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Free Online Preparing to Feed Your Baby Workshop - Southwark

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Free Online Preparing to Feed Your Baby Workshop - Southwark

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Effective July 27th - September 4th 2026

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Summer Infant Feeding Support - Lambeth & Southwark 

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Summer Infant Feeding Support - Lambeth & Southwark 

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FINAL Lambeth and Southwark Infant Feeding Summer Timetable

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Southwark & Lambeth online antenatal class - Preparing to Feed Your Baby

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Southwark & Lambeth online antenatal class - Preparing to Feed Your Baby

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Donor Human Milk and Milk Kinship - a guide for Muslim parents

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By Kelly Bonyata, IBCLC

Specific guidelines

Jewish law exempts from fasting anyone whose health might be even a little harmed by it - this would include pregnant and nursing women whose health (or the health of her baby or fetus) might suffer from fasting. There may be ways of eating and drinking small increments that are still compatible with fasting. However, a local competent Orthodox rabbinic authority should be consulted so that the method and amounts of eating and drinking will be done within the correct guidelines.

Muslim women who are pregnant or breastfeeding may be exempt from fasting if they feel that their health or the baby's health would be negatively affected by the fasting. The mother may be expected to compensate for the missed fasting at a later time or pay some expiation for not fasting. Consult a scholar or a book of fiqh to determine the appropriate guidelines.

Roman Catholic mothers who are pregnant or breastfeeding are excused from fast or abstinence "according to need for meat or nourishment." - from Catholic.org

"[ Latter-day Saint] nursing mothers may do well to skip fasting. And there are others with special situations, temporary or permanent, who should not fast." - from LDS.org

"The [ Bahá'í] Faith exempts from fasting those who are ill, elderly, traveling, pregnant, nursing, menstruating or engaged in heavy labor." - from Bahai.us

"The [ Orthodox Christian] Church has always exempted small children, the sick, the very old, and pregnant and nursing mothers from strict fasting." - from The Fasting Rule of the Orthodox Church

How does fasting affect the breastfeeding mother and child?

Breastfeeding research tells us that short-term fasting (not eating) will not decrease milk supply, but that severe dehydration can decrease milk supply. Fasting does affect the biochemical/nutrient content of breastmilk to a certain extent.

There have been a few studies on fasting and breastfeeding (see the references below). Zimmerman et. al. (2009) tested the milk of Israeli women before and after religious fast days and found a number of biochemical changes in the milk associated with fasting 24+ hours. Studies in the United States by Neville et. al. (1993), Neville & Oliva-Rasbach (1987) and Tigas et. al. (2002) likewise showed no significant decrease in milk supply after a short fast (the women in these studies did drink water during the fast). The breastfeeding woman's body appears to make several metabolic adaptations during short-term fasting to ensure that milk production is not affected.

Rakicioğlu et. al. (2006) studied mothers with babies aged 2-5 months who fasted during Ramadan (no food or fluids between 5:00 am and 7:30 pm). They found that although infant growth and macronutrient content of breastmilk was not affected, levels of several nutrients in breastmilk (zinc, magnesium and potassium) decreased and the nutritional status of the breastfeeding mothers was affected. These authors noted that "it would seem prudent to excuse lactating women from fasting during Ramadan." Prentice et. al. (1983) studied women in West Africa who were fasting for Ramadan and found that milk volume was not affected but milk composition did change to a certain extent. The researchers noted that the women appeared to superhydrate themselves overnight when fluids were allowed to lessen daytime dehydration.

Mothers may want to err on the safe side, and drink water even if they are not eating. There are two risks to not drinking all day: (1) mom gets dehydrated, and (2) if the dehydration is severe enough milk supply can decrease. Mom's dehydration is comparatively easy to deal with - if she feels thirsty (or urine gets very yellow, or she feels dizzy or ill) she needs to drink. The decrease in milk supply related to dehydration may be a bigger issue for some fasting mothers - some mothers have a hard time getting supply back up (this is often seen in mothers who don't eat or drink due to illness). When a mother does not drink fluids for a day, baby generally nurses as usual the day of the fast, but often needs to nurse more often the next day or two.

Some mothers have found that drinking water on fast days is more of a need during the first six months when baby is exclusively breastfed (not taking any food or drink other than breastmilk); once baby is older and taking other foods, it may be feasible to neither eat nor drink during the fast.

Keep in mind that mothers who have sugar metabolism problems (diabetes or hypoglycemia) or other health problems, fasting could be risky (for mom). Consult both your doctor and your religious advisor if you feel that you might have health issues that preclude fasting.

Additional information and references

Pregnancy, Nursing, and Ramadan by Stacey Greaves-Favors

Breastfeeding during Ramadan by Dr. Naomi Mirza, Medical Specialist at maya.com.bd

Fasting According to Five Islamic Schools of Law by 'Allamah Muhammad Jawad Maghniyya

Advice to pregnant and breastfeeding mothers from Islamweb

Fasting for pregnant women and breastfeeding mothers from Principles of Fiqh at islamqa.info

Fascinating research on Ramadan fasting gives breastfeeding mothers 'food for thought' from the Sharjah Baby Friendly Emirate Campaign (2012)

Breastfeeding and Fasting from BabyCenter UK

Fasting on Yom Kippur During Pregnancy by Hannah Katsman

Breastfeeding and Jewish Law from the Nishmat Women's Online Information Center (includes some Q&As on fasting)

Eidelman AL. Fasting and the Nursing Mother: A Jewish Law (Halachic) Perspective. ABM News and Views. 1998;4(3).

Straight from the Heart: A Torah Perspective On Mothering Through Nursing by Tehilla Abramov

Fasting and Abstinence in the Roman Catholic Church, by Colin B. Donovan, STL

Fasting and Latter-day Saints: " Frequently we hear how beneficial it is to fast. Is it ever harmful to fast, and especially to go without water? " by Brother Lindsay R. Curtis, M.D.

The Bahá'í Fast from bahai.us

The Fasting Rule of the Orthodox Church from abbamoses.com

Mazidi M, Rezaie P, Nematy M. The Effects of Ramadan Fasting on Growth Parameters: A Narrative Review. Journal of Fasting and Health. 2014;2(1):41-45.

Haratipour H, Sohrabi MB, Ghasemi E, Karimi A, Zolfaghari P, Yahyaei E. Impact of maternal fasting during Ramadan on growth parameters of exclusively breastfed infants in Shahroud, 2012. Journal of Fasting and Health. 2013;1(2):66-69.

Bajaj S, Khan A, Fathima FN, et al. South Asian consensus statement on women's health and Ramadan. Indian J Endocrinol Metab. 2012;16(4):508-11.

Kridli SA. Health beliefs and practices of Muslim women during Ramadan. MCN Am J Matern Child Nurs. 2011 Jul-Aug;36(4):216-21; quiz 222-3.

Zimmerman DR, Goldstein L, Lahat E, Braunstein R, Stahi D, Bar-Haim A, Berkovitch M. Effect of a 24+ hour fast on breast milk composition. J Hum Lact. 2009 May;25(2):194-8.

Khodel A, Kheiri S, Nasiri J, Taheri E, Najafi M, Salehifard A, Jafari A. Comparison of Growth Parameters of Infants of Ramadan Fasted and Non-Fasted Mothers. Iranian Journal of Endocrinology and Metabolism. 2008;10(2):155-161.

Khoshdel A, Najafi M, Kheiri S, Taheri E, Nasiri J, Yousofi H, Jafari A. Impact of Maternal Ramadan Fasting on Growth Parameters in Exclusively Breast-fed Infants. Iranian Journal of Pediatrics 2007. 17(4):345-352.

Rashid H. Ramadan Fasting And Breast Milk. Breastfeeding Medicine. 2007 Mar;2(1):59-60. doi: 10.1089/bfm.2006.0021.

Rakicioğlu N, Samur G, Topçu A, Topçu AA. The effect of Ramadan on maternal nutrition and composition of breast milk. Pediatr Int. 2006 Jun;48(3):278-83.

Tigas S, Sunehag A, Haymond MW. Metabolic adaptation to feeding and fasting during lactation in humans. J Clin Endocrinol Metab. 2002 Jan;87(1):302-7.

