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This leaflet explains the benefits of skin to skin for all babies, and how to do this safely

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Skin to skin leaflet online version English

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Building a strong relationship with your baby helps their brain development - you can start this before your baby is born

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Reflux is normal in most babies. If you have concerns about your baby's symptoms talk to your Midwife or Health Visitor

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has vomit that's green or yellow, or has blood in it

is projectile vomiting (being sick with more force than usual)

has blood in their poo

has a swollen or tender tummy

has a very high temperature or they feel hot or shivery

keeps being sick and cannot keep fluid down

has diarrhoea that lasts for over a week or has signs of dehydration

will not stop crying and is very distressed

is refusing to feed

Also call your GP or 111 if you have any other concerns about your baby.

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Find out about reflux, where a baby brings up milk during or soon after a feed.

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Tummy time can help with your baby's development. Find out how to do this here

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Tummy time is a great way to help your baby to strengthen the muscles they need for sitting, rolling and crawling (Pin et al, 2007). Encouraging them to lie on their tummy also gives them a different view of the world.

Here's what else tummy time is about and how to do it...

What is tummy time?

Tummy time is, quite simply, all about getting your baby to spend a little bit of time on their tummy.

Why is tummy time important?

Tummy time has plenty of benefits for your baby:

It's important for their physical development, helping your baby to strengthen their back, arms and neck muscles.

Tummy time helps your baby to develop their motor skills and encourages them to roll over.

Tummy time varies the position your baby lies in, which can also help prevent head flattening (positional plagiocephaly).

(Pin et al, 2007; AAP, 2017; NHS, 2017; Worcestershire Health and Care Trust, 2017)

When do you start tummy time?

You can get your baby to try out tummy time from when they born (AAP, 2017; NHS, 2017; Worcestershire Health and Care Trust, 2017). You will need to be careful though to only give your baby tummy time when you're both totally awake and they're under your close watch (AAP, 2017; NHS, 2017).

"You could start off by giving your baby very short stretches of tummy time, maybe up to three to five minutes of tummy time two or three times a day (AAP, 2017)."

But see how they get on with this and trust your instincts, especially if your baby doesn't like it (Worcestershire Health and Care Trust, 2017). If they're happy with tummy time, you could try to build it up by a minute every few days (Worcestershire Health and Care Trust, 2017).

If your baby isn't keen on tummy time, you could just hold them upright, for example by giving them a cuddle. Babies who don't do tummy time might take a little longer to walk but they'll still take a normal amount of time to do it (Pin et al, 2007).

How do you do tummy time?

From birth, you could try a few different positions to help them play and wriggle around on their tummy. For a comfy and reassuring position with loads of eye and skin contact, you could lay your baby on your chest while you're lying on your back (Worcestershire Health and Care Trust, 2017). You could also place your baby across your lap, holding them securely so they don't squirm away (Worcestershire Health and Care Trust, 2017).

When they're ready and can lean on their arms, you could see how they are with tummy time on the floor. Try this using a rolled up towel under their chest and armpits so they can lift their head more easily (NHS, 2017; Worcestershire Health and Care Trust, 2017).

Once they're four months old and can prop themselves up fully through their arms, they might not need the towel support for tummy time on the floor. This position is great for play and reaching for toys can help your baby to get stronger (Worcestershire Health and Care Trust, 2017).

After they're six months old, you could have even more fun with them by playing 'Superman'. That's where you hold them under their arms and gently lift them up so they stretch into the flying superhero's pose (Worcestershire Health and Care Trust, 2017).

Top tips for tummy time:

Stay with your baby

You need to supervise your baby during tummy time. Only get them to try out tummy time when you're both on the ball and you're watching them closely (NHS, 2017).

Little and often

It's a good idea to start your baby's tummy time with a little and often approach (NHS, 2017).

Try very short periods of time, possibly even a minute or two at a time, to start with. Nappy changes or when they wake up could give you a good opportunity to try tummy time (AAP, 2017).

Increase stamina slowly

It will take time for your little one to develop confidence and strengthen their muscles during tummy time (Worcestershire Health and Care Trust, 2017).

Trust your instincts as some babies won't like being on their tummy at first - try holding them upright instead if so. For babies that are ok on their tummies, you could help them to play and encourage them when they're on their belly so they start enjoying it more. You can then increase their tummy time when they show they're enjoying it - see what works (AAP, 2017). They will soon get the hang of it.

Tummy to tummy

Try lying on your back, tummy to tummy with your baby, smiling, talking or singing softly to them (Worcestershire Health and Care Trust, 2017). Dads or partners can get involved with this too. Skin-to-skin tummy time can be a good bonding experience.

The eye and body contact will be comforting and reassuring for your little one. You might find they stay engaged with tummy time for a bit longer this way (Worcestershire Health and Care Trust, 2017).

Tummy time fun

Try to turn tummy time into playtime (NHS, 2017; Worcestershire Health and Care Trust, 2017). You can buy baby tummy time play mats to help make tummy time more fun for your baby.

Otherwise, lie your little one on a soft blanket and put some playthings out for them. You could put brightly coloured books, toys or a baby mirror nearby for them to look at and reach out to.
This page was last reviewed in October 2017.
Further information

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

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

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

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Top tips for tummy time | Baby & toddler, Your child's development articles & support | NCT

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We look at what tummy time is, when to start and why it's important. We also give you some top tips for tummy time success.

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Where to find support if you live in Bolton

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The early relationship you, your partners and family have with your baby is very important.

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The early relationship you, your partners and family have with your baby is very important.

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Developing a relationship with your baby

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How having a strong bond with your baby can help them manage their feelings and develop their own relationships later in life.

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Keeping Your Baby Safe during Skin to Skin

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Keeping Your Baby Safe during Skin to Skin

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Whatever your feeding choices skin to skin benefits you and your baby

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How to make bottles with formula safely.

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How to make bottles with formula safely.

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Watch the video for a step by step guide to making up formula using powder

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Newborn baby poo in nappies: what to expect |  NCT

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The dirty nappies your baby produces can be one way of telling that your baby is getting enough milk.

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Newborn baby poo in nappies: what to expect | Baby & toddler articles & support | NCT

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Your baby’s nappy can tell you a lot - find out more here.

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Caring for your baby at night and when sleeping

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Caring for your baby at night and when sleeping

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Making up feeds during the night and keeping your baby safe

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Making feeding a special time helps to strengthen the bond between you and your baby, and helps your baby's brain development - follow the tips in this leaflet

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If you are bottle feeding, you will need to make sure that all the equipment you buy is sterilised and safe for use every time you feed your baby. Find out more about sterilising bottle feeding equipment.

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Have a look at our step-by-step guide on how to make up a formula feed.

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The Lullaby Trust's website contains lots of information about safe sleep

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The safest cot is a clear cot

The safest cot for a baby is a clear cot. That means removing anything that isn't essential. Babies need just two items in their cot:

It's important to remove anything that isn't essential because items such as toys, blankets and bumpers could cover their face and obstruct their breathing.

When preparing your baby's sleep space, remember:

No pillows or duvets

No cot bumpers

No soft toys or comforters

No weighted or bulky bedding

No products designed to keep your baby in one sleeping position, such as wedges or straps

No pods or nests, rolled up towels or anything soft placed on top of the mattress.

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Safer sleep overview - The Lullaby Trust

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An easy guide to practicing safer sleep for your baby and reducing the risk of sudden infant death syndrome (SIDS, or cot death).

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Bolton Infant Feeding Team run a clinic for those babies who are having feeding difficulties caused by tongue tie. Your midwife or health visitor can refer you if feeding support does not help to resolve the problem

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A tongue-tie (also known as Ankyloglossia) is caused by a short or tight membrane under the tongue (the lingual frenulum).

Where the membrane is attached at, or close to the tongue tip, the tongue tip may look blunt, forked or have a heart shaped appearance. However, where the membrane is attached further back the tongue may look normal in appearance.

Research suggests that approximately 1 in 10 babies may be born with some restrictive membrane under the tongue. But only about half of those babies display significantly reduced tongue function, making breast or bottle feeding difficult.

These babies may benefit from treatment to release the restriction that the membrane is having on the tongue and enable a baby to feed effectively.

Tongue-tie assessment

Tongue-tie practitioners often talk to parents who have had conflicting advice around whether or not their baby has a tongue-tie so it may be helpful for parents, and professionals who do not assess and divide tongue-ties, to have an understanding of what an assessment for tongue-tie involves.

The decision on whether or not a tongue-tie is impacting on feeding and whether it is appropriate to offer to divide it should be made after a detailed feeding history has been taken. This will usually include information about the pregnancy and birth and the medical history of both mum and baby. The baby is usually observed at the breast. This may be done by the person who divides tongue-ties or by someone who has been supporting you with feeding, prior to you being referred for division, such as a midwife, Health Visitor or breastfeeding counsellor/lactation consultant. The function of the tongue will also be assessed to establish if the baby is tongue-tied and if this is impacting on feeding.

The video clip shows part of an assessment for tongue-tie: Assessment of a Tongue Tie video curtesy of Sarah Oakley .

Assessment for tongue-tie requires training and skill and involves placing a finger in the baby's mouth. It cannot be done by just taking a look. Assessment is usually carried out with the baby on the assessor's lap or a flat surface such as a table or couch. It involves observing how the baby uses their tongue.

Professionals assessing babies for tongue-ties should assess elevation, lateralisation and extension. Elevation can most easily be assessed when baby cries. With the mouth wide open, the tongue tip should lift up to at least the mid mouth. In tongue-tied babies the tongue often stays quite flat in the floor of the mouth or the edges curl up to form a bowl shape or 'v' shape. Babies should be able to poke their tongue tip out well over the bottom lip when the bottom lip is stimulated. When the assessor runs their finger along the top ridge of the bottom gum the tip of the baby's tongue should follow the finger so the tongue sweeps side to side (lateralisation).

Some assessors perform a suck assessment by placing their finger in the baby's mouth (pad side up, nail side down) and feeling how the baby is cupping and using their tongue. Assessors sweep their finger under the baby's tongue so they can feel the extent of the tongue tie and the tongue will also be lifted to visualise the frenulum. The appearance of the frenulum is also documented including the shape of the tongue tip, where it attaches to the floor of the mouth and the underside of the tongue and how long and elasticated it is.

Problems which may be due to a restrictive tongue-tie:

Breast/Chest Feeding Parent:

Sore/damaged nipples

Nipples which look misshapen or blanched after feeds

Low milk supply or fast, quick let-down

Exhaustion from frequent/constant feeding

Distress from failing to establish breastfeeding

Infant/Baby:

Restricted tongue movement

Small gape resulting in biting/grinding behaviour

Unsettled behaviour during feeds

Difficulty staying attached to the breast or bottle

Frequent or very long feeds

Excessive early weight loss/ poor weight gain/faltering growth

Clicking noises and/ or dribbling during feeds

Colic, wind, hiccoughs

Reflux (vomiting after feeds)

Your baby may not display all of these signs and there can be other causes for these symptoms too so a thorough assessment by a practitioner skilled in breastfeeding is essential.

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A tongue-tie (also known as Ankyloglossia) is caused by a short or tight membrane under the tongue (the lingual frenulum). Where the membrane is attached at, or close to the tongue tip, the tongue tip may look blunt, forked or have a heart shaped appearance.

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This leaflet provides a summary of safe sleep information

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A guide to expressing and storage if you would like your baby to have your milk through a bottle

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Most infant formula is made from cows' milk. Here is what to do if you think your baby might be showing symptoms of allergies

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If you think your baby is having a reaction to cows' milk, see your GP or health visitor to discuss your concerns.

They will be able to assess if your baby's symptoms may be caused by a cows' milk allergy or something else. Make sure you get medical advice before taking cows' milk out of your child's diet as it contains important nutrients.

Cows' milk allergy in babies

Cows' milk allergy (CMA), also called cows' milk protein allergy, is one of the most common childhood food allergies. It is estimated to affect around 7% of babies under 1, though most children grow out of it.

CMA typically develops when cows' milk is first introduced into your baby's diet either in formula or when your baby starts eating solids.

More rarely, it can affect babies who are exclusively breastfed because of cows' milk from the mother's diet passing to the baby through breast milk.

There are 2 main types of CMA:

immediate CMA - where symptoms typically begin within minutes of having cows' milk

delayed CMA - where symptoms typically begin several hours, or even days, after having cows' milk

Symptoms of cows' milk allergy

Cows' milk allergy can cause a wide range of symptoms, including:

skin reactions - such as an itchy rash or swelling of the lips, face and around the eyes

digestive problems - such as stomach ache, vomiting, colic, diarrhoea or constipation

hay fever-like symptoms - such as a runny or blocked nose

eczema that does not improve with treatment

Occasionally CMA can cause severe allergic symptoms that come on suddenly, such as swelling in the mouth or throat, wheezing, cough, shortness of breath, and difficult, noisy breathing.

A severe allergic reaction ( anaphylaxis) is a medical emergency. Call 999 for an ambulance immediately if you think your child has anaphylaxis (even if they start to feel better).

Treatment for CMA

If your baby is diagnosed with CMA, you'll be offered advice by your GP or an allergy specialist on how to manage their allergy. You may also be referred to a dietitian.

Treatment involves removing all cows' milk from your child's diet for a period of time.

If your baby is formula-fed, your GP can prescribe special infant formula.

Do not give your child any other type of milk without first getting medical advice.

If your baby is exclusively breastfed, the mother will be advised to avoid all cows' milk products.

Your child should be assessed around every 6 to 18 months to see if they have grown out of their allergy.

Read more about cows' milk allergy in children on National Institute for Health and Care Excellence (NICE).

Could it be lactose intolerance?

Lactose intolerance is another type of reaction to milk, when the body cannot digest lactose, a natural sugar found in milk. However, this is not an allergy.

Lactose intolerance can be temporary - for example, it can come on for a few days or weeks after a tummy bug.

Symptoms of lactose intolerance include:

diarrhoea

vomiting

stomach rumbling and pains

wind

Treatment for lactose intolerance

Treatment depends on the extent of your child's intolerance. Some children with lactose intolerance may be able to have small amounts of dairy products without having symptoms.

Your child may be referred to a dietitian for specialist advice.

Read more about treatment for lactose intolerance.

Further information:

Page last reviewed: 28 November 2022
Next review due: 28 November 2025

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What should I do if I think my baby is allergic or intolerant to cows' milk?

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If you think your baby is having a reaction to cows' milk, see your GP or health visitor to discuss your concerns. They will be able to assess if your baby's symptoms may be caused by a cows' milk allergy or something else.

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Use this information to help you if you need to, or choose to, combine breast and bottle feeding. Ypur midwife or Health Visitor can also advise you.

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Choosing which method is best for you

There are different things to think about with each method. If you're mixing breast and bottle feeding, you may find that your baby struggles with one of the methods, depending on how and when you introduce them.

Expressing exclusively

If your baby is not feeding properly, expressing can be a good way to make sure they get the benefits of breast milk.

If you're expressing breast milk, you are less likely to have problems with engorgement (breasts becoming uncomfortably full) and mastitis. However, some mums find that expressing is time consuming and tiring and it can be tricky to get the hang of expressing at first.

Find more information about expressing.

Mixing breastfeeding and expressing

If you mix breastfeeding with bottle feeding expressed milk, your baby will benefit from having breastmilk at every feed. You will also be able to use expressed milk later so your partner or family members can share the feeds. See our guide to expressing for more on how to store expressed breast milk.

You are also less likely to have problems with becoming engorged and getting mastitis. However, some mums find expressing tricky and it can be tiring.

Mixing breastfeeding and formula feeding

If you decide to mix formula feeding with breastfeeding you might find that your body does not produce enough milk - especially if you introduce this method too quickly. See mixed feeding challenges to find out more.

However, some mums prefer this method because they are reassured that their baby is getting enough to eat whilst still benefitting from having breastmilk.

Mixing expressing and formula feeding

If you decide to mix bottle feeding expressed breast milk along with infant formula, your baby will benefit from having breast milk and you can share the feeding with a partner or other family member.

Expressing can take time and effort to get the hang of at first and you will need to buy equipment such as sterilisers and bottles and pumps (if you decide not to hand express).

However, some mums prefer this method because they are reassured that their baby is getting enough to eat whilst still benefitting from having breastmilk.

Mixing breastfeeding, expressing and formula feeding

Some parents choose to combine breastfeeding, expressing and formula feeding. This means that your baby benefits from having breastmilk, you are more likely to produce enough milk because you're expressing between feeds and your partner or other family member can help out with feeds when you use formula.

However, it can be very complicated, time consuming and tiring to combine all 3 methods and you will have to buy equipment such as sterilisers, bottles and pumps (if you decide not to hand express).

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There are different reasons to combine breast and bottle feeding - which method you choose will depend on your circumstances

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There are different things to think about with each method. If you're mixing breast and bottle feeding, you may find that your baby struggles with one of the methods, depending on how and when you introduce them. If your baby is not feeding properly, expressing can be a good way to make sure they get the benefits of breast milk.

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Colic is a common set of symptoms in young babies but can be challenging to cope with

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Did you know that colic is a very common condition affecting 1 in 5 babies? Find out how to soothe a colicky bottle-fed baby

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Read more about common bottle feeding issues such as colic. If you have any concerns, it’s important to talk to your health visitor.

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Most jaundice in babies happens as part of a normal process and resolves with good feeding. If you have any questions or concerns about jaundice contact your midwife.

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Jaundice is caused by too much bilirubin in the blood. This is known as hyperbilirubinaemia.
Bilirubin is a yellow substance produced when red blood cells, which carry oxygen around the body, are broken down.

The bilirubin travels in the bloodstream to the liver. The liver changes the form of the bilirubin so it can be passed out of the body in poo.

But if there's too much bilirubin in the blood or the liver cannot get rid of it, the excess bilirubin causes jaundice.

Jaundice in babies

Jaundice is common in newborn babies because babies have a high number of red blood cells in their blood, which are broken down and replaced frequently.

A newborn baby's liver is not fully developed, so it's less effective at processing the bilirubin and removing it from the blood.

This means the level of bilirubin in babies is much higher than in adults.

By the time a baby is around 2 weeks old, they're producing less bilirubin and their liver is more effective at removing it from the body.

This means the jaundice often corrects itself by this point without causing any harm.

Breastfeeding

Breastfeeding your baby can increase their chances of developing jaundice.

But there's no need to stop breastfeeding your baby if they have jaundice, because the symptoms normally pass in a few weeks.

Some breastfed babies can have jaundice for as long as 12 weeks, but it's important that this is checked by a health visitor or GP so other more serious causes of jaundice can be ruled out.

The benefits of breastfeeding outweigh any potential risks associated with the condition.

If your baby needs to be treated for jaundice, they may need extra fluids and more frequent feeds during treatment.

See treating newborn jaundice for more information.

It's unclear why breastfed babies are more likely to develop jaundice, but a number of theories have been suggested.

For example, it may be that breast milk contains certain substances that reduce the ability of the liver to process bilirubin.

Newborn jaundice thought to be linked to breastfeeding is sometimes called breast milk jaundice.

Underlying health conditions

Sometimes jaundice may be caused by another health problem. This is known as pathological jaundice.

Some causes of pathological jaundice include:

an underactive thyroid gland (hypothyroidism) (where the thyroid gland does not produce enough hormones)

blood group incompatibility (when the mother and baby have different blood types, which are mixed during the pregnancy or the birth)

rhesus disease (a condition that can occur if the mother has rhesus-negative blood and the baby has rhesus-positive blood)

a urinary tract infection (UTI)

Crigler-Najjar syndrome (an inherited condition that affects the enzyme responsible for processing bilirubin)

a blockage or problem in the bile ducts and gallbladder (the gallbladder stores bile, which is transported by the bile ducts to the gut)

An inherited enzyme deficiency known as glucose 6 phosphate dehydrogenase (G6PD) could also lead to jaundice or kernicterus.

It's important to let your midwife, GP or paediatrician know if you have a family history of G6PD. Your baby's jaundice symptoms will need to be closely monitored.

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Jaundice is caused by too much bilirubin in the blood. This is known as hyperbilirubinaemia. Bilirubin is a yellow substance produced when red blood cells, which carry oxygen around the body, are broken down. The bilirubin travels in the bloodstream to the liver.

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Safety Considerations When Using A Sling

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Safety Considerations When Using A Sling

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Slings and carriers can be useful, especially for times when your baby needs to be close to you. Here's how to make sure your baby is safe while you do this

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TICKS used with permission of the UK Sling Consortium, please credit when used.

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Babies who are having more than 500ml (about a pint) of infant formula a day should not be given vitamin supplements. This is because formula is fortified with vitamins A, C and D and other nutrients.

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Vitamin supplements

The government recommends all children aged 6 months to 5 years are given vitamin supplements containing vitamins A, C and D every day.

Babies who are having more than 500ml (about a pint) of infant formula a day should not be given vitamin supplements. This is because formula is fortified with vitamins A, C and D and other nutrients.

Babies who are being breastfed should be given a daily vitamin D supplement from birth, whether or not you're taking a supplement containing vitamin D yourself.

Where you can get baby vitamin drops

Your health visitor can give you advice on vitamin drops and tell you where to get them.

You're entitled to free vitamin drops if you qualify for Healthy Start.

The Department of Health and Social Care only recommends vitamin supplements containing vitamins A, C and D.

But some supplements you can buy contain other vitamins or ingredients. Talk to a pharmacist about which supplement would be most suitable for your child.

Having too much of some vitamins can be harmful. Keep to the dose recommended on the label, and be careful not to give your child 2 supplements at the same time.

For example, do not give them cod liver oil and vitamin drops because cod liver oil also contains vitamins A and D. One supplement on its own is enough, as long as it contains the recommended dose of vitamin D.

Vitamin D

Vitamin D is only found in a few foods, such as oily fish and eggs. It's also added to some foods, such as fat spreads and breakfast cereals. But it's difficult to get enough vitamin D from food alone.

The main source of vitamin D is summer sunlight on our skin. But it's important to keep your child's skin safe in the sun.

Children should not be out in the sun too long in hot weather. Remember to cover up or protect their skin before it turns red or burns.

Young children should still have vitamin drops, even if they get out in the sun.

The Department of Health and Social Care recommends:

Babies from birth to 1 year of age who are being breastfed should be given a daily supplement containing 8.5 to 10 micrograms of vitamin D to make sure they get enough. This is whether or not you're taking a supplement containing vitamin D yourself.

Babies fed infant formula should not be given a vitamin D supplement if they're having more than 500ml (about a pint) of infant formula a day, because infant formula is fortified with vitamin D and other nutrients.

Children aged 1 to 4 years old should be given a daily supplement containing 10 micrograms of vitamin D.

Vitamin A

Vitamin A is important for babies and young children, and some may not be getting enough.

It's needed for a healthy immune system, can help their vision in dim light, and keeps skin healthy.

Good sources of vitamin A include:

dairy products

fortified fat spreads

carrots, sweet potatoes, swede and mangoes

dark green vegetables, such as spinach, cabbage and broccoli

Vitamin C

Vitamin C is important for your child's general health and immune system. It can also help their body absorb iron.

Good sources of vitamin C include:

A balanced diet for babies and young children

It's important for children to eat a wide variety of foods to make sure they're getting all the energy and nutrients they need to grow and develop properly.

Get more advice and information on a balanced diet for babies and young children:

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Find out why vitamins are important for the health of your baby or young child, and which vitamin supplements they should take.

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What you need to know about making up a bottle feed safely - Arabic

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What you need to know about bottle feeding - Arabic

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What you need to know about making up a bottle feed safely - Somali

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What you need to know about bottle feeding - Somali

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What you need to know about making up a bottle feed safely - Hungarian

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What you need to know about bottle feeding - Hungarian

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What you need to know about making up a bottle feed safely - Urdu

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What you need to know about bottle feeding - Urdu

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Making up a bottle feed - Kurdish Sorani

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Making up a bottle feed - Kurdish Sorani

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What you need to know about making up a bottle feed safely - Kurdish Sorani

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What you need to know about bottle feeding - Kurdish

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The benefits of skin to skin and keeping your baby safe - Arabic

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The benefits of skin to skin and keeping your baby safe

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What happens on the first feed - Hungarian

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The benefits of skin to skin and keeping your baby safe - Urdu

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The benefits of skin to skin and keeping your baby safe - Kurdish Sorani

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What happens on the first feed - Kurdish

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Hand expression video - Baby Friendly Initiative

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Hand expressing is a useful skill to learn - it doesn't require any special equipment and can be used to help with many situations

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

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

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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

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Exclusively Expressing Breastmilk for Your Baby - La Leche League GB

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A guide to expressing if you wish your baby to have breastmilk through a bottle

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When babies cannot feed at the breast comfortably and effectively, and breastfeeding support is hard to find or not able to help, mothers may choose to use a breast pump to express all the milk their baby needs, and then feed via a bottle or feeding tube. This is known as exclusive pumping. While this is often a temporary solution to protect milk supply until the baby is able to nurse directly at the breast, some mothers may find themselves exclusively pumping long term. Some mothers may also actively choose to exclusively pump and some mothers may be unable to feed their baby directly at the breast because their baby is poorly or has medical difficulties.

The decision to exclusively express breastmilk usually stems from an awareness of the irreplaceable qualities of breastmilk. Mothers also find that providing their babies with breastmilk can help with the grief from not being able to nurse directly at the breast. If their baby has medical difficulties, many mothers feel strongly that providing human milk will give their child the best possible start, particularly if their baby is in hospital. Yet, exclusive pumping is a significant undertaking which requires dedication, information and support.

You might find the decision to exclusively express feels difficult, and that you don't feel you fit with breastfeeding mothers or with those using formula. Please be sure that you will receive a warm welcome and support at LLL meetings and from your local Leader, and that we understand the lengths you're going to, to make sure your baby has your milk.

This page concentrates on the practicalities of how and when to express your milk and feed it to your baby, to establish exclusive expressing as your feeding method. Sometimes it can help to focus on all these practicalities and, once you have a workable plan, to give yourself time too to process how you're feeling about it, as you settle into life with your new baby. If you have a partner or supporter at home with you, all the things that are useful in supporting a breastfeeding mother will apply to you too!

Getting Started

If you have recently given birth and your mature milk has not yet come in, hand expressing is the most effective way of collecting colostrum to feed to your baby. It is important to start expressing colostrum within six hours (ideally after one hour, if possible) of giving birth, though if this doesn't happen for you, it is still possible to get started.

A newborn would expect to feed 8-12 times in 24 hours, and the feeds might not be evenly spread over that time, though they do need to include some feeds in the night; it is important to try to express breastmilk just as frequently in order to lay the groundwork for a robust milk supply later on. If you can have skin to skin contact with your baby while you're expressing, it can really help, and a photo or something that smells of your baby can be a substitute. You can collect your colostrum in a syringe, a small clean cup or a spoon. See our article on Hand Expression of Breastmilk for more information on hand expressing, and you might also find this video on hands-on pumping helpful. This technique can be tricky to get the hang of, so please do ask your midwife or other breastfeeding supporter to help. It's very common to need an extra pair of hands to collect the drops of colostrum.

Equipment

As your milk starts to transition, you will probably notice it start to change colour and spray out as you are expressing; this is a good time to introduce a breast pump. Although some women respond better to hand expressing, using a hospital grade double electric pump is the most effective way of removing breastmilk when a baby isn't latching or is not nursing adequately. If you are planning on exclusively expressing for your baby long term, then it will be worth investing in a hospital grade double pump. If you would like to try one before deciding whether or not to buy it, your hospital or midwife may be able to provide you with one on a short-term loan. Alternatively, you can hire a pump, although it may turn out to be rather expensive if you are exclusively expressing long term.

A breast pump usually comes with a collection set and the part that sits over your nipple/areola, which is called a flange. As women's nipples and skin elasticity differ, flanges are available in different sizes. It's important to ensure you have the right size for your nipples, as flanges that are too large or too small may cause pain or nipple damage and reduce the amount of milk you are able to express. Finding the right flange size may be a bit of a trial and error process; you may want to start by trying the standard size that comes with the pump (which varies for different pump brands) and see how you respond. If the standard flange sucks in too much areola, or if your nipple is at the back of the pump, you may need to go down a size. If, instead, you are left with a white ring around your nipple, you may need to go up a size.

Many mums find being able to express handsfree invaluable in terms of allowing them to fit regular pumping sessions into their day. There are a small variety of pumps that provide milk collection cups that sit inside your bra, freeing you up to cuddle your baby without fear of spilling your milk. However, they tend to have a limited range of flange sizes. Alternatively, you can buy special bras designed to hold your pump flanges against your breasts, or you can even DIY your own by cutting holes in a stretchy bra that line up with your nipples.

There are several other things to consider when choosing which hospital grade double pump to purchase or hire:

- How often will you use it? If you are planning to exclusively pump long term, you may need to consider motor life, to make sure the pump you purchase will live up to its use.

- How portable is it? If it uses a battery, then it can be carried around the house or out and about with you. Some pumps have built-in rechargeable batteries, while others offer the option to purchase a power pack or a car charger. Some pumps use removable batteries which are easy to replace if you unexpectedly run out of charge while away from a plug socket. However, using removable batteries may end up being rather expensive long term. You might find you end up using two different pumps - an efficient hospital grade one when you're at home and a hand pump or battery pump when you're out and about.

- Can you purchase spare collection sets? Having a spare collection set or two can come in handy, as most mothers find that it is easier to stick to their pumping schedule if their pump is set up and ready to go at a moment's notice, especially at nighttime.

Setting your schedule

For the first three-four months, you will need to express regularly to build a robust milk supply, ideally 8-12 times in 24 hours. Although you do not always need to pump at regular intervals, it is best not to go more than two to three hours between pumping sessions, with one longer stretch of four-five hours at night if you can take this break without damaging your milk supply. You will need to have at least one pumping session overnight, ideally between 2am and 5am when prolactin levels are highest. If you are able to pump when your baby wakes up for a feed, you may find it easier to do so than setting an alarm. If you need to set an alarm, but are having difficulty waking up, it may be worth experimenting with setting it for different times to try and coincide with the periods in your sleep cycle where you are in a lighter sleep. Many mothers find that they are able to express the most milk first thing in the morning, and less as the day goes on. You will notice your own patterns. It's also common for one breast to produce more milk or have a faster flow than the other side.

Working out ways to fit pumping sessions into your routine is key to long-term success. Some mothers will express while cooking, or holding a sleeping baby, or while travelling; sometimes before they feed their baby, sometimes afterwards. Experiment to find out what works best for your family and your daily rhythms.

In the early days, you may find that you are producing more milk than your baby needs; this is common and it will settle down in a few weeks. It can be useful to freeze any excess milk in small portions for later on, should your baby suddenly require more milk, such as during a growth spurt or period of illness.

Once your supply has established, usually between three and four months, you may decide to slowly reduce your number of daily pumping sessions. If you are planning to exclusively express long term, however, you may decide not to make any changes to your pumping schedule. If you start to reduce your expressing sessions, you may like to keep a record of your daily pumping outputs so that you can monitor what effect it has on your overall milk supply. You could start by increasing the intervals between your overnight pumping sessions, although it will still be important to express once at night. After doing this for about three-four weeks, you may consider dropping one daytime session. This may require you to adjust the time of all your other pumping sessions, in order to avoid leaving a big gap in between them, which could make you vulnerable to experiencing blocked ducts or mastitis.

Once your baby starts eating solids reliably, around eight-nine months, you may start to notice a change in their milk requirements and can adjust your pumping schedule and milk supply accordingly. However, many mothers find that introducing solids does not affect milk intake for a lot longer (in some cases, 18 months). When your baby is sat in a highchair, it can be a good time to express your milk without them pulling on the pump tubes.

How long is an expressing session?

The length of each expressing session will vary for each mother, based on her breast storage capacity and the type of pump she uses. If you are able to express milk from both breasts at once, then you will find it much faster.

While some experts recommend pumping for about 15-20 minutes, others believe that specifying the duration of a pumping session may not be helpful, as some mothers may take up to 45 minutes. In her book Exclusively Pumping Breastmilk, Stephanie Casemore suggests spending two hours over the course of 24 hours expressing. However, this total pumping time may need to be adjusted for mothers who need long individual expressing sessions. Also, other experts believe the total number of separate sessions to be more important than total pumping duration, with shorter, more frequent expressing sessions usually being more effective than fewer, longer sessions.

As a general rule of thumb, you can express until your milk stops spraying, and then for an additional five minutes to stimulate another let-down. If you need to increase your supply, you can pump for 10 more minutes and use hand expression right after to remove as much milk as possible. Breast compressions and massage during sessions ( hands-on pumping) also help to stimulate let-downs and maximise milk output. Some mothers find that it helps to experiment with "power pumping", where they pump frequently for short periods, to mimic cluster feeding. This might be something to use on occasion rather than as part of a daily routine as it can be quite time-intensive.

If, on the other hand, you need to decrease your supply, then slowly reduce the length of time you are expressing for. In both cases, many of the techniques discussed in our articles " My baby needs more milk" and " Too Much Milk and Oversupply " can be adapted for use with a breast pump.

If you are worried that you do not have enough time to do a full session, then it is better to pump less time and have a longer session later, than to miss one entirely.

Over time, as you reduce the number of pumping sessions, you may find that you will need to express for longer to obtain the same amount of milk. Many women find that if they cycle through their pump settings again, they can trigger a second or even a third let-down over a period of 30-45 minutes.

The importance of Oxytocin

Oxytocin is the hormone that triggers your letdown (milk ejection reflex). It is especially important to be mindful of this when expressing, as even mildly stressful situations of feeling rushed can make it difficult to trigger a letdown when using a breast pump. Many mothers find looking at their baby - or at pictures of their baby if they are separated - while expressing helpful. Gently massaging your breasts before and during your pumping session, as well as applying warm compresses or taking a warm shower before expressing can also trigger a let-down. Other ways to boost your oxytocin might include listening to music, watching a comedy on TV, reading a book, or browsing social media on your phone.

If you are able to cuddle your baby while expressing, you may see an increase in your normal milk output! It is even possible to express while carrying your baby in a sling or baby carrier. As your baby gets older and more mobile, you may find it easier to remove yourself to a different room where you can relax without worrying about them pulling on your tubes, or getting into things they shouldn't.

It can feel disheartening if you are watching your collection bottles and feel that they are not filling up quickly enough. Covering the bottles with socks, or distracting yourself so that you are not watching, can be helpful. If you are struggling to get a let-down, it is ok to put your pump away and come back to it 10-20 minutes later and try again. If it is a persistent problem at certain times of day, try to remember that the stimulation you are giving your breast still has a valuable purpose.

How to pump

In order to keep pumping comfortable and avoid nipple damage, you may want to consider using lubrication, such as lanolin or olive oil, inside the pump flange to reduce friction. The flange needs to make a comfortable seal around the breast.

Pumps have different suction and cycles settings. You may want to start with a low suction and high number of cycles to stimulate your let-down. Once your milk starts flowing, you can decrease the number of cycles and increase suction. In order to avoid getting sore, it is a good idea not to use the same suction setting for long periods of time. Switching between low and high suction also helps to trigger more let-downs.

Once you are done pumping, you can massage both breasts and hand express to make sure your breasts are completely drained.

How much milk to pump

As breastmilk is highly digestible, breastfed babies tend to feed little and often. When babies nurse directly at the breast, milk intake varies from feeding to feeding, so the amount of breastmilk taken per bottle may also vary throughout the day. On average, babies need 750-1035ml of breastmilk per day between one and six months of age. You may want to pump slightly more than this to make sure you have enough milk when your baby goes through a grow spurt.

Feeding your breastmilk

Babies drink from a bottle and nurse from the breast in a completely different way. When drinking from a bottle, babies cannot control the flow of milk, which can be uncomfortable for them and can lead to overfeeding. In order to minimise this problem, you may want to feed your baby your expressed milk in a way that is as close as possible to nursing. This is often referred to as paced bottle feeding.

Rather than feeding your baby bottles of expressed milk according to a strict schedule, you may want to feed on demand, as you would if they were nursing at the breast, being aware of early hunger cues. Holding your baby upright and keeping the bottle in a horizontal position allows the baby to suck actively, as he would at the breast, and to control the flow of milk, taking a break whenever he needs to. Offering the bottle teat gently, letting the baby draw it into their mouth, and feeding to satiation also allow the baby to be more in control of his feed. You can find more information on how to feed your baby your expressed milk in our article ' Bottles and other tools '.

It's important to remember that breastmilk should not be warmed up in a microwave or in a pan on the hob, in order to avoid damaging its nutrients. Shaking breastmilk is also not necessary.

Storing your breastmilk

Breastmilk's antibacterial properties help it stay fresh, so it can be safely stored at room temperature for four-six hours and in the fridge for up to a week. If away from home, you could use a cool bag with ice packs. Our page Storing Your Milk has comprehensive details on safe periods for storing expressed milk for healthy babies. If your baby is unwell or premature, then follow hospital guidelines. Your baby will benefit more from fresh than frozen breastmilk because its living properties will help him fight off possible infections, however all human milk is beneficial for you baby.

You may well see that your expressed milk is not always the same colour, and that it separates into layers when it has been stored for a while. Neither of these is a cause for concern, and a gentle swirl of the container before you feed your milk to your baby should make the layers mix again.

If you find that you are producing more milk than your baby needs, you might like to consider donating your milk by registering as a donor for your local breastmilk bank.

Stopping exclusively pumping

When you feel ready to stop expressing milk for your baby, it's important not to rush into dropping pumping sessions, in order to avoid the risk of experiencing blocked ducts or mastitis. Your breasts need time to adjust, so it's best to adopt a gradual approach. You could try to reduce the length of your pumping sessions by a few minutes over a few weeks, or you could try slowly increasing the intervals between sessions.

Exclusive pumping, while also doing the day to day work of looking after your baby, can be exhausting, and sometimes mothers and parents wrestle with feeling guilty about having stopped "too soon". By taking on the work of exclusive pumping, though, you gave your baby a wonderful gift.

Written by Nicola Sheldon (LLL Berkshire and Oxfordshire) and Eva Williams (LLL Oxfordshire), May 2020.
Thanks to Harriet Valentino for her input and to Lois Rowlands, Rae Vacher Lowe and Laura Loasby for the photos.

Further reading

https://www.laleche.org.uk/hand-expression-of-breastmilk/
https://www.laleche.org.uk/my-baby-needs-more-milk/
https://www.laleche.org.uk/too-much-milk-and-oversupply/
https://www.laleche.org.uk/bottles-and-other-tools/
https://www.laleche.org.uk/expressing-your-milk/#Pumps
https://www.laleche.org.uk/storing-your-milk/
A mother's story from our members magazine breastfeeding matters
https://kellymom.com/category/bf/pumpingmoms/pumping/
Exclusively Pumping Breastmilk, Second edition. Casemore, S. Gray Lion Publishing, 2014

i Exclusively Pumping Breastmilk. Second edition. Casemore, S. Gray Lion Publishing, 2014

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Exclusively Expressing Breastmilk for Your Baby - La Leche League GB

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When babies cannot feed at the breast comfortably and effectively, and breastfeeding support is hard to find or not able to help, mothers may choose to use a breast pump to express all the milk their baby needs, and then feed via a bottle or feeding tube. This is known as exclusive pumping.

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This leaflet gives you a guide for expressing and storing your milk

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Information about the advantages and disadvantages of equipment for expressing your milk

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I decided to write this blog after seeing a mum post on a Facebook breastfeeding group asking for pump recommendations. The Admin for that group directed her to a link on the American Kellymom.com breastfeeding website on buying new and used breast pumps which really is not particularly helpful. I did a quick google and really could not find anything useful to help a mum select an appropriate breast pump from the vast array on offer. This reaffirmed to me the difficulties mothers in this situation face. I see families daily who are using a breast pump that is not appropriate to meet their needs or who have spent hundreds of pounds on a pump that remains in its box unused.

So, as a parent how do you choose a breast pump? There are many reasons why you may need to or want to express. The reason for expressing will also dictate how often you will be pumping. This is key to choosing a suitable breast pump.

In the early days after birth you may find you need to pump frequently to provide milk for your baby who, for whatever reason, is not able to latch and feed directly at the breast. Or your baby may be struggling to drain the breast effectively. Frequent expressing will be needed to stimulate milk production and manage engorgement as the milk starts to come in. Later, you may need to express because of inefficient feeding and/or slow weight gain to provide top ups and/or boost a low supply. As baby gets older you may want the flexibility of being able to leave her baby in the care of someone else so you can have a break, go to bed early or attend appointments. You may be returning to work and need to leave milk for your baby.

There may also be situations where a mother wishes to re-establish a milk supply after a break from breastfeeding (relactation). More parents are now inducing lactation in situations where they are adopting a baby, or in same sex couples where the non-birthing parent wishes to share in the breastfeeding, or where a parent is transgender. Both these situations usually necessitate frequent expressing.

Not all breast pumps are equal, and some are designed for frequent use, whereas others are more suited to occasional use.

When a baby cannot latch and suckle effectively at the breast immediately after birth due, for example to prematurity, illness in the baby or mother, other additional needs, an oral abnormality such as a cleft palate or tongue-tie or simply because of a difficult birth then it is vital that expressing starts early. This will ensure a good milk supply is established and provide colostrum for the baby. Early stimulation and drainage of the breast helps to further develop the glandular tissue (the milk factory) within the breast.

Furthermore, once the milk comes in at day 3-6 milk production begins to switch from endocrine control (driven by hormones) to autocrine control (driven by the frequent and effective removal of milk from the breast).

So which type of pump is most suited to this situation? Expression of colostrum in the first few days is best done by hand expression due to the small amounts of colostrum produced. However, once the milk starts to come in then a double electric breast pump is recommended. Preferably a multi user pump as these are designed to be used by multiple mothers, multiple times per day. They are powerful, robust, and durable and offer smoother cycling curves than personal use double pumps.

These multi user pumps were traditionally called 'hospital grade'. Unfortunately the term 'hospital grade' is no applied to virtually every pump on the market as a marketing ploy. The only two pumps available in the UK that were designed to be used by multiple mothers are the Medela Symphony and Ardo Carum and these cost around £1000 to purchase so are usually hired. However, in terms of efficacy the Spectra S1, which can also be hired, compares favourably with the Medela Symphony but is more light weight and portable. Double pumping not only reduces the time required to express, as both breasts can be expressed simultaneously, it also tends to stimulate more milk production ( Jones et al, 2001) .
Hospital grade pumps are expensive so are usually hired, rather than purchased. In the UK there are three companies who provide pump hire services:
https://www.ardomedical.co.uk/shop/products/rent-a-breastpump/ https://www.medela-rental.co.uk/ https://www.anawiz.com/collections/breast-pump-rental

Some Children's Centres loan out breast pumps for free. This happens in my local area. However, the pumps which are loaned out in my area are 'personal use' double pumps, not hospital grade. They are also often loaned out with just one collection set meaning they can only be used to pump one breast at a time. Parents are sometimes placed on a waiting list. So, they are not suitable in the situations previously described. It is important to check that what you are being offered is right for the purpose you intend to use it.

Personal use electric pumps come in double and single options. All double personal use pumps can be used as a single pump. However, most single electric pumps cannot be converted to double. Double personal use pumps are good for maintaining supply, returning to work or for boosting supply if for any reason it has dipped. Many mums will switch to a personal use pump, after the first month or so, when they have established a good supply with a hospital grade pump, if they are in a situation where ongoing frequent expressing is needed.

Sometimes, mothers experience a drop in supply after the early weeks due to illness, the use of formula, certain medications, an undiagnosed latching or sucking issue (commonly a tongue-tie), or because they have implemented scheduled feeding to get baby into a routine. Double personal use pumps can be extremely helpful in boosting supply in these situations. Generally supply recovers more quickly and efficiently than with a single electric pump. Double personal use pumps are also helpful when returning to work as pumping sessions at work will take less time.

Single electric pumps can be used for the same purposes as the double personal use pumps, but pumping will be less effective and more time consuming. They are more suited to mothers who only need to pump once or twice a day to stock the freezer or provide milk so someone else can feed the baby. Some single electric pumps, such as the Medela Swing Flex, retail for the same price as personal use double pumps, such as the Spectra S1 and S2 or the Ardo Calypso, so this is something to be aware of.

Electric pumps, whether single or double, can be helpful in effectively draining breasts affected by engorgement, blocked ducts, or mastitis when a baby is struggling to do this, or the nipples are too sore for breastfeeding.

What about hands free wearable pumps like the Elvie? These are relatively new to the market. They can be useful for mothers who need to pump on the go or discreetly and my feeling is that working mothers with established milk supplies are the ones who may benefit most from this type of pump. I have had a few mothers use the Elvie in the early days of their breastfeeding journey, but supply has been slow to pick up. This is probably because we know that double pumping is most effective at this stage. Plus, the design of hands-free pumps necessitates the use of a very small motor which is not likely to be as powerful as the much larger motors found in the hospital grade pumps. The size, shape, texture and contour of the breast will influence how well a wearable pump fits and works for individual users. For a single pump hands free designs are comparatively expensive. There are some cheaper models like the Momcozy and Fraupaw which some of my clients have reported positive experiences with.

Some mums find the hands free wearable pumps don't fit particularly well to their breasts.

There are other ways to achieve hands free pumping. The simplest way is to use a 'pumping bra' or, if you have basic sewing skills, convert a standard nursing bra or close-fitting crop top for the purpose. are cups that can be worn inside your bra and in place of the flange and collection bottle on your usual pump. They are compatible with the major brands of pumps. Some pump companies, such as Spectra, make their own hands-free pumping kits.

But what about manual pumps and the all-in-one silicone pumps? These are useful for the occasional pumping session for the occasional bottle feed or for softening up engorged breasts for making latching easier. Many mums get in to the habit of using the silicone pumps for collecting the milk that is ejected when the baby is feeding on the opposite breast, rather than allowing this milk to soak into a breast pad and be wasted. However, caution is needed when doing this. Unlike breast shells which are designed to simply collect 'drip' milk from the 'let down', the silicone pumps actually create suction at the breast and draw milk so frequent use can result in an oversupply. Over supply can be associated with engorgement, blocked ducts and mastitis for mum and latching difficulties, gulping and choking, wind and reflux for baby.

When choosing a breast pump correct flange fit is vital. An ill-fitting flange will affect pumping efficiency and can cause damage to your nipples and breast tissue. Not all makes and model of pump come with the option of different flange sizes.
The standard size flange supplied with many pumps is a 24mm but most women will ned a flange that is no larger than 21mm.

Some pump flanges have soft silicone inserts which can be removed to create a larger flange and some pumps are supplied with more than one flange size. But in most cases if the flange/s supplied with your pump do not fit then you will need to buy a different sized flange or a flange insert.

Manufacturers have fitting guides on their websites and they usually suggest a flange that is about 4mm larger than the diameter of your nipple. But recent research on this suggests a snugger fit, with a flange that is no more than 2mm larger than the nipple diameter is better.

Most manufacturers of pumps do not make flanges in the smaller 13mm-19mm size range. But Maymom and other companies do make a range of smaller flanges and flange inserts compatible with most of the pumps on the market. One nipple may be larger than the other, so some mums find they need a different size flange on each breast.

I strongly recommend seeking out an IBCLC who offers a flange fitting service to avoid using the wrong size flange and spending money on flanges and inserts that may not fit. I offer this service.

The availability and cost of spare parts is also something to investigate before you buy. With cheaper pumps it is unlikely you will be able to obtain spares in a situation that a part gets lost or damaged. The cost of spare parts for some brands of pump are higher than for others.

Some electric pumps work just off the mains. But others have the option to work off a battery, making them more portable, or can be powered via the 12-volt socket in a car which means you can pump in locations away from home and mains electricity.

The quality of a pump is something to consider too. Generally speaking pumps made by companies whose core business is the manufacture of breast pumps are better in terms of reliability, efficiency and durability and they often offer better after sales service. They dedicate a lot of resources to research and development of their products. Pumps made by bottle manufacturers, such as Tommee Tippee, in my experience do not compare well. Why would they? Bottle manufacturers make their money from families who formula feed and the breast pump in their range is purely a complement to their other products, not their core business or main source of income.

Finally, a word about second-hand pumps. These may seem like a good idea as they are cheaper than a new pump and many mums are given second-hand pumps by friends and relatives. However, in my experience there can be problems with this. Some second-hand pumps have been very well used and may be third or fourth hand. Even if they have only had one previous owner, she may have used the pump for more than one baby. I have seen many situations where a mum has complained that she cannot pump much milk or her supply is not increasing and upon investigation I have found that she has been using a second-hand pump with a worn out motor or defective parts.

Parts, particularly the crucial but delicate valves, can easily get damaged during use and plastic can deteriorate with repeated cleaning and sterilising, and storage meaning that seal and therefore suction is compromised. For these reasons and for reasons of hygiene it is recommended that collection sets are replaced and not handed on. Furthermore, not all pumps are 'closed systems', notably personal use pumps in the Medela range. This means that it is possible for milk to be drawn up the tubing and into the motor housing and this poses a theoretical risk of cross infection. So, if you do opt for a second-hand pump ensure that it has not been overused, replace the collection sets and check that it is a 'closed system' pump.

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In this post, I delve into the complexities of selecting an appropriate breast pump, emphasizing that the choice should align with your specific needs and circumstances. I discuss various types of pumps, including hospital-grade, personal-use double electric, single electric, manual, and wearable models, highlighting their suitability for different situations.

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A series of videos on how to reduce the risk of SIDS when caring for your baby.

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Safer Sleep for babies online presentations

To access the presentations simply click the link and enter your name and email address to register. You will then be able to view the presentation
Safer sleep for babies - Sleep position, sleep environment and bedding
Find out more about the safest way to put your baby down to sleep for both daytime naps and at night.
https://attendee.gototraining.com/r/99838260930278401 Safer sleep for babies - Overheating, temperature and overwrapping
Find out more about the safest room temperature for your baby and the risk associated with overheating and overwrapping your baby.
https://attendee.gototraining.com/r/4732765744628309762 Safer sleep for babies - Baby ill-health, Baby Check app and vaccination
Find out more information about checking for signs that your baby maybe unwell, how to use the Baby Check app and the importance of vaccinating your baby.
https://attendee.gototraining.com/r/3914196930066085890 Safer sleep for babies - Breastfeeding
Find out more about the benefits of breastfeeding.
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Find out more about the benefits of not smoking before and after your baby is born.
https://attendee.gototraining.com/r/5716067789797323522

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To access the presentations simply click the link and enter your name and email address to register. You will then be able to view the presentation Safer sleep for babies - Sleep position, sleep environment and bedding Find out more about the safest way to put your baby down to sleep for both daytime naps and at night.

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The array of feeding products available can be confusing. There is no one formula milk that is better than another. Here is more information.

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Watch our video for information about formula milk.

What is infant formula?

Infant formula is a breastmilk substitute that is given to babies who are either not breast fed or are combination fed (fed both breastmilk and formula milk). Formula milk provides babies with the nutrients they need to grow and develop. But it does not have the same benefits as breastmilk for you and your baby. For example, it cannot protect your baby from infections (NHS, 2019a).

Is powdered or ready-made formula better?

Infant formula normally comes in two different forms: a dry powder that you mix with water, or a ready-to-feed liquid formula. You might hear that one is better than the other, but any difference between the two comes down to production methods and there is no evidence that any differences have any effect on your baby (First Steps Nutrition Trust, 2021).

Ready-made milks are more expensive and use more packaging. The source of ingredients used varies between manufacturers, and there might also be differences from batch to batch (First Steps Nutrition Trust, 2021).

Ready-made products are less likely to be halal-approved and this can also vary between product sizes. So always check each product label (First Steps Nutrition Trust, 2021).

What ingredients are in infant formula?

The majority of infant formula milks start with a base of cows' milk protein, although a few contain goats' milk protein. Lactose and other carbohydrates, vegetable, fish and other oils, vitamins and minerals are all added to the milk base (First Steps Nutrition Trust, no date).

The basic components of any infant milk, regardless of whether they're powdered or ready-made, are proteins, fats, carbohydrates, vitamins and minerals. The major infant formula producers develop their own brands with a combination of each of these components. You can see a full list of constituents on the packaging of infant formula milk for babies.

Which formula milk nutrients are best?

If a substance has proven benefits for your baby and can be added to infant formula, the law requires it to be added to all formula. So buying a more expensive brand of formula does not mean that your baby will grow or develop better than if you were buying a cheaper one. The basic nutritional profile of the majority of infant milks is actually very similar (First Steps Nutrition Trust, 2020; 2021).

In the UK, the ingredients in infant formula are strictly regulated and each manufacturer must follow strict national and EU guidelines on composition (Department of Health, 2013). Formula producers have to add formula milk components in accordance with the regulatory framework of the Infant Formula and Follow-on Formula Regulations 2007. They also have to comply with any relevant changes to those regulations and to regulations around foods for special medical purposes (First Steps Nutrition Trust, 2020).

Which formula milk is best?

The answer to this question is that there is no 'best' type of formula. For a healthy, full-term baby, it really doesn't matter which brand or type you choose. While manufacturers make different claims about their products, regardless of their cost, all brands have to meet the same nutritional and safety standards and have a relatively similar composition (First Steps Nutrition Trust, 2021).

First Steps Nutrition Trust is an independent organisation, which has more information here on the different brands of formula milk available in the UK and their ingredients. First Steps Nutrition Trust also has information on the claims about formula milks that manufacturers make.

Can I change the formula my baby has?

Traditionally, parents were advised to stick to one brand, but there's no good evidence that changing does any harm or good (NHS, 2019a). You can try different formulas to see which your baby might prefer in case the small variations in ingredients have an effect.

As manufacturers sometimes change ingredients slightly from batch to batch, it may be that one brand no longer agrees with your baby (NHS, 2019a).

A few babies may do better with a special formula instead of the regular kind. If you're worried your baby might be reacting to the formula you're using, your GP or health visitor should be able to advise you (NHS, 2021).

Is formula vegetarian or vegan?

Most formula, and all formula for babies under six months old, is made from animal milk protein. Information on suitable formulas is available here from First Steps Nutrition Trust.

Soya-based formulas are suitable for vegetarians, but are not recommended for babies under six months old except under medical supervision (NHS, 2019a). There are currently no infant milks suitable for vegans in the UK because even those without animal proteins contain vitamin D from sheep's wool (First Steps Nutrition Trust, 2021).

It is recommended that those who follow a vegan diet breastfeed throughout their baby's first year of life. They can move their children onto a non-animal milk at one year of age. Parents who want to bring up their children as vegans should seek medical advice to ensure their nutritional needs are being met (First Steps Nutrition Trust, 2021).

How does formula milk compare to breastmilk for my baby's health?

When formula is prepared safely, it provides babies with the nutrients they need to grow and develop (Martin et al, 2016). Yet formula milk cannot offer many of the same health benefits as breastfeeding, such as protection from infections and other illnesses. This is because breastmilk contains living cells, hormones and friendly bacteria, which change continuously to meet the baby's needs. And this cannot be replicated by a man-made process (First Steps Nutrition Trust, 2020).

Can I use formula and continue to breastfeed?

If you continue to breastfeed as well as feed formula, your breastmilk will continue to provide nutrition and protection to your baby (NHS, 2019c). Yet because milk supply is driven by frequent, effective breastfeeding, giving your baby formula can mean they breastfeed less often, so you make less milk. Read our article about mixed feeding to find out more.

You may find it useful to talk through your options with your midwife, health visitor or breastfeeding counsellor. You can contact one of our friendly and knowledgeable breastfeeding counsellors by calling our Infant Feeding Support Line on 0300 330 0700. They're open between 8am and midnight every day.

How do I make up powdered formula?

As powdered formula is not sterile, it is important that it's made up correctly each time, using boiled water that has cooled for no more than 30 minutes. To kill any bacteria within the powder, it is important that the water is at least 70⁰C (NHS, 2019a).

Safe preparation is key - all formula has to be made using the right amount of powder as diluting or using too much powder could make your baby unwell (NHS, 2019b). See our step-by-step guide to preparing baby formula and how to make up a bottle if you're out for more details.
This page was last reviewed in February 2022.
Further information

We support all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

For more detailed information on the different formula milks that are available, visit First Steps Nutrition Trust.

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What's the best kind of formula milk? | Baby & toddler, Feeding articles & support | NCT

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With so many different formula milk brands on the market, how do you know which one to choose for your baby? Are the more expensive ones better? Find out everything you need to know here.

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A simple guide to formula milks

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Advice from the Lullaby Trust to help you keep your baby safe.

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It is important to make sure that your baby is a comfortable temperature - not too hot or too cold. The chance of SIDS is higher in babies who get too hot. A room temperature of 16-20°C - with light bedding or a lightweight, well-fitting baby sleep bag- is comfortable and safe for sleeping babies.

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Welcome to this Padlet - it's full of information to help you if you are bottle feeding your baby.

Breastfeeding is the healthiest way to feed your baby. If you decide not to breastfeed or to stop breastfeeding, it is possible to restart. Giving infant formula to a breastfed baby will reduce your milk supply. Please contact the Infant Feeding Team on 01204 390423 if you need further support.

Each section is titled so you can easily find what you're looking for.

Scroll across to see all the sections.

Once you have the section you want, scroll down to click on the link that you want to watch or read.

If you have any concerns for yourself or your baby contact your midwife - this Padlet is not intended to replace advice from a Health Professional.

Padlet is not owned by Bolton NHS Foundation Trust - access to any third party website is at your own risk. Padlet may contain terms and privacy policies that are different from the Trust's.

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Tips to help you understand how your baby communicates

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Learning What Your Newborn Is Saying

My Language

Right from birth and well before your baby speaks their first words, they are communicating with you through their behaviour. This communication can be as clear as a good loud cry or as subtle as a slight movement of their eyebrow. Think of all your baby's movements, expressions and responses as phrases they use to communicate with you- the unspoken words of their first language. Watch for, observe and interpret the meaning of your baby's signals and cues and you will soon become familiar with what they are saying and get to know them very well.

Window Into My World

Your baby's cues are completely trustworthy and authentic responses giving you information about what care they need and what they like and dislike. Unlike adults, there is no discrepancy between the feeling and its expression. Your baby cannot mask their feelings so what you observe you can trust unconditionally.

My Favourite Toy

Your baby not only knows your face and voice but also loves nothing more than connecting with you when they are in a quiet and alert state. They are much more engaged with your expressions and slow directed speech than they are in a toy. Have your face at a distance of around 10-18 inches. They will enjoy following your face and finding your voice- see their inborn hunger to connect with you.

Watch and Wait

When your baby's eyes are heavy or flicker open and closed, they are in a kind of 'no man's land' between sleep and wakefulness. As much as you would love to play, your baby is asking for you to wait for them during this transitional state. You will soon see if they are going back to sleep or ready to wake up.

Do Not Disturb

At this early stage, your baby will sleep for long periods in the day as they grow and develop rapidly. Your baby has an amazing ability to selectively tune out sounds and bright lights to preserve their sleep. They also appreciate your support in minimising disturbances in the environment.

Learning Emotions

Your baby feels validated and learns to understand how different emotions feel when you reflect those for them. When they have bright smiling eyes, beam back at them. When they are upset show them you sympathise with what is bothering them are ready to help.

Clever Me

Along with support from you, your baby has amazing inbuilt abilities to help himself/herself stay calm and organised; especially if they are beginning to feel a little overwhelmed from the environment and stimulation around them. Admire how focusing in on an object or the rhythmic suck of their hand calms them.

Grow My Brain

Your baby is exquisitely sensitive to your touch, words and affirmation. Every loving response and every social experience will leave imprints on their brain, major transformations at this time of rapid brain development. When your baby is in a quiet, alert state, take every opportunity to interact. You will be deepening their sense of security and laying the foundations of a relationship that will last a lifetime.

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Learning What Your Newborn Baby Is Saying - Brazelton Centre UK

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Right from birth and well before your baby speaks their first words, they are communicating with you through their behaviour. This communication can be as clear as a good loud cry or as subtle as a slight movement of their eyebrow.

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Useful information for co-sleeping with your baby. Many parents find themselves co-sleeping whether they mean to or not. Wherever you’re planning for your baby to sleep we recommend making your bed a safer place for baby.

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

When not to co-sleep

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

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

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

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

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

Never leave your baby unattended in an adult bed

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

Co-sleeping with your baby: FAQs

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

Click here to open this question

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

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

Should I co-sleep with my baby?

Click here to open this question

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

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

Can I co-sleep with twins or multiples?

Click here to open this question

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

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

Click here to open this question

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

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

Click here to open this question

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

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

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

Click here to open this question

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

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

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

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

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

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Technique to help baby’ gas up and out. The shape of the stomach means that if you tilt baby to their left on your right shoulder gas escapes more easily as a burp.

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Shel Banks IBCLC Infant Feeding Specialist

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Technique for getting gas out of the baby's stomach

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Intuitive Bottle Feeding for Breastfed Babies

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It is best to avoid giving bottles to a breastfed baby as this can affect their eagerness to breastfeed. Giving formula to a breastfed baby will reduce your milk supply.

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Intuitive Bottle Feeding for Breastfed Babies

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You can attend a free 10 week parenting course to help you understand your baby's behaviour and development if you live in Bolton

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Empowering Families Through Peer Support

Our Parenting Groups are designed for parents who would like a better understanding of responsive and effective parenting techniques.

The Solihull Approach serves as the foundation for this program. For more information on about The Solihull Approach, please click HERE

About the groups

Each Solihull Approach Parenting Group consists of 10 sessions, and lasts for two hours.

Each week we'll cover a different topic and there will be discussion, activities and hopefully some fun as we develop our understanding of parent-infant relationships and gain new ways of thinking, strategies, and skills.

The groups are open to all families living in Bolton with children under the age of 3 years, who would like to have a better understanding of responsive and effective parenting techniques. You do not need to be experiencing difficulties or your child experiencing behavioural problems to attend. The goal of the groups is to establish a framework for understanding parent-child relationships, that can be made into a lifelong skill we can use both now and in the future!

What we'll Cover:

Introduction to Understanding your child's behaviour

How are you and your child feeling?

Tuning in to your child's development

Responding to your child's feelings

Different styles of parenting

Parent-child partnership - having fun together

The rhythm of interaction and sleep

Self regulation and anger

Communication and attunement

Reflecting on and celebrating our progress

You can book your place by clicking HERE or by calling 07514 484157

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Our Parenting Groups are designed for parents who would like a better understanding of responsive and effective parenting techniques. The Solihull Approach serves as the foundation for this program. For more information on about The Solihull Approach, please click HERE About the groups https://videopress.com/v/4HQpCMcT?resizeToParent=true&cover=true&preloadContent=metadata&useAverageColor=true Each Solihull Approach Parenting Group consists of 10 sessions, and lasts...

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Information for parents who use formula to feed their babies

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Information for parents who use formula to feed their babies

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QR code links to evidence based resources on formula feeding

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If you stopped breastfeeding before you wanted to or have changed your mind this information may be useful. You can also be referred to an Infant Feeding Specialist through your Health Visitor or Midwife.

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Ewan McGregor reads 'Baby, I Love You'

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Watch the video for a guide to paced bottle feeding - this is useful for all babies who are bottle fed, either partly or fully.

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This leaflet may help you to cope with your baby's crying and keep them safe

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Having your baby in a sling is a great way to keep them calm and close. You can get advice and help from the Sling Library.

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Here is some advice for the times when you find your baby's crying challenging

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Who we are

In 1981 a small group of parents, who were experiencing problems with their crying and sleepless babies, set up a support group. They discovered how important support is and how reassuring it can be to talk to someone. Today that support group has become Cry-sis, the only UK charity offering help and support to parents with babies who cry excessively or have sleeping problems. From modest beginnings Cry-sis has become a well-respected national charity which:

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Support For Crying And Sleepless Babies | Cry-sis

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Cry-sis, the only UK charity offering help and support to parents with babies who cry excessively or have sleeping problems. Call the helpline now...

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Why Skin to skin is important and how to do this safely

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Why Skin to Skin is important and how to do this safely

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Why Skin to Skin is important and how to do this safely

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Why Skin to Skin is important and how to do this safely

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Why Skin to Skin is important and how to do this safely

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Why Skin to Skin is important and how to do this safely

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Why Skin to Skin is important and how to do this safely

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Why Skin to Skin is important and how to do this safely