paroxetine in utero. Symptoms include jitteriness, vomiting, irritability and hypoglycaemia. Paroxetine may be difficult to stop due to discontinuation syndrome.

Fluoxetine (Prozac®) - has a very long half-life which may in theory, lead to accumulation and high levels in the infant. It has an active metabolite. Adverse effects including increased irritability and colic have been reported. One anecdotal report linking severe colic with the use of fluoxetine has been published. Hale reports personal communications, indicating that it can cause excessive sedation if used throughout pregnancy and then in subsequent lactation. It has been recommended in the past 10 years that if it is used in pregnancy that the mother is changed onto another SSRI in the 2 weeks before expected delivery. However, this is a time when women are very vulnerable and to suggest that they change a medication which is effective drug for them at this time may not be in their best interest. If it has been taken during pregnancy the baby may be very sleepy for several days and need help to obtain full milk volumes (syringe feeding, antenatal expression of colostrum etc). Symptoms seem to resolve within 5 days (Hale). If it has been shown to be effective for a mother in the past it would be the drug of choice for her regardless of the slightly higher passage into milk (Jones 2018). It is suggested that initiation in mothers of babies more than 4 months old would appear to be compatible with breastfeeding particularly if it has been shown to be effective for that woman in the past.

Venlafaxine (Efexor®) - The dose transferred to the infant is relatively high although no adverse reports have been reported. As the drug is associated with discontinuation syndrome it would be difficult for the mother to stop abruptly. In neonates, monitoring for excessive sedation and lower than expected weight gain is advisable.

The mean total drug dose reported in the infant is 7.6% of the maternal weight adjusted dose. Metabolites have been detected at low levels but infants have shown no adverse effects and would appear able to metabolise the drug. The action is similar to that of fluoxetine but with fewer anti-cholinergic effects.

Mirtazapine (Zispin®) - Mirtazapine maybe initiated if other antidepressants have proved ineffective or not been tolerated. It may also be invaluable when poor sleep is the major symptom of depression. Mirtazapine produces fewer symptoms of sexual dysfunction that have been reported in SSRIs. It can initially cause drowsiness and abnormal dreams. Care should be taken with co sleeping as natural reactions will be lessened. In a study of 8 babies whose mothers were taking up to 120mg at night. Levels of mirtazapine were only identified at a low level in one baby and were undetectable after 12 hours.

Tricyclic antidepressants have been around for a considerable period and much is known of their metabolism, safety and side effects. However. the latter can be intolerable for some patients, particularly nursing mothers. Side effects include sleepiness, dry mouth, urine retention and constipation. Care should be taken with co sleeping due to the possibility of drowsiness.

Amitriptyline - The levels measured in breastmilk are low because the drug is 94.8% bound to plasma proteins. There have been no reports of adverse effects on the baby and in one study where the mother took 150milligrammes there was no detectable drug in the infant's serum.

Clomipramine (Anafranil®) - is particularly useful for panic attacks and obsessive, compulsive disorders. In one study of 4 women taking 75-125milligrammes daily, plasma levels of clomipramine in the infants were below the level of detection. No untoward effects were noted in any of the infants.

Imipramine - has an active metabolite, desipramine. At therapeutic doses it is estimated that the baby would receive 20-200microgrammes / day and no adverse effects have been noted. It would be prudent to observe the baby for sedation and dry mouth.

Lofepramine (Gamanil®) - amount in breastmilk likely to be too small to present risk to breastfed baby. No precise data on transfer is available.

The use of cognitive counselling together with anti-depressant therapy has been shown to be advantageous.
©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network May 2022

# data[].attributes.attachment_link.title
Antidepressants and Breastfeeding - The Breastfeeding Network

# data[].attributes.attachment_link.description
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.

# data[].attributes.body
The Infant Feeding Health Visitors can support you if your baby is over 6 weeks old and no longer under the midwife.

Nicola Duncanson and Ciara Scofield run Appointment led clinics with Batley and Dewsbury at Dewsbury Moor Children's centre

# data[].attributes.body
1. Do you live within Wakefield consider FAB for Peer support before your appointment. They can help with position and attachment, better latching

2. Do you need a breast pump to loan they can organise this.

# data[].attributes.attachment_link.title
Welcome to Families and Babies - Families and Babies (FAB)

# data[].attributes.body
Please be aware of the New Immune Boost information - See Posters around Gate 18 and Neonatal Unit. Please speak to either Meg or Zoe about it. Please share the leaflet with parents and ensure all mothers with babies under 34 weeks are given an Immune Boost pack

# data[].attributes.body
Your Milk is their Medicine

# data[].attributes.body
Do you need support with breastfeeding - poor latch?

Do you live within North Kirklees?

# data[].attributes.attachment_link.title
HappyMOMents – Inspiring MOMS Across Batley & Dewsbury

# data[].attributes.body
Our unique Drugs in Breastmilk service (DiBM) provides information to mothers, parents, families and healthcare professionals on taking medication whilst breastfeeding – 365 days a year. It is run by registered pharmacists who are all trained to give breastfeeding support.

We provide evidence-based information on the compatibility and relative risk of individual medications, products and procedures with breastfeeding. We help you to explore your situation by asking open questions, listening, and sharing current research and evidence.

# data[].attributes.attachment_link.readable_text
An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations. BfN endeavours to provide information to enable mothers to breastfeed their babies for as long as they wish and to provide information on the safety of medicines for each mother and baby pair.

Please use the below links for more information

We are constantly reviewing the information available on drugs and breastfeeding as new research is conducted. Therefore, from time-to-time the information on this website may be updated - please be sure to check regularly for any new information and changes to the drug information fact sheets and leaflets.

What is the Drugs in Breastmilk Information Service?

The original Drugs in Breastmilk Helpline was set up by BfN in response to the number of calls we were receiving that concerned medication.

In 2017 we noticed that majority of enquiries from parents and professionals to the Drugs in Breastmilk Helpline were coming via email or social media. As a charity operating on reducing funds we need to run the service in the most efficient and effective way possible without compromising the needs of parents. As a result we decided to run the Drugs in Breastmilk service via email and social media enquiry only.

You can still access information on taking prescription drugs while breastfeeding by sending a private message via our Facebook page or via . Please provide as much information as possible (age of baby, dose, frequency and name of medication or drug). All enquiries are answered as soon as possible by one of our small, volunteer team of qualified pharmacists or breastfeeding supporters. As we can't guarantee a response time, in an emergency situation, please do not wait for our reply, but access help from a trained healthcare professional.

If you call the old Drugs in Breastmilk helpline 0844 number, you will hear a recorded message with information about where to access alternative support. Calls won't be answered live and there is no voicemail service available.

If you still have the Drugs in Breastmilk helpline number on any materials or web pages please could you remove it and replace it with the following information:
'If you have specific questions about medications or treatments, please message the Drugs in Breastmilk information service Facebook page or email druginformation@breastfeedingnetwork.org.uk. If you require breastfeeding support, please call the National Breastfeeding Helpline on 0300 100 0212."

The service is open to mothers and professionals. As the time available to deal with breastfeeding support of mothers is limited, professionals are encouraged to find out the information to enable them to support the mothers themselves.

Evaluation of the Drugs in Breastmilk Information Service

In 2019, BfN commissioned Swansea University to undertake an evaluation of the DIBM service we offer. The executive summary of this report can be found and the full report can be found .

Become a Friend of Drugs in Breastmilk

Please click here for more information on how you can help support this vital service.

# data[].attributes.attachment_link.title
Drugs In Breastmilk - Is It Safe? - The Breastfeeding Network

# data[].attributes.attachment_link.description
An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations.

# data[].attributes.attachment_link.title
ADHD and Breastfeeding - The Breastfeeding Network

# data[].attributes.attachment_link.description
This information can also be viewed as a PDF by clicking here. This factsheet is intended to provide access to relevant evidence-based information. The national guidelines, research, data, pharmacokinetic properties and links shared are taken from various reference sources, they were checked at the time of publication for appropriateness and were in date. These are […]

# data[].attributes.body
https://www.breastfeedingnetwork.org.uk/factsheet/antihistamines/Non-sedating antihistamines are the preferred choice if you are breastfeeding:

Loratadine (Clarityn®) (Powell 2007, Hilbert 1997),

Cetirizine (Zirtek®, BecoAllergy®, Piriteze®, Benadryl®) reaches low levels in breastmilk and is recommended by the British Society for Allergy and Clinical Immunology (Powell 2007)

Fexofenadine (Telfast®) is a newer antihistamine with similar low levels of transfer and no reports of adverse events (LactMed).

Acrivastin (Benadryl Relief®) can cause drowsiness in mother and baby (Lucas 1995). As there is less research it is the least favoured option in younger babies unless it is the only drug that you find effective. In such a situation your baby should be observed for drowsiness.

# data[].attributes.attachment_link.title
Antihistamines and Breastfeeding - The Breastfeeding Network

# data[].attributes.attachment_link.description
This information is also available in PDF format by clicking here.

# data[].attributes.body
https://www.breastfeedingnetwork.org.uk/factsheet/antibiotics/The following antibiotics are all safe to take whilst breastfeeding:

Amoxycillin, Amoxil®

Azithromycin, Zithromax®

Cefaclor, Distaclor®

Cefuroxime, Zinnat®

Cephalexin, Cefalexin, Keflex®

Cephradine, Velosef®

Clarithromycin, Klaricid®

Co-amoxiclav, Augmentin®

Co-fluampicil, Flucloxacillin + Ampicillin, Magnapen®

Erythromycin, Erymax®, Erythrope®, Erythrocin®

Flucloxacillin, Floxapen®,

Penicillin V, Phenoxymethyl penicillin

Pivmecillinam, Selexid®

Trimethoprim, Monotrim®

# data[].attributes.attachment_link.title
Antibiotics and Breastfeeding - The Breastfeeding Network

# data[].attributes.attachment_link.description
This information is also available in PDF form 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 […]

# data[].attributes.body
Sharing 3 stories of birth of premature babies - Sensitive information