Beneremail A, Galadari S, Gillett M, Osman N, Al-Taneiji H, Al-Kuwaiti MHH, Al-Sabosy MMA. Fasting during the holy month of Ramadan does not change the composition of breast milk. Nutrition Research. 2001Jun;21(6):859-864.

Ertem IO, Kaynak G, Kaynak C, Ulukol B, Gulnar SB. Attitudes and practices of breastfeeding mothers regarding fasting in Ramadan. Child Care Health Dev. 2001 Nov;27(6):545-54.

Neville MC, Sawicki VS, Hay WW Jr. Effects of fasting, elevated plasma glucose and plasma insulin concentrations on milk secretion in women. J Endocrinol. 1993 Oct;139(1):165-73.

Hamosh M, Dewey KG, Garza C, et al: Nutrition During Lactation. Institute of Medicine, Washington, DC, National Academy Press, 1991, p. 92. This book is available free from the HRSA Information Center.

Neville M, Oliva-Rasbach J. Is maternal milk production limiting for infant growth during the first year of life in breast-fed infants? p. 123-133 in Goldman AS, Atkinson SA, Hanson LA, eds. Human Lactation 3: The Effects of Human Milk on the the Recipient Infant. Plenum Press 1987, New York.

Prentice AM, Lamb WH, Prentice A, Coward WA. The effect of water abstention on milk synthesis in lactating women. Clin Sci (Lond). 1984 Mar;66(3):291-8.

Prentice AM, Prentice A, Lamb WH, Lunn PG, Austin S. Metabolic consequences of fasting during Ramadan in pregnant and lactating women. Hum Nutr Clin Nutr. 1983 Jul;37(4):283-94.

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Religious Fasting and Breastfeeding * KellyMom.com

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By Kelly Bonyata, IBCLC Jewish law exempts from fasting anyone whose health might be even a little harmed by it - this would include pregnant and nursing women whose health (or the health of her baby or fetus) might suffer from fasting. There may be ways of eating and drinking small increments that are still compatible with fasting.

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If you’re generally healthy, and perhaps feeding an older baby or child, it might be fine to do your usual fast

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Breastfeeding Support in different languages 

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Breastfeeding Support in different languages 

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Multi-lingual Infant Feeding Padlet

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Breastfeeding in the biological nurturing position | Breastfeeding

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South Warwickshire University NHS Foundation Trust

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Infant Feeding Classes at Kings College Hospital

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Infant Feeding Classes at Kings College Hospital

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Copy of Infant Feeding workshop - Denmark Hill

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Specialist and evidence-based infant feeding advice from King’s College Hospital maternity. Learn about your options for feeding your baby.

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Do you often find yourself wondering how long your baby should sleep? We explain baby sleep patterns, baby sleep cycles and what to expect…

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Cows Milk Protein Allergy and breastfeeding

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Cows Milk Protein Allergy and breastfeeding

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This information can also be viewed as a PDF by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.

Feeding with artificial formula in the first 4-6 months of life increases the risk to cow's milk protein allergy (CMPA) compared to exclusive breastfeeding (Vandenplas et al 2007)

0.5% of exclusively breastfed infants show reactions to cow's milk protein compared to 2%-7.5% of formula fed infants. (Vandenplas et al 2007)

If a breastfed baby is thought to have CMPA the mother should eliminate all sources of cow's milk from her own diet as well as that of her baby for a minimum of 3 weeks. Although improvement may be seen after 3 days it may not resolve for 4 weeks (Ludman et al 2013)

A breastfeeding mother who is on a diet free of cow's milk protein she should be prescribed a supplement of 1000 mg of calcium and 10 microgramme of vitamin D every day. (Ludman et al 2013)

Cows' milk allergy can often be recognised and managed in primary care. Patients warranting a referral to specialist care include those with severe reactions, faltering growth, atopic comorbidities, multiple food allergies, complex symptoms, diagnostic uncertainty, and incomplete resolution after cows' milk protein has been excluded (Ludman 2013).

Cow's milk protein allergy (CMPA) can affect people of all ages but is most prevalent in infants, affecting between 2 and 7.5% of formula fed and 0.5% of exclusively breastfed babies. Exclusively breastfed babies develop CMPA as a result of milk proteins from products the mother has eaten transferring through breast milk. The level of cow's milk protein present in breast milk is 100,000 times lower than that in cow's milk. Most reactions to cow's milk protein in exclusively breast fed babies are mild or moderate and severe forms of CMPA very rare. It is thought that immunomodulators present in breast milk and differences in the gut flora of breastfed and formula fed infants may contribute to this. (Ludman 2013).

Secretory immunoglobulin A (sIgA) in breastmilk "paints" a protective coating on the inside of a baby's intestines to prevent penetration by potential allergens such as foreign proteins. SIgA cannot be replicated in formula.

The reaction may be mediated by IgE (anaphylaxis, urticaria) if they occur immediately following consumption of cow's milk protein or non IgE (GI reactions, eczema, GOR) which may occur several hours or even days after consumption. The immune system responds to the protein casein or the whey found in cow's milk.

Although these symptoms may be related to other conditions, they are likely to be due to CMPA if the severity is related to a change in the amount of cow's milk consumed by the mother and/or baby, or if cow's milk based formula or other similar foods are introduced into the baby's diet. CMPA is also a likely cause if the symptoms appear in more than one system, for example diarrhoea and atopic dermatitis, and also if these symptoms are resistant to treatment. It is important to consider all outcomes and to take a full medical history to ensure that the symptoms are not due a cause other than CMPA. (Ludman 2013). Attention should also be paid to optimising attachment and frequent feeding if the baby is breastfed.

Where CMPA is suspected in a breastfed baby, the recommended treatment is for the mother to remove all sources of products containing cow's milk from her diet, ideally under medical supervision. Mothers should be prescribed a supplement of 1000mg of calcium and
10 microgrammes of vitamin D every day.

Algorithm for the diagnosis and management of cow's milk protein allergy (CMPA) in exclusively breast-fed infants. (eHF= extensively hydrolysed formula.)

Vandenplas et al (2007) state that 10-35% of infants with CMPA have adverse reactions to soya. While Ludman et al (2013) report that up to 60% of patients with non-IgE mediated cow's milk allergy and up to 14% with IgE mediated allergy also react to soya.

Where solid foods have been introduced, all sources of products containing cow's milk should also be removed from the baby's diet. It will usually take between 2 and 4 weeks for symptoms to disappear. It is suggested that milk is then reintroduced to ensure that this has been the cause of the symptoms. (Ludman 2013, NICE 2011).

Where a diagnosis of CMPA is confirmed the mother should avoid cow's milk products in her diet for as long as she is breastfeeding. She will continue to require support to manage her nutrition, particularly where the elimination diet is over an extended period of time. A dietician or other healthcare professional managing the case will recommend at which point reintroduction of cow's milk should be trialled and how this should be managed. Care should also be taken with the weaning diet and appropriate alternative sources of calcium included under dietetic supervision.

There is generally no need to add special prescription formula or soya formula. The baby can continue to receive breastmilk even whilst his/her mother is beginning to eliminate cow's milk protein from her diet.

A diagnosis of cow's milk protein allergy has many ramifications for mother and baby. A mother should not be asked to remove products containing cow's milk protein lightly e.g. to resolve colic symptoms, without first considering referral to a breastfeeding expert to address issues around optimal attachment.

Update 2019

In a BMJ article in 2018 Dr C Van Tullekan suggested that the diagnosis of CMPA is a trojan horse for formula milk manufacturers to forge relationships with healthcare professionals under the guise of education. He noted that "Between 2006 and 2016, prescriptions of specialist formula milks for infants with cow's milk protein allergy (CMPA) increased by nearly 500% from 105 029 to over 600 000 a year while NHS spending on these products increased by nearly 700% from £8.1m to over £60m annually. Epidemiological data give no indication of such a large increase in true prevalence-and the extensive links between the formula industry and the research, guidelines, medical education, and public awareness efforts around CMPA have raised the question of industry driven overdiagnosis. Nigel Rollins from the World Health Organization's department of maternal, newborn, child, and adolescent health agreed that "It's reasonable to question whether these [prescription and spending] increases reflect a true increase in prevalence."

It would be easy to identify virtually every child with symptoms in the table above. This does not imply that every day has CMPA although an exclusion diet is recommended to many mother "just to see if it helps". The repercussions from diagnosis cannot be underestimated for the mother, the baby and the health economy. A diagnosis can be made only by excluding cows' milk protein from the maternal diet, observing symptoms, and then reintroducing. Many mothers are willing to go to any lengths to maintain breastfeeding although others may perceive their milk as toxic to their baby and stop breastfeeding. Many support organisations and guidelines are written by industry sponsored sources and therefore seen as likely to influence perception of symptoms. Conflict of interest with organisations such as Nutricia should be taken into consideration when interpreting information.

Dr Helen Crawley First Steps Nutrition booklet Specialised Infant Formula (2018) notes that:

Amino-acid based infant milks contain protein in the form of individual amino acids and are marketed to be used in the dietary management of moderate to severe cows' milk protein allergy or multiple allergies. Amino-acid based infant milks are unlike other hypoallergenic infant milks in that they contain amino acids which are synthetically derived, as opposed to peptides originating from cows' milk, meat or soya as found in extensively hydrolysed formula.

These milks are about three times more expensive than extensively hydrolysed formula milks, and are an area in which cost savings to the NHS can be made with use of appropriate prescribing.

Breastfeeding is the optimal way to feed a baby with cows' milk protein allergy, with individualised maternal elimination of cows' milk protein foods and fluids, and with adequate calcium and vitamin D supplementation to meet the mother's nutritional requirements during breastfeeding.

Amino-acid based infant milks are low in lactose or are lactose-free and contain maltodextrin or dried glucose syrup as the main carbohydrate source, meaning that oral care is particularly important for individuals being given these products.

References

Crawley H Specialised Infant Milks in the UK 0-6 months. First Steps Nutrition 2018 https://www.firststepsnutrition.org/composition-claims-and-costs

LIFIB Cows' Milk Protein Allergy Briefing Paper Oct 15 http://lifib.org.uk/cows-milk-protein-allergybriefing-paper-oct-15/

Ludman, S., Shah, N., Fox, A.T. Managing Cow's Milk Allergy in Children BMJ 2013; 347:f5424

National Institute for Health and Clinical Excellence (2011) Food allergy in children and young people Diagnosis and assessment of food allergy in children and young people in primary care and community settings

Van Tulleken C Overdiagnosis and industry influence: how cow's milk protein allergy is extending the reach of infant formula manufacturers. BMJ 2018;363:k5056

Vandenplas, Y., Brueton, M., Dupont, C., Hill, D., Isolauri, E., Koletzko, S., Oranje, A.P., Staiano, A. Guidelines for the diagnosis and management of cow's milk protein allergy in infants Arch Dis Child 2007; 92:902-908

Competing interests of referenced papers

Vandenplas et al declared funding "Funding: The consensus panel, the literature search and the drafting of the manuscript were funded by a grant from SHS/Nutricia. The paper was drafted by Mark Greener, a medical writer. SHS International Ltd and Nutricia did not have any editorial control over the final manuscript, which remains entirely the responsibility of the authors. Competing interests: DH, CD, MB, SK and YV declare they have received support for clinical research projects from SHS/Nutricia and the same authors and MB declare they have presented lectures at SHS/Nutricia-sponsored meetings. Also, SK has presented lectures at sponsored meetings and received support for scientific work from Mead Johnson and Nestle. YV has received support from Janssen Pharmaceuticals, Astra, Wyeth, Biocodex and Nestle. None of the other authors made any declarations relevant to the preparation of this manuscript. The authors declare the absence of competing interests and confirm their independence regarding the content of this manuscript.

Ludman et al We declare the following interests: ATF has done consultancy work for Mead Johnson Nutrition Danone, Nestle Nutrition,and Abbot. He has received fees for lectures or producing educational material from Mead Johnson Nutrition and Danone. He is site principal investigator for a Danone sponsored study funded through Guy's and St Thomas' NHS Hospitals NHS Foundation Trust and King's College London.
©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019

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Cows' Milk Protein Allergy (CMPA) and Breastfeeding - The Breastfeeding Network

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

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How to Express Breastmilk - Video - Global Health Media Project

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Expressing breastmilk can relieve breast fullness, soften the breasts, and make it easier for the milk to flow. It is also important to maintain a mother’s

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NHS Parent Education in Spanish, Portuguese, French, Arabic, Romanian, and Somali. For women accessing maternity care at: St Thomas’, Kings College, Princess Royal University (PRUH) , Lewisham University Hospital and Queen Elizabeth Hospitals

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Breastfeeding Twins and Triplets UK began life as a Facebook Group. Kathryn realised that there were no UK based Facebook groups specifically for mums of twins and triplets to access breastfeeding support. So one late night she created one. It was a huge success and over the first 18 months, it gained 1400 members and now has just tipped 3000.

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An at-breast supplementer, nursing supplementer or ‘supply line’ allows a mother to feed her baby supplemental milk at the breast. It

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BFN Breastfeeding Peer Support in Lambeth

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BFN Breastfeeding Peer Support in Lambeth

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Southwark Drop-in Groups 2024 - A4 Handout

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Recommendation

Complete a full assessment to understand the underlying cause of the low milk supply and correct any known problems before considering domperidone.

Domperidone is the medicine of choice if medical treatment is required for low milk supply.

Use 10mg three times daily, initially for 7 days then review.

Limited evidence shows negligible amounts of domperidone pass into breast milk.

How lactation works

Lactation is complex, involving hormonal, physical, and emotional factors.

Several hormones (including prolactin, insulin and hydrocortisone) are needed for colostrum production, and for the onset of copious milk supply. For breasts to continue producing milk, the following are needed:

a rise in prolactin levels, usually caused by nipple stimulation

oxytocin release to allow milk ejection, caused by nipple stimulation

regular removal of milk

Milk production is based on supply and demand. If milk isn't removed, supply will reduce and eventually stop.

Signs of normal milk supply

Colostrum, in small volumes, is produced during the first 24 to 48 hours after birth. Larger volumes of breast milk are produced by the fifth day.

After the first two weeks of life, the best indicator of adequate milk supply is the baby gaining weight, and wetting nappies and passing stools as expected.

Diagnosing low milk supply

Up to half of breastfeeding women worry their milk supply is low. A true low milk supply is uncommon, affecting only about 15% of mothers.

There is often an underlying cause which can be resolved. A proper assessment of breastfeeding technique and other maternal and infant factors to identify any potential cause, will lead to the most successful outcome, potentially without the need for medication.

Assessment tools are available and should be used by a suitable qualified person with skills in lactation support.

Some medicines may affect milk production. If you are concerned, check the Safety in Breastfeeding information, or contact the UK Drugs in Lactation Advisory Service (UKDILAS).

Medicines used to increase milk supply

Substances to increase milk supply are known as galactagogues.

No medicines are licensed in the UK for the treatment of low milk supply, and are therefore used off-licence. Follow the GMC's guidance on unlicensed and off-licence prescribing.

Most galactagogues work by increasing prolactin levels. However, a higher prolactin level does not mean more milk. It is unknown if all women with a low milk supply also have low prolactin levels, and therefore if increasing prolactin levels further would help. A sudden increase in prolactin levels (usually triggered by nipple stimulation) seems to be important, not the maximum level produced. The frequent removal of milk via feeding also increases prolactin levels.

Evidence for the efficacy of galactagogues is limited, but they probably do increase milk volume initially. Prolactin levels also increase. We do not know if they help maintain breastfeeding long-term or increase infant weight gain.

Choice

If a galactagogue is required, domperidone is first choice due to most evidence for use and efficacy, better side-effect profile, and negligible passage into breast milk.

Other galactagogues include metoclopramide, sulpiride, and some herbal products. However, there is less evidence of efficacy, and these have other safety considerations.

Domperidone

Most evidence is in pre-term infants, which shows a moderate short-term effect on expressed breast milk volume, increasing by around 86 to 245mL per day. There is less evidence evaluating domperidone in mothers feeding term infants.

When to start

In studies, domperidone was started between days 1 and 33 post-delivery. It may be effective after this point, but there is no good evidence to support this.

Dose

Domperidone should be prescribed at a dose of 10mg three times daily. Doses higher than this should not be used.

Most studies used domperidone 10mg three times daily. Some small studies used higher doses. Only two small studies compared domperidone 10mg and 20mg three times daily. The 20mg groups produced on average slightly more milk, but it is uncertain whether this was a real difference or due to chance.

Domperidone does not always work. One study used domperidone 10mg and 20mg three times daily found a third of mothers did not have an increased milk supply at either dose. The study suggested that if there was no response to 10mg, increasing to 20mg was unlikely to work.

Duration of treatment

Domperidone should be prescribed for 7 days and then reviewed.

This is in line with the maximum treatment duration for the licensed indication (nausea and vomiting), due to the increased risk of cardiac events (particularly in certain populations), and potential for psychiatric withdrawal effects.

There is limited evidence regarding how long to use domperidone to increase milk supply. Some evidence shows the maximum effect is usually achieved within 7 to 14 days. Therefore, continuing treatment is unlikely to make a difference.

Whether to continue domperidone for longer than 7 days is a clinical decision after considering the evidence and potential increased risks.

Stopping treatment

Maintaining milk supply

It is not known whether stopping treatment with a galactagogue suddenly or gradually is better for maintaining milk supply. The American Academy of Breastfeeding Medicine recommends considering gradual discontinuation.

If milk supply reduces after stopping domperidone and improves on restarting again, gradually decrease to the lowest effective dose, and attempt discontinuation again.

Gradual withdrawal may also help reduce concerns about discontinuation.

Withdrawal symptoms

A small number of case reports suggest withdrawal symptoms occur when domperidone is discontinued either suddenly or gradually. In all cases, either prolonged use (up to 10 months) or higher than recommended doses (up to 160mg daily) were used.

Symptoms of withdrawal include insomnia, anxiety, headaches, palpitations, gastro-intestinal disturbances and depression. Re-emergence of previous mental health conditions has been reported.

If suspected withdrawal symptoms occur, increase the dose of domperidone back to a level that does not produce symptoms, and restart withdrawal more slowly.

A Canadian Safety Review on this issue is available.

Risk of cardiac events

Domperidone can cause a small increased risk of serious cardiac events, including certain types of arrhythmias, especially when used in high doses, for longer periods, or when additional risk factors are present. Patients at higher risk include those with cardiac disease, severe liver problems, electrolyte imbalances, or taking medicines affecting the QT interval or which interact with domperidone.

Maternal risk

Most breastfeeding women are relatively young and healthy and their baseline risk of cardiac events is very low.

A large cohort study involving over 1 million post-partum patients found domperidone increased the baseline ventricular tachycardia rate from 0.20 to 0.74 per 10,000 person years. It is not possible to prove whether the increase was due to chance or not. No sudden cardiac deaths in the domperidone group were reported, and the rate of all-cause mortality was decreased.

An increased incidence of arrhythmia in women with no arrhythmia history, taking domperidone to increase milk supply, has generally not been seen in studies.

Domperidone can be considered if a woman has no additional cardiac or medical risk factors, and is not taking medication that interacts with domperidone or affect the QT interval. Further information on drug-induced QT interval prolongation is available.

However, if risk factors are present, then ECG monitoring may be required, or an alternative considered. Contact UKDILAS for alternative galactagogue use.

Infant risk

Cardiac events in the infant have not been reported after domperidone exposure via breast milk.

In one study in premature infants, five babies had a prolonged QT interval, although none had symptoms or needed intervention. This was more likely due to infant prematurity than domperidone exposure.

If the infant has cardiac disease, severe liver disease or is receiving medicines which may be a problem, then domperidone use in the mother is best avoided. Contact UKDILAS for alternative galactagogue use.

Domperidone levels in breast milk

Very limited information shows domperidone passes into breast milk in negligible amounts (less than 0.5% of the maternal weight-adjusted dose), even with high dose, long term therapy.

In addition, there is a very low risk of accumulation in the infant and its low oral bioavailability will limit the amount absorbed from the breast milk.

Monitoring the infant
No serious side-effects have been reported in infants exposed to domperidone via breast milk.
As a precaution, monitor for gastro-intestinal disturbances, or signs of dry mouth, such as difficulty feeding.

Since there is no evidence that domperidone via breast milk can cause significant ECG changes in the infant, infant ECG monitoring is not routinely required. If there are additional risk factors, contact UKDILAS.

Ongoing support

Ongoing lactation support will be necessary during treatment with domperidone. Regular review is needed if domperidone is used beyond 7 days.

Induced or restarting lactation

Inducing lactation in a person who has not given birth, or restarting after a period of non-lactation, is beyond the scope of this article.

Get in touch with the UK Drugs In Lactation Advisory Service if:

you need further advice

you are considering a different medicine for low milk supply

multiple medicines are being taken

Acknowledgement

Thanks to Dr Louise Santhanam, General Practitioner, and Leicester Mammas CIC for their expert review.

Bibliography

A referenced version is available on request.

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Domperidone can be used to treat low milk supply. However, this is only after thorough assessment and once non-medical interventions have been tried.

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A companion to your infant feeding journey, this podcast explores how to get breastfeeding off to a good start (and how to end it) in a way that meets everyone's needs.

Breastfeeding / chest feeding may be natural, but it isn't always easy for everyone. Hearing about other parent's experiences and getting information from lactation-obsessed experts can help.

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A companion to your infant feeding journey, this podcast explores how to get breastfeeding off to a good start (and how to end it) in a way that meets everyone's needs. Breastfeeding / chest feeding may be natural, but it isn't always easy for everyone.

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Breast and nipple pain in breastfeeding women can be caused by a thrush infection in the breast. You can still breastfeed while being treated for thrush.

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Koan's Story

Koan was born with a rare genetic condition and received donor milk from the HMF. Watch Koan's parents - Shurron and Kel tell their amazing story.
WATCH VIDEO OF KOAN'S STORY

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Koan was born with a rare genetic condition and received donor milk from the HMF. Watch Koan's parents - Shurron and Kel tell their amazing story. WATCH VIDEO OF KOAN'S STORY

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The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate.

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How to support your baby to sleep without stress

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How to support your baby to sleep without stress

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How to support your baby to sleep without stress

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1. Terms of website use This page tells you the terms of use on which you may make use of our website www.all4birth.com (our site). Please read these terms of use carefully before you start to use the site. By using our site, you indicate that you accept these terms of use and that you agree to abide by them.

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What to do when your breastfed baby won't take a bottle

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What to do when your breastfed baby won't take a bottle

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What to do when your baby won't take a bottle | Rachel O'Brien, IBCLC

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Bottle refusal is incredibly hard for breastfeeding parents. Learn exactly what to do when your breastfed baby won't take a bottle.

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When a baby won't take a bottle

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Some babies need extra milk. Maybe baby is not yet able to attach to the breast well, or maybe the mother is working on building up her lactation, or is separated from her baby. Perhaps the baby is not yet feeding effectively or is struggling to gain weight.

Bottle feeding is ubiquitous in our society and when a baby needs extra milk, a bottle is often suggested by health professionals involved in their care. However, using bottles can make breastfeeding more challenging.

Research suggests that early introduction of bottles and teats leads to premature cessation of breastfeeding. Reasons for this may be that the feeding technique and experience is quite different. The teat can be a firm stimulus to the baby's suck reflex and the baby may become progressively less responsive to the softer stimulus of mother's nipple - baby may exhibit behaviour such as increased 'fussiness' at the breast or breast refusal once accustomed to fast flowing milk from a bottle and teat.

In addition, the impact on the mother's confidence and feelings of self-efficacy when her baby needs to be given additional milk is often overlooked. A mother may be aware that using bottles and teats can significantly undermine breastfeeding and be anxious to avoid their use.

A mother may be unaware that bottles and teats may undermine breastfeeding and enter into their use with little safeguards in place to protect her breastfeeding and find herself with subsequent feeding issues that could have been avoided.

For an assisted feeding method to work well and avoid undermining breastfeeding:

It needs to be suitable for the baby and the individual feeding situation

The mother needs to view it positively as supportive of her breastfeeding goals and not 'supplantive'.

There are actually many ways of delivering extra milk to a baby which can be effective at supporting breastfeeding. This is a brief overview of some assisted methods of feeding that Breastfeeding Supporters may wish to become more familiar with:
Breastfeeding aide tube
If a baby can attach to the breast effectively, they could have extra milk via a tube at the breast.

The other end of the tube is placed in a container of milk. As the baby suckles at the breast extra milk is delivered via the tube. The flow can be adjusted by raising or lowering the milk container.

This encourages the baby to stay at the breast, so alongside delivering the required extra milk, it also helps stimulate the mother's lactation.

There are commercially available kits for breastfeeding aide devices, and 'Nursing Support tubes' are also available to purchase to make up a breastfeeding aide tube device.
Spoon Feeding
If a young baby needs small quantities of colostrum or milk, a spoon can work well.

Baby needs to be awake and alert in order to take milk from a spoon. Baby should be well supported in a semi upright position. Milk is placed on a clean, shallow plastic spoon and brought to the baby's lips. Baby sucks and laps the milk from the spoon. Milk should not be poured into the baby's mouth as this risks the baby aspirating the milk.
Syringe Feeding
Another great option particularly for small quantities of colostrum is via a syringe (no needle).

Colostrum in small 'doses' is introduced via the syringe into the corner of the baby's mouth, aimed into the cheek and the baby observed closely for acceptance of milk and safe swallowing.
Cup Feeding
For larger volumes of milk a small baby feeding cup can be used. In the home any clean suitable receptacle can be used - a clean 'shot glass' or egg cup can be used successfully. Again, baby should be positioned so s/he is well supported in a semi-upright position, bring the cup to the baby's mouth. Tip the milk slightly so the milk reaches the edge of the cup and the baby will lap the milk.

Milk should not be poured into the baby's mouth as this risks the baby aspirating the milk.

Cup feeding is often preferred as an adjunct to breastfeeding in resource-poor settings as they are usually easier to keep clean and avoid the potential for contamination and illness associated with unhygienic bottle use.
Finger Feeding
For slightly larger volumes of colostrum or milk, finger feeding using a syringe is an effective, accessible, and popular option with many families. Baby is supported in a semi-upright position facing the parent so there is good eye contact and baby can be closely monitored. Baby is encouraged gently to accept a clean finger orally. Once the finger is accepted and resting lightly at the hard palate/soft palate junction the baby's suck reflex is triggered. Baby starts sucking and swallowing rhythmically, the tip of the syringe is placed gently into the corner of the baby's mouth and pressed very gently to introduce milk in small volumes (e.g 0.1-0.2mls). The parent monitors the baby closely so that milk is introduced in a slow and paced manner that baby is clearly coping well with and enjoying.

Finger feeding can also be done using a feeding tube taped onto a clean finger. Baby is supported in a semi-upright position facing the parent so there is good eye contact and baby can be closely monitored. Place or tape a feeding tube to a clean finger. The other end of the tube is placed into a container of milk. Baby is encouraged gently to accept the clean finger (nail side down) with tube attached orally. Once the finger is accepted and resting lightly at the hard palate/soft palate junction the baby's suck reflex is triggered. Baby starts sucking & swallowing rhythmically and milk is drawn up through the feeding tube. Baby's sucking controls the flow, although the flow rate can be varied by raising or lowering the height of the container of milk.

The sucking mechanism of finger feeding is considered to be more similar to suckling at the breast. Finger feeding using a syringe or feeding tube can work really well with babies who can't yet attach well and feed effectively and who require additional milk 'top ups'. Supporting not supplanting the dyad's breastfeeding journey.

When helping parents to draw up and implement a feeding plan, all methods of assisted feeding should be considered and discussed - it is often helpful if more than one assisted feeding method is employed as part of a feeding plan, e.g. a common approach when weight gain needs a boost is for the mother to breastfeed using a breastfeeding aide tube for some breastfeeds and her partner to finger feed additional milk after other breastfeeds.

Bottle and teat use has overwhelming cultural connotations in our society and once introduced appear to often negatively affect maternal confidence and self-efficacy and lead to early breastfeeding cessation.

Offering information on and supporting the use of a 'toolkit' of assisted feeding methods that do not appear to undermine breastfeeding in the same way may empower the mother to continue her breastfeeding journey despite her baby requiring additional milk from another source for a period of time.

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Beyond bottles: when a breastfed baby requires additional milk - ABM

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Some babies need extra milk. A bottle is often suggested however, using bottles can make breastfeeding more challenging.

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Bob is 18 months. He is breastfeeding on demand. This usually means breastfeeding at least 6 times in 24 hours.

Billie is 3 years old. She breastfeeds in the morning, at bedtime and usually once during the night.

Let's imagine you are Bob or Billie's mum and you want to end breastfeeding.

First, let's take a moment to check this is a decision you are happy about. Am I going to try to talk you out of it? Nope.

I breastfed both my children until they self-weaned and I speak to mothers breastfeeding toddlers every day. I know it isn't for everyone.

If you are in the tiny minority of mothers breastfeeding well into the second year and beyond, that is something to be celebrated and praised and baton-twirled.

You get to choose when you stop.

The job of the breastfeeding support community is to enable each mother to reach her own breastfeeding goals. When it comes to breastfeeding an older child, we are allowed to listen to our own maternal instincts. Not everyone's maternal instincts tell them the same thing.

However this is an important decision so let's do a few checks.

If you are 100% confident with your decision, feel free to skip to the row of asterisks.

Are you ending breastfeeding because you want to conceive again and you believe weaning will be necessary?

Every woman's fertility responds differently to breastfeeding. To conceive, we need oestrogen levels to rise again and ovulation to occur and then we need the womb to receive a fertilised egg and give it enough chance to hang around and implant properly. Most women do not need breastfeeding to end completely for this to happen. However most of us do need at least one gap of 5-6 hours without any breastfeeding in 24 hours.

It might be worth experimenting with night weaning or extending intervals in order to trigger your period before ending breastfeeding entirely if you'd rather not. Get familiar with your cervical fluid (or as my friend Sarah Panzetta, a fertility expert, calls it, 'your lady liquid') and get a sense of what it's likely to look like when you ovulating (stretchy and egg-whitey). Some people are told they need to wean from breastfeeding in order to start another round of IVF. That is a very difficult and personal decision.

We can probably say that is likely that you would be maximising your chances of conceiving by ending breastfeeding. You may still decide you'd rather continue breastfeeding.

Are you ending breastfeeding because you need to take medication and the doctor says you have to?

Check. Many many women are told this inaccurately. In the UK, the Breastfeeding Network is a great source of information - both their medication factsheets and the 'drugs in breastmilk' helpline. You can also check with LactMed or the resources (book and website) of Dr. Thomas Hale. There are many lactation consultants available through Twitter who would be happy to check for you.

Are you ending breastfeeding because someone else is putting pressure on you?

Is this someone who you feel has a right to comment on your body and what you choose to do with it? Is it someone who you feel has as much right to make decisions about your child's health and happiness as you do? If you answer yes to both of those questions, then you may feel you want to listen.

However, you should also feel you have the right to explain very clearly why this matters to you and carry on. You have the right to continue even though other adults in your life are uncomfortable. Just because we live in a society which squirms at the idea of breastfeeding older children, it doesn't mean a push into unhappy weaning is the 'right' opinion. You have science on your side.

This is a decision you will live with for a very long time. You have invested a huge amount in making breastfeeding work up until now. For many women, it has taken literal blood, sweat and tears. You have spent hours and hours and hours breastfeeding. One day, decades from now, you may be a grandmother and breastfeeding will be part in your world again. Wouldn't it be great to look back with no regrets and know that you stopped breastfeeding at a time that was absolutely right for you?

Your nursling can't speak up. If you are being pressured to wean when you don't want to, you may need to be brave and speak up for them.

Are you ending breastfeeding because you aren't getting enough sleep?

One possibility is to night wean and see how that feels. It may enable you to continue breastfeeding for longer than you imagined you would. You can follow the suggestions below and pause at any point in the process.

So we're going to try and wean Bob. He's breastfeeding a lot. He breastfeeds in the morning and at naptime. He falls asleep breastfeeding at the beginning of the night and breastfeeds during the night several times. He uses the breast for comfort when he feels sad or shy. It's the first thing he wants when he falls over. When you sit together on the sofa, he wiggles over and lifts your shirt with a big smile on his face. He loves it all.

Have you done anything wrong by parenting this way up until now? No, you have not. You have followed your instincts and met his needs and what a lucky little bloke Bob is.

This is clearly going to be tough and Bob may be sad but YOU ARE STILL ALLOWED TO WEAN. This is your choice and you will be able to make it happen with the minimum amount of upset if you are sensitive and careful.
Some things to bear in mind before we start:
This is not about milk - completely. This is about YOU. Bob is connecting with you and being as close to you as he possibly can. He is feeling safe and loved and cosy and warm. Your milk still contains immunological properties and Vitamin A and protein and all the other useful things. However Bob's breastfeeding behaviour is about security and love and not much about Vitamin A.

So don't offer milk in a bottle or sippy cup instead and not in response to a request to breastfeed. Don't offer milk in a cup at bedtime instead of that connection with you. That's like you asking a loved one for a hug and he gives you a sausage roll. You may be a big fan of sausage rolls but right then, in that context, that's a rejection.

We need to talk about ways of trying to avoid the 'rejections'. It may not be entirely possible but we want to minimise them as much as possible.

Don't offer another person instead. Does it seem entirely logical that at the moment we are pulling bits of ourselves away from our nursling, we pull our entire self away?

Does it seem logical to leave your toddler for a night or longer just to wean from breastfeeding when breastfeeding was about connecting with you as much as the milk?

We need to show that you are still there and you are still very much there for connecting - just not at the nipply bits.

You will still be there at bedtime when he feels scared and vulnerable. You will still be there for comfort. You will be there for him when he's going through this really tough transition of losing breastfeeding. Does it seem sensible to pull yourself away when he's potentially going to be losing something that really matters? You are the person he really needs to help him through this.

Of course partners and dads are a key part of this process but in addition to mum - not instead of. I hope daddy/partner is part of the bedtime process and able to comfort your child. I'm just not sure it's brilliantly sensible for you to be stepping away and leaving them entirely to it.

Together - all 3 of you (mum, partner and nursling) - you will be making new routines and patterns and developing a new parenting language.

That doesn't take a night and it probably doesn't take a week. It might take a week for the 18 month old who is only breastfeeding a couple of times in 24 hours and falls asleep without the breast in his mouth - but that isn't Bob.

First steps:

While it's true that this isn't simply about milk, Bob has been having quite a lot of milk which have met a lot of his nutritional demands and provided a portion of his hydration through the day. We need to look at his diet. Is Bob confidently using a cup? Would he be able to indicate if he was thirsty? Can he help himself?

What will be Bob's sources of calcium, protein, vitamins and minerals and good quality fats? It might be that Bob enjoys drinking cow's milk but he also might really not. Does he eat dairy? He would ideally get around 300ml of full-fat cow's milk a day. If he won't drink milk, he can eat cheese and yoghurt and you can use cream and butter in cooking. He might like a yoghurt-based fruit smoothie or a milkshake. There are other sources of calcium and other minerals like green leafy vegetables, nuts and tofu. Bob doesn't need to drink a commercial formula. Full-fat cow's milk is the recommendation.

Take a moment to reflect on what his nutritional sources will be. Do some research. He's been taking a significant portion of his calories overnight so you will need to look at extra snacks and opportunities to offer food once that's gone.

Now it's time to look at sleep skills. This may be the most difficult aspect of the process so we need to address it from the beginning because it could take the longest.

Bob right now has a prop dependency - a loving and comforting prop dependency. He's using the breast to aid his drop-off to sleep and he's using it to transition between sleep cycles at night. As he moves between sleep cycles, he fully rouses and seeks the breast to help him move on to the next sleep cycle. Some babies need dummies replugged or a pat. Bob has a breast as his sleep prop. For lots of mums, this is not really something that bothers them and it can continue until it naturally fades. But if you want to wean from breastfeeding, it's a problem for you.

Night weaning

You can't end breastfeeding until you have helped Bob find a new way to sleep. If we just take breastfeeding away suddenly, it's really not very fair. This has been the way Bob has fallen asleep for a very long time. Sleep time is often when we feel the most vulnerable and when we can really get into habits.

Imagine you'd always fallen asleep by putting your head on a pillow and turning out the light and thinking peaceful thoughts and someone suddenly announces sleep isn't allowed to happen this way anymore and you have to touch your nose with your thumb while whistling the star-spangled banner. You'd quickly become distressed and angry and think the whole thing was entirely unreasonable. You literally wouldn't know how to do it.

You would probably prefer to make any transition gradually and with the support of someone you love.

A really good resource for this stage is 'The No-cry Sleep Solution for Toddlers and Pre-schoolers' by Elizabeth Pantley. You may already have read about her 'pull-off' method in her book aimed at babies. You would start a feed as normal but then resist the temptation to feed right to the end when your toddler is in a deep sleep and absolutely out for the count. You would use your little finger and break the latch just before they completely fall asleep. The first time, it really would only be seconds before. You want them to do the final drop-off from drowsy to deep sleep without the breast actually being in their mouth. You are right there but the breast has been removed. If your nursling fully rouses at this point and searches for the breast, you may gently place your hand on their chin to see if they might still settle. If not, and they wake further, you latch them back on again and try a few moments later. Then, over several nights, you would gradually detach them earlier and earlier in the process. After a while, you may feed them and after the feed they may still pretty much be awake. It has been a gentle and slow process. They learn how to fall asleep without actually sucking. What then often starts to happen is the nursling who can do the final drop-off without the breast being in their mouth is less likely to rouse between sleep cycles during the night. They semi-wake (as we all do between sleep cycles at night) but feel safe about moving onto the next sleep cycle without needing their prop.

At the same time as working on the pull-off technique, you can work on introducing a different structure for bedtime. Before you even start, you could introduce a lovey - a comfort object that could become associated with sleep and bedtime. It could be cuddled between you during night time breastfeeds. Then as the feeds start to change, the lovey is still there. You could also think about singing a little song that is your 'bedtime song'. This is a song that you initially sing during the breastfeed and as the breastfeed fades, it's a new part of your routine. It might happen during the final cuddle or if they appear to rouse and be looking for comfort. It's calm and soothing and - this is the important bit - you don't mind singing it every night for a while. If you are feeling very creative, choose a tune you know well and write your own lyrics about your day and your loved ones. Or choose a little poem and phrase that says, 'this is sleep time now'.

As the breastfeeds end, the song or the poem is still there. It remains consistent. It's the sign that it's sleep time now. You are still there and we're just removing the prop of the breast.

As your nursling finishes a breastfeed more and more awake, you've got the chance to insert other things as your new 'final stage'. You could read a story. It is sometimes said that sharing a book with your toddler is more similar to breastfeeding than offering a cup or bottle of milk. You are devoting yourself to your child. You are sharing a connection. They have your attention and a cuddle.

There are even some books on the process of weaning and night weaning that you might find useful. I don't mean books for you about technique but picture books for both of you that will usually have illustrations of jolly toddlers and rested mothers greeting the sunrise. 'Nursies when the sun shines' is a classic example.

You could also make your own book. Make a photo book using one of the online photo companies about your night weaning journey. Toddlers at this age love seeing photos of themselves and their friends and family. It could just be something as simple as saying 'goodnight' to all the things he loves. And I dare you to have 'good night mummy's boobs' on the last page. 'See you in the morning!'

So the breastfeeding moves back further. After it comes the story and the song (bored of it yet?). Then one day, breastfeeding happens in a different room and then before bath and one day, it gets dropped. Perhaps that night something exciting happens instead - a new toy in the bath, some ice cubes to play with. The breastfeed is something that he will want to get out of the way to get onto the fun stuff.

Some people prefer to leave the bedtime breastfeed as the very last one that gets dropped when full weaning happens. You may have been working on daytime feeding while this whole process was going on. The point is though that we may need to start AND finish with the weaning the bedtime feed because the process of setting up a new routine could take a while.

When a nursling wakes up in the middle of the night, we can hopefully develop new techniques that help them transition without using breastfeeding. Ideally now that we've done the pull-off, we are getting fewer night wakings but we may still see some. What else will make your toddler feel calm and safe? You may be able to use some of those techniques from bedtime. The lovey is there. You can sing your special song and use your special phrases. You may stroke and pat. You may put on a gentle piece of music or white noise. You're going to be finding your own strategies.

There may be tears. It may be tempting to offer the breast because this is too difficult to manage. You have to follow your instincts. You may discover you are not ready to wean and you can cope with just one feed at night. You may decide that some tears of frustration are going to have to happen because you are absolutely ready to end this stage of motherhood. Try and be consistent.

Daddy/partner can be a great help but you also need to develop your boob alternatives now - the way you will show physical love and give your mothering comfort.

Some 18 month olds are verbal enough that they can understand that milkies are sleeping now and they will be awake in the morning - cuddles instead.

What about weaning breastfeeds in the daytime?

Once you have broken the sleep prop, the process will get easier. You will need to ensure of course that naps can happen without breastfeeding. Now the rest of the weaning is about distraction.

We are trying to avoid the need for refusal. This is a key aspect of weaning all older nurslings. You sometimes hear the phrase ' Don't offer, Don't refuse' used as a weaning technique. It will work for everyone in the end but sometimes we need to jiggle our day around so we don't actually get to the point of being asked if we want weaning to happen more quickly.

Once we get to the point of being asked, refusal means rejection. Not just a missing out on milk but a rejection from mummy. The request and breastfeed was a way that toddler communicated with you. He asked and it happened and it was magic. It was a dialogue between you that made him feel empowered and special. Really not just about the milk.

What other things can be ask for? Make a special box of books he can request. Make a snuggly book nest with pillows and beanbags. Instead of asking for a breastfeed, he could lead you by the hand and ask for a 'book cuddle'. Or a dance? Or a big squeezy cuddle with a raspberry on his neck?

You may need to restructure your day for a while - more time outside or at activities. Perhaps meals as a picnic if he normally asks for feed at the dinner table and climbs onto your lap. Perhaps moving the special chair where he normally asks for a feed. In the morning, it's a big hug and a scoop out of bed and a race downstairs to find the little ice cube tray full of fun snacks to avoid the morning feed. Or Thomas The tank Engine says good morning in a silly voice before mummy says a word. Distraction.

You may need to get up a little earlier for a while so you've got the energy to think ahead before he wakes and starts asking.

When you see the glint in his eye that indicates an 'ask' is on its way, think imaginatively. It's really not about offering a cup of cow's milk instead.

Some toddlers will do really well with limits. Some are starting to become fascinated by counting. If you've not managed to avoid 'the ask', how about? "We'll have milkies for as long as it takes mummy to count to ten". Count as fast or as slow as you like. You are in control. Talk about what you will be doing next. If there's a big protest at the end of a feed? "OK, one more. Do you want 'count to ten' or 'count to eleven'?" He is control too.

Pre-schooler Billie

A lot of the techniques will be the same for three-year-old Billie. She'll also need to learn how to drop to sleep without the breast and transition between sleep cycles in another way. It's likely she'll have a much greater understanding of what's going on and you can talk about your plans together.

You may decide to use a token system. Each morning you could give her 2 or 3 (or however many) tokens and she can swap them for breastfeeds at any time but she won't get new tokens until tomorrow. The tokens may be plastic gold coins (that one seems a bit too 'Wolf of Wall Street' for some) or perhaps little stretchy bracelets that she wears in the day and takes off each time she wants to 'buy' a breastfeed.

Again - you are both in control. She gets to decide whether to hold on to her tokens. When she requests a feed you might talk through her decision: "Are you sure? Because that means you only have one left for tonight? It's up to you but maybe check you're really sure." You may well find she gains comfort from keeping that last one 'just in case' and it never gets used. Gradually there are fewer tokens given.

She would also be old enough to talk about a weaning party or special treat. We don't want too much emphasis on the 'you're a big girl now' stuff because that sounds pretty scary. Big girls want cuddles and mummy too - but she might be ready for something new that celebrates her moving on.

It's OK to talk about what's happening. This is her first intimate relationship and you are teaching important lessons about empathy and understanding. Mummy's milkies are getting ready to stop breastfeeding soon. We will find new ways to give cuddles and be close. A three year old may also have ideas about a cosy reading corner and a new bedtime routine.
Remember
This might not be easy but you are allowed to stop. You have given such a magical gift to your child but that doesn't mean you have to continue breastfeeding beyond a point that feels right for you. I once heard a mother of a toddler say she simply couldn't 'bear' breastfeeding anymore. She counted the seconds in her head until each feed finished and felt physically uncomfortable. Is it in that toddler's interest for his mother to carry on?

If we say mothers of older nurslings are not allowed to wean, we will be frightening people of younger children who will feel stuck on a path. We do not want a world where mothers of nine month olds are ending breastfeeding because 'it's easier when they're younger'.

Breastfeeding can continue when it's right for toddler AND mother. It can also end when it feels right.

There are forums and Facebook pages with other mums in your situation who you may be able to share your decision and your journey with. You can make up your own rules. You may decide to pause along the way. Perhaps when you have finished night-weaning, it will suddenly seem more manageable for a while. Just see how you feel.

Bob is 18 months. He is breastfeeding on demand. This usually means breastfeeding at least 6 times in 24 hours.

Billie is 3 years old. She breastfeeds in the morning, at bedtime and usually once during the night.

Let's imagine you are Bob or Billie's mum and you want to end breastfeeding.

First, let's take a moment to check this is a decision you are happy about. Am I going to try to talk you out of it? Nope.

I breastfed both my children until they self-weaned and I speak to mothers breastfeeding toddlers every day. I know it isn't for everyone.

If you are in the tiny minority of mothers breastfeeding well into the second year and beyond, that is something to be celebrated and praised and baton-twirled.

You get to choose when you stop.

The job of the breastfeeding support community is to enable each mother to reach her own breastfeeding goals. When it comes to breastfeeding an older child, we are allowed to listen to our own maternal instincts. Not everyone's maternal instincts tell them the same thing.

However this is an important decision so let's do a few checks.

If you are 100% confident with your decision, feel free to skip to the row of asterisks.

Are you ending breastfeeding because you want to conceive again and you believe weaning will be necessary?

Every woman's fertility responds differently to breastfeeding. To conceive, we need oestrogen levels to rise again and ovulation to occur and then we need the womb to receive a fertilised egg and give it enough chance to hang around and implant properly. Most women do not need breastfeeding to end completely for this to happen. However most of us do need at least one gap of 5-6 hours without any breastfeeding in 24 hours.

It might be worth experimenting with night weaning or extending intervals in order to trigger your period before ending breastfeeding entirely if you'd rather not. Get familiar with your cervical fluid (or as my friend Sarah Panzetta, a fertility expert, calls it, 'your lady liquid') and get a sense of what it's likely to look like when you ovulating (stretchy and egg-whitey). Some people are told they need to wean from breastfeeding in order to start another round of IVF. That is a very difficult and personal decision.

We can probably say that is likely that you would be maximising your chances of conceiving by ending breastfeeding. You may still decide you'd rather continue breastfeeding.

Are you ending breastfeeding because you need to take medication and the doctor says you have to?

Check. Many many women are told this inaccurately. In the UK, the Breastfeeding Network is a great source of information - both their medication factsheets and the 'drugs in breastmilk' helpline. You can also check with LactMed or the resources (book and website) of Dr. Thomas Hale. There are many lactation consultants available through Twitter who would be happy to check for you.

Are you ending breastfeeding because someone else is putting pressure on you?

Is this someone who you feel has a right to comment on your body and what you choose to do with it? Is it someone who you feel has as much right to make decisions about your child's health and happiness as you do? If you answer yes to both of those questions, then you may feel you want to listen.

However, you should also feel you have the right to explain very clearly why this matters to you and carry on. You have the right to continue even though other adults in your life are uncomfortable. Just because we live in a society which squirms at the idea of breastfeeding older children, it doesn't mean a push into unhappy weaning is the 'right' opinion. You have science on your side.

This is a decision you will live with for a very long time. You have invested a huge amount in making breastfeeding work up until now. For many women, it has taken literal blood, sweat and tears. You have spent hours and hours and hours breastfeeding. One day, decades from now, you may be a grandmother and breastfeeding will be part in your world again. Wouldn't it be great to look back with no regrets and know that you stopped breastfeeding at a time that was absolutely right for you?

Your nursling can't speak up. If you are being pressured to wean when you don't want to, you may need to be brave and speak up for them.

Are you ending breastfeeding because you aren't getting enough sleep?

One possibility is to night wean and see how that feels. It may enable you to continue breastfeeding for longer than you imagined you would. You can follow the suggestions below and pause at any point in the process.

So we're going to try and wean Bob. He's breastfeeding a lot. He breastfeeds in the morning and at naptime. He falls asleep breastfeeding at the beginning of the night and breastfeeds during the night several times. He uses the breast for comfort when he feels sad or shy. It's the first thing he wants when he falls over. When you sit together on the sofa, he wiggles over and lifts your shirt with a big smile on his face. He loves it all.

Have you done anything wrong by parenting this way up until now? No, you have not. You have followed your instincts and met his needs and what a lucky little bloke Bob is.

This is clearly going to be tough and Bob may be sad but YOU ARE STILL ALLOWED TO WEAN. This is your choice and you will be able to make it happen with the minimum amount of upset if you are sensitive and careful.
Some things to bear in mind before we start:
This is not about milk - completely. This is about YOU. Bob is connecting with you and being as close to you as he possibly can. He is feeling safe and loved and cosy and warm. Your milk still contains immunological properties and Vitamin A and protein and all the other useful things. However Bob's breastfeeding behaviour is about security and love and not much about Vitamin A.

So don't offer milk in a bottle or sippy cup instead and not in response to a request to breastfeed. Don't offer milk in a cup at bedtime instead of that connection with you. That's like you asking a loved one for a hug and he gives you a sausage roll. You may be a big fan of sausage rolls but right then, in that context, that's a rejection.

We need to talk about ways of trying to avoid the 'rejections'. It may not be entirely possible but we want to minimise them as much as possible.

Don't offer another person instead. Does it seem entirely logical that at the moment we are pulling bits of ourselves away from our nursling, we pull our entire self away?

Does it seem logical to leave your toddler for a night or longer just to wean from breastfeeding when breastfeeding was about connecting with you as much as the milk?

We need to show that you are still there and you are still very much there for connecting - just not at the nipply bits.

You will still be there at bedtime when he feels scared and vulnerable. You will still be there for comfort. You will be there for him when he's going through this really tough transition of losing breastfeeding. Does it seem sensible to pull yourself away when he's potentially going to be losing something that really matters? You are the person he really needs to help him through this.

Of course partners and dads are a key part of this process but in addition to mum - not instead of. I hope daddy/partner is part of the bedtime process and able to comfort your child. I'm just not sure it's brilliantly sensible for you to be stepping away and leaving them entirely to it.

Together - all 3 of you (mum, partner and nursling) - you will be making new routines and patterns and developing a new parenting language.

That doesn't take a night and it probably doesn't take a week. It might take a week for the 18 month old who is only breastfeeding a couple of times in 24 hours and falls asleep without the breast in his mouth - but that isn't Bob.

First steps:

While it's true that this isn't simply about milk, Bob has been having quite a lot of milk which have met a lot of his nutritional demands and provided a portion of his hydration through the day. We need to look at his diet. Is Bob confidently using a cup? Would he be able to indicate if he was thirsty? Can he help himself?

What will be Bob's sources of calcium, protein, vitamins and minerals and good quality fats? It might be that Bob enjoys drinking cow's milk but he also might really not. Does he eat dairy? He would ideally get around 300ml of full-fat cow's milk a day. If he won't drink milk, he can eat cheese and yoghurt and you can use cream and butter in cooking. He might like a yoghurt-based fruit smoothie or a milkshake. There are other sources of calcium and other minerals like green leafy vegetables, nuts and tofu. Bob doesn't need to drink a commercial formula. Full-fat cow's milk is the recommendation.

Take a moment to reflect on what his nutritional sources will be. Do some research. He's been taking a significant portion of his calories overnight so you will need to look at extra snacks and opportunities to offer food once that's gone.

Now it's time to look at sleep skills. This may be the most difficult aspect of the process so we need to address it from the beginning because it could take the longest.

Bob right now has a prop dependency - a loving and comforting prop dependency. He's using the breast to aid his drop-off to sleep and he's using it to transition between sleep cycles at night. As he moves between sleep cycles, he fully rouses and seeks the breast to help him move on to the next sleep cycle. Some babies need dummies replugged or a pat. Bob has a breast as his sleep prop. For lots of mums, this is not really something that bothers them and it can continue until it naturally fades. But if you want to wean from breastfeeding, it's a problem for you.

Night weaning

You can't end breastfeeding until you have helped Bob find a new way to sleep. If we just take breastfeeding away suddenly, it's really not very fair. This has been the way Bob has fallen asleep for a very long time. Sleep time is often when we feel the most vulnerable and when we can really get into habits.

Imagine you'd always fallen asleep by putting your head on a pillow and turning out the light and thinking peaceful thoughts and someone suddenly announces sleep isn't allowed to happen this way anymore and you have to touch your nose with your thumb while whistling the star-spangled banner. You'd quickly become distressed and angry and think the whole thing was entirely unreasonable. You literally wouldn't know how to do it.

You would probably prefer to make any transition gradually and with the support of someone you love.

A really good resource for this stage is 'The No-cry Sleep Solution for Toddlers and Pre-schoolers' by Elizabeth Pantley. You may already have read about her 'pull-off' method in her book aimed at babies. You would start a feed as normal but then resist the temptation to feed right to the end when your toddler is in a deep sleep and absolutely out for the count. You would use your little finger and break the latch just before they completely fall asleep. The first time, it really would only be seconds before. You want them to do the final drop-off from drowsy to deep sleep without the breast actually being in their mouth. You are right there but the breast has been removed. If your nursling fully rouses at this point and searches for the breast, you may gently place your hand on their chin to see if they might still settle. If not, and they wake further, you latch them back on again and try a few moments later. Then, over several nights, you would gradually detach them earlier and earlier in the process. After a while, you may feed them and after the feed they may still pretty much be awake. It has been a gentle and slow process. They learn how to fall asleep without actually sucking. What then often starts to happen is the nursling who can do the final drop-off without the breast being in their mouth is less likely to rouse between sleep cycles during the night. They semi-wake (as we all do between sleep cycles at night) but feel safe about moving onto the next sleep cycle without needing their prop.

At the same time as working on the pull-off technique, you can work on introducing a different structure for bedtime. Before you even start, you could introduce a lovey - a comfort object that could become associated with sleep and bedtime. It could be cuddled between you during night time breastfeeds. Then as the feeds start to change, the lovey is still there. You could also think about singing a little song that is your 'bedtime song'. This is a song that you initially sing during the breastfeed and as the breastfeed fades, it's a new part of your routine. It might happen during the final cuddle or if they appear to rouse and be looking for comfort. It's calm and soothing and - this is the important bit - you don't mind singing it every night for a while. If you are feeling very creative, choose a tune you know well and write your own lyrics about your day and your loved ones. Or choose a little poem and phrase that says, 'this is sleep time now'.

As the breastfeeds end, the song or the poem is still there. It remains consistent. It's the sign that it's sleep time now. You are still there and we're just removing the prop of the breast.

As your nursling finishes a breastfeed more and more awake, you've got the chance to insert other things as your new 'final stage'. You could read a story. It is sometimes said that sharing a book with your toddler is more similar to breastfeeding than offering a cup or bottle of milk. You are devoting yourself to your child. You are sharing a connection. They have your attention and a cuddle.

There are even some books on the process of weaning and night weaning that you might find useful. I don't mean books for you about technique but picture books for both of you that will usually have illustrations of jolly toddlers and rested mothers greeting the sunrise. 'Nursies when the sun shines' is a classic example.

You could also make your own book. Make a photo book using one of the online photo companies about your night weaning journey. Toddlers at this age love seeing photos of themselves and their friends and family. It could just be something as simple as saying 'goodnight' to all the things he loves. And I dare you to have 'good night mummy's boobs' on the last page. 'See you in the morning!'

So the breastfeeding moves back further. After it comes the story and the song (bored of it yet?). Then one day, breastfeeding happens in a different room and then before bath and one day, it gets dropped. Perhaps that night something exciting happens instead - a new toy in the bath, some ice cubes to play with. The breastfeed is something that he will want to get out of the way to get onto the fun stuff.

Some people prefer to leave the bedtime breastfeed as the very last one that gets dropped when full weaning happens. You may have been working on daytime feeding while this whole process was going on. The point is though that we may need to start AND finish with the weaning the bedtime feed because the process of setting up a new routine could take a while.

When a nursling wakes up in the middle of the night, we can hopefully develop new techniques that help them transition without using breastfeeding. Ideally now that we've done the pull-off, we are getting fewer night wakings but we may still see some. What else will make your toddler feