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Guide for parents who formula feed - Baby Friendly Initiative

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This simple, concise guide provides parents who are formula feeding with an overview on how to choose infant formula, and how to bottle feed as responsively as possible to help develop a close and loving relationship with your baby.

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NCT Breastfeeding Line 0300 330 0771
NHS Breastfeeding Line 0300 100 0212

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How to help your baby attach and breastfeed | Baby & toddler, Feeding articles & support | NCT

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Many people assume breastfeeding just comes ‘naturally’ but it’s a learning process for many mums and babies. Here are our tips on getting the hang of it…

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Below are a range of useful resources for parents on infant feeding and relationship building, as well as information on overcoming common breastfeeding challenges.

Overcoming breastfeeding problems

You may find whilst trying to establish breastfeeding that you run into problems. Whilst these can be debilitating and painful, thankfully the most common ones can be solved relatively quickly and easily - given the right support.

Unfortunately, support is often not available or, what is worse, mothers are told that problems such as engorgement and sore nipples are a normal part of breastfeeding. This is not true.

Below you can read about how different problems develop, how to spot them at a early stage, and how to solve them by yourself or with the support of a health professional.

There are various mother support groups which offer infant feeding support:

Find more useful organisations.

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. You do not need to eat any special foods while breastfeeding, but it is a good idea for you, just like everyone else, to eat a healthy diet.

Resources to support you

Below is a selection of resources to support you with feeding, caring, and building a close and loving relationship with your baby.

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Support for parents - Baby Friendly Initiative

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You may find whilst trying to establish breastfeeding that you run into problems. Whilst these can be debilitating and painful, thankfully the most common ones can be solved relatively quickly and easily - given the right support.

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When it comes to breastfeeding, you might wonder what you can do to support your partner and baby. The truth is you can make a huge difference.

Did you know that a mum is more likely to choose to breastfeed if she's sure her partner is positive about it? And if she does decide to breastfeed, she's much more likely to have a good experience and manage any difficulties if her partner supports her decision (Tohotoa, 2009; Rempel, 2011). A partner's emotional support is so important for helping mums to breastfeed for longer too (Tohatoa et al, 2009; Su, 2016).

Why is breastfeeding important?

If your partner is breastfeeding your baby - or planning to - that's fantastic because breastmilk has so many benefits for babies. For instance, breastmilk can help to reduce the risk of your baby getting infections and diseases (NHS, 2017). It also contains hormones that help your baby's development (Victora et al, 2016).

Overall, breastfeeding will have a positive impact on your baby's health. What's more, it can influence their health as an adult too (Victora et al, 2016).

Is breastfeeding hard or will my partner just know what to do?

Many parents see breastfeeding as a natural process but it can take time for mum and baby to learn this new skill together. It might take around six weeks to get the hang of it fully (NHS, 2016).

The good news is that with the right support, your partner can overcome any challenges and continue breastfeeding if she wants to. If you think your partner needs more information, support or just someone to talk to, why not give one of our trained breastfeeding counsellors a call on our support line: 0300 330 0700. The line is open every day from 8am to midnight, including bank holidays.

You might find it helpful to read up about breastfeeding and attend a breastfeeding session before your baby is born. This can help you know what to expect and perhaps give you a little more confidence. It can also help you both talk about feeding your baby and raise any questions or worries you might have.

What do I need to know about breastfeeding?

You might find it helpful to know how breastfeeding works and what normal behaviour is for breastfed babies. Here are a few quick and handy facts:

Babies are happier if they're fed as soon as they show signs of being hungry.

Babies usually feed frequently (anything from eight to 12 times or more in 24 hours) in the early weeks, especially during the evenings.

Some babies are slow feeders at first, but they get quicker as they get older.

The more a baby feeds, the more milk their mum makes because it's the removal of milk that drives the production of it.

The Department of Health recommends exclusive breastfeeding for at least your baby's first six months. Breastfeeding is also beneficial for toddlers because it gives them a health boost every time they feed. So your partner can breastfeed your baby for as long as they both want to.

Nipple soreness or pain during feeding might be a sign that a baby needs some adjustment to their attachment at the breast. If there is soreness or pain when breastfeeding, talking to a healthcare professional or breastfeeding counsellor can help.

Women enjoy feeding more when they are comfortable and relaxed.

(Department of Health, 2011; La Leche League, 2016; NHS, 2016)

What can I do to help support my partner with breastfeeding?

There are lots of things you can do to support and encourage breastfeeding.

Here are 10 tips:

1. Boost your partner's confidence by encouraging her and being positive about her progress. As with learning any new skill, reassurance and praise are a massive help.

2. Listen and talk honestly about how you each feel about finding your way with your new baby.

3. Be involved with your baby in other ways so that the caring is shared (see below).

4. Help to reduce the household chores so your partner can feed your baby for as long and as often as they need.

5. Try to help your partner to relax by giving them a massage.

6. Women don't need to eat anything special while breastfeeding, but it's a good idea to encourage your partner to eat and drink regularly.

7. Help her get specialist support if she's struggling with breastfeeding. As mentioned above, you can both talk to one of our breastfeeding counsellors on 0300 330 0700.

8. Help out by bottle feeding your baby expressed milk once your partner and baby have got the hang of breastfeeding (see below).

9. Accept your partner's decision on when to stop breastfeeding.

10. Try to remember that with your support, breastfeeding can quickly become just another part of your family life.

(Rempel et al, 2010)

What practical support can I give to my baby if my partner is breastfeeding?

You might expect to feel like a bit of a spare part with feeding but it's good to remember that each parent plays a different and vital role. The decision on how you feed your baby is certainly a joint one (deMontigny et al, 2018). It might take a while to get used to the different parts you play though.

Whatever you decide to do, you might actually find feeding is less important to you than you expected anyway. Especially if you're hands-on with your baby in different and rewarding ways.

Tips for being a hands-on partner with your baby

Changing nappies and generally caring for your baby - it's great if you can spend time with your baby and interact (see below) with them while you're looking after them.

Bathing your baby - you could bath your baby or even have a bath with your baby. You'll both enjoy the bonding benefits of skin-to-skin contact and one-to-one time together (NHS, 2018).

Talking and playing - babies enjoy hearing gentle sounds. They even recognise the muffled tones of people talking from their time in the womb and they'll be aware of familiar voices like yours (Lee and Kisilevsky, 2013). So a chat with your baby might be a little one-sided but rest assured, they know it's you. Socially interacting with your baby through their senses helps to stimulate their brain development; for example, you could pull some different expressions (Boucenna et al, 2010).

Baby carrying - this means taking your baby out and about in a sling. It can be a rewarding and comforting experience for both you and your baby (Miller, 2019).

For more ideas on being a hands-on parent, see our article about bonding with and getting to know your baby.

How can I share feeding our baby?

If you're keen to feed your baby, you could give them expressed breastmilk from a spoon, syringe, cup or a bottle. But only introduce your baby to a bottle once breastfeeding is going well. For more on expressing, see our 10 bottle feeding tips for breastfed babies article.

And once your baby's moved on to solid food, there are so many ways you can get involved with that...chopping, mashing, cleaning up all the food that ends up on the floor...

I want to support breastfeeding but will it affect our sex life?

Possibly, but tiredness - and your partner's birth experience and recovery - is more likely to affect their sex drive rather than breastfeeding (Rowland et al, 2005). See our article about breastfeeding and sex for more details.

What if I feel uncomfortable about my partner breastfeeding in public?

If you're feeling uncomfortable or nervous about your partner breastfeeding in public, have a chat with her so you can talk it through. Maybe you're worried about your partner showing her breasts in public? Yet in reality, very little breast actually shows when a baby is feeding. You might have even seen a mum breastfeeding before without realising it.

It might also help to talk to other families where the mum is breastfeeding and find out about both partners' experiences of it. The chances are, you'll change your mind as you get used to seeing breastfeeding.

It's good to know that breastfeeding in public is protected by the law under the Equality Act 2010. That means providers of any services or facilities open for the public are not allowed to discriminate against women who are breastfeeding (Maternity Action, 2019).

Many places now welcome breastfeeding and have special facilities for mums if they'd prefer to feed in private.

Some mums might feel uncertain themselves about feeding in public at first and may appreciate the reassurance of having their partner with them.

At the end of the day...

Don't underestimate the huge difference you can make if your partner is breastfeeding. With you both on board, breastfeeding can quickly become an everyday part of your lives (Rempel, 2011).
This page was last reviewed in October 2017.
Further information

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

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.

Visit our breastfeeding support contacts page.

NHS Choices breastfeeding information.

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

Health Talk has some interesting videos about different people's experiences of breastfeeding, click here to view them.

Boucenna S, Gaussier P, Andry P, Hafemeister L. (2010) Imitation as a communication tool for online facial expression learning and recognition. 2010 IEEE/RSJ International Conference on Intelligent Robots and Systems, Taipei: 5323-5328. Available at: https://ieeexplore.ieee.org/abstract/document/5650357 (Accessed 1st July 2018)

deMontigny F, Gervais C, Larivière-Bastien D, St-Arneault K. (2018) The role of fathers during breastfeeding. Midwifery. 58:6-12. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29272696 (Accessed 1st July 2018)

Department of Health. (2011) Breastfeeding. Available at: http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Publichealth/Nutrition/Nutritionpregnancyearlyyears/DH_127625 (Accessed 1st July 2018)

La Leche League. (2016) Still nursing? Available at: https://www.laleche.org.uk/still-nursing/ (Accessed 1st July 2018)

Lee GY, Kisilevsky BS. (2013) Fetuses respond to father's voice but prefer mother's voice after birth. Dev Psychobiol. 2014 Jan;56(1):1-11. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23817883 (Accessed 1st July 2018)

Miller R. (2019). Babywearing education in the neonatal intensive care unit. The International journal of childbirth education: the official publication of the International Childbirth Education Association. 34. 43-47. Available at: https://www.researchgate.net/publication/334151320_Babywearing_Education_in_the_Neonatal_Intensive_Care_Unit (Accessed 1st July 2018)

NHS. (2016) How to combine breast and bottle feeding. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/combining-breast-and-bottle/ (Accessed 1st July 2018)

NHS. (2017) Benefits of breastfeeding. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/benefits-breastfeeding.aspx (Accessed 1st July 2018)

NHS. (2018) Washing and bathing your baby. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/washing-your-baby/ (Accessed 1st July 2018)

Rempel LA, Rempel JK. (2010) The breastfeeding team: the role of involved fathers in the breastfeeding family. J Hum Lact. (2):115-21. Available at: http://journals.sagepub.com/doi/abs/10.1177/0890334410390045 (Accessed 1st July 2018)

Rowland M, Foxcroft L, Hopman WM, Patel R. (2005) Breastfeeding and sexuality immediately post partum. Can Fam Physician. 2005 Oct;51:1366-7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479788/ (Accessed 1st July 2018)

Su M, Ouyang YQ. (2016) Father's role in breastfeeding promotion: lessons from a quasi-experimental trial in China. Breastfeed Med. 11:144-9. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26836960 (Accessed 1st July 2018)

Tohotoa J, Maycock B, Hauck Y, Howat P, Burns S, Binns C. (2009) Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. Int Breastfeed J. 4:15. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788531/ (Accessed 1st July 2018)

Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC; Lancet Breastfeeding Series Group. (2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 387(10017):475-90. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26869575 (Accessed 1st July 2018)

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How can dads and partners support breastfeeding?

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When it comes to breastfeeding, you might wonder what you can do to support your partner and baby. The truth is you can make a huge difference. Did you know that a mum is more likely to choose to breastfeed if she's sure her partner is positive about it?

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Over the course of her breastfeeding journey, it is almost inevitable that a mother will encounter the terms "foremilk" and "hindmilk". There is certainly no shortage of confusing and conflicting advice on the concept, which has led to a lot of misunderstanding.

In The Breastfeeding Answer Book, "foremilk" and "hindmilk" were defined as follows:

"Foremilk" is the milk the baby receives when he begins breastfeeding, which is high in volume but low in fat (1).

"Hindmilk" is the milk near the end of the feeding, which is low in volume but high in fat (1).

Actually, the terms "foremilk" and "hindmilk" only really refer to samples of breastmilk taken right at the beginning of a feed ("foremilk") and samples of breastmilk taken right at the end of a feed ("hindmilk"). Even then, the advantage of using these terms is debatable. A photo on

Why?

Wikipedia "helpfully" shows two 25ml samples of human breastmilk: "foremilk" on the left and "hindmilk" on the right:

The problem with showing a sample of breastmilk from the start of a feed together with a sample of breastmilk from the end of a feed is that it tells us nothing about what happens to the breastmilk in between the two samples. Mothers end up mistakenly believing that their breasts make two different types of milk, and wonder how long they must feed for before the "foremilk" magically switches over into "hindmilk" (2).

So if the terms "foremilk" and "hindmilk" are misleading and there's no "magic switch" from one to the other, what really happens?

Since The Breastfeeding Answer Book was published in 2003, research in human lactation has advanced (2), so we now understand more about how breastmilk is produced:

Your breasts make just ONE type of milk

There is no magic switch between two different types of milk over the course of a feed. In fact, The answer lies in what happens to the
there is no sharp distinction between breastmilk at the start of a feed and breastmilk at the end of a feed (3). "Milk does indeed change consistency during a feed - but this happens gradually rather than suddenly" (4).

Why does the consistency of breastmilk change over the course of a feed?

fat in breastmilk when breastmilk is

Your breasts are continuously making just one type of milk, containing 'sticky' fat globules that tend to stick to each other and to the milk ducts in the breast as breastmilk is produced (2,3,5).

Breastmilk produced between feeds moves down towards the nipple and collects in the breast, leaving increasing amounts of fat globules 'stuck' together further up the milk ducts (3).

When let-down occurs, the milk ducts dilate (5) and the milk is ejected from the breast. The milk removed at the beginning of a feed may be lower in fat because the fat globules are still 'stuck' further up in the milk ducts (6). As the feed progresses, multiple milk ejections occur (5) and the breast is emptied, more and more fat globules become dislodged and the breastmilk increases in fat (3,6). This has the overall effect of a gradual increase in fat content of breastmilk in each breast independently as milk is removed.

How do we know that the increase in fat is gradual?

Studies involving several mothers have been conducted in which samples of breastmilk were taken at intervals over the course of a feed. The evidence from these studies suggests that the fat content of breastmilk increases gradually as the breast becomes progressively emptier over the course of a feed (7,8).

It's much easier to explain this gradual increase in fat content using pictures...

...so, revealing the crazy lengths I'm prepared to go to so I can prove a point, I visited The Countess of Chester Hospital, where several wonderful people enabled me to take consecutive small samples of breastmilk from one breast only over the course of one pumping session, and professionally photograph the results. The samples were then taken to the Cheshire and North Wales Human Milk Bank, where the fat content of each sample was analysed.

This is the snapshot we got of the gradual increase in fat content of my milk over the course of one pumping session:

Note the gradual colour change of each breastmilk sample. This is the gradual increase in fat content from the beginning of a feed (test tube 1) to the end of a feed (test tube 12).

Remove test tubes 2-11, and the result is a picture similar to the one on Wikipedia:

This shows a sharp contrast between the breastmilk at the When breastmilk is left to stand for a while, it separates into two layers. This very beginning and the breastmilk at the very end of a feed only - it tells us nothing about what happens to the breastmilk in between the two samples. Only the photo containing all 12 test tubes shows the complete picture: a gradual increase in fat content.

isn't the separation of "foremilk" from "hindmilk"; it is simply the fat in the milk rising to the top, not the separation of two different kinds of milk (4).
So what's that stuff that rises to the top of expressed breastmilk?

The reason this separation doesn't occur in a bottle of cow's or goat's milk you buy in a shop is that this milk has been homogenised. "

Whole homogenised milk is identical in fat and nutrient content to whole standardised milk however it has undergone a process known as "homogenisation" which breaks up the fat globules in the milk. This spreads the fat evenly throughout the milk and prevents a creamy layer forming at the top." (9)

After a while, the breastmilk in our test tubes separated into two layers (click on the image to open a larger version in a new window):

Again, removing test tubes 2-11 shows
Note that the breastmilk in test tube 1 does, in fact, contain a layer of fat.

Note also the increasing thickness of the fatty layer that collects at the top of the breastmilk from test tubes 1-12. This further demonstrates a gradual increase in fat content from the beginning of a feed (test tube 1) to the end of a feed (test tube 12).

only a sharp contrast between the thin fatty layer that rises to the top of the breastmilk at the very beginning, and the much thicker fatty layer that rises to the top of the breastmilk at the very end of a feed.

This photo tells us Before I continue, I must stress that this is just a snapshot of
nothing about what happens to the breastmilk in between the two samples. Remember: only the photo containing all 12 test tubes shows the complete picture: a gradual increase in fat content.

Showing us pretty pictures is nice, but how much fat did the breastmilk samples actually contain?

my breastmilk. It is unlikely that the results shown here will be an exact reflection of what happens to every mother's breastmilk. However, it does provide a rough idea of what happens, so here are the results of the analysis of each sample of my breastmilk:

If looking at raw data isn't your thing, here's a line
TS = Total Solids, ie. the bulk of the rest of the milk
Protein, carbohydrate, fat and TS values are in grammes per 100ml

graph showing the amount of protein, fat, carbohydrates and total solids present in each of my 12 breastmilk samples (fat content is shown in red).

The graph clearly shows there was a gradual (if slightly wobbly) increase in fat content as the breast is emptied. Quite plainly, there is no arbitrary "magic switch" between two different types of breastmilk during a feed.

Remember, though, that all of this is just a tiny piece in a vast breastfeeding jigsaw...

Although it is true that the fat content does gradually increase as the breast is emptied, it is important to understand that the difference in fat content between milk at the beginning of a feed and milk at the end of a feed can vary greatly from mother to mother. Not only this, but it can vary greatly over a 24 hour period, even among individual mothers (2). The difference in fat content can also depend to some degree on the amount of time elapsed between each feed (this is truer the younger the baby is) - another reason why it might not be a good idea to wait for your breasts to "fill up" before a feed.

the higher the fat content of the milk

the lower the difference in fat content between the breastmilk at the beginning and end of a feed (2,3)

This is not simply a case of the longer the feed, the higher the fat content: if there is a shorter gap between feeds (such as during periods of cluster feeding), the milk at the beginning of a feed may not necessarily be low in fat (2,10).

"Babies can show a wide variety of feeding patterns, suckling for varying lengths of time and at varying intervals over the course of a day, and maintain a healthy weight" (4,10)

Whilst fat is important, we can and do get far to preoccupied with the issue of fat content - take another look at the graph showing the amount of protein, fat, carbohydrates and total solids present in each of my 12 breastmilk samples:
The most important thing to remember is this:
In the vast majority of cases, as long as you are:

breastfeeding on cue

and allowing your baby to come away from the breast spontaneously at the end of a feed,

there is no need to worry about what's in the breastmilk your baby is getting. ALL of the components of breastmilk are essential for the growth and the physical and mental development of your baby, not just its fat content.

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If you liked this article, please consider making a small donation to Cheshire and North Wales Human Milk Bank (a charity which does a fantastic job of getting breastmilk to our most vulnerable babies), without whom this article could not have existed.

Lynda Coulter (Cheshire and North Wales Human Milk Bank) for very kindly agreeing to analyse the samples of my breastmilk.

Janet Beech and Linda Gendler (Cestrian Ward, The Countess of Chester Hospital) for entertaining my mad idea and helping to co-ordinate the experiment.
Becca Williamson (Bosom Buddy breastfeeding peer supporter) for being my extra pair of hands.

Jenni Ross (Medical Photography, The Countess of Chester Hospital) for taking such excellent photos of my breastmilk samples. This article has been republished as a guest blog on
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Acorn Pack
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Foremilk and Hindmilk: In Quest of an Elusive Arbitrary Switch.

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Over the course of her breastfeeding journey, it is almost inevitable that a mother will encounter the terms "foremilk" and "hindmilk". There is certainly no shortage of confusing and conflicting advice on the concept, which has led to a lot of misunderstanding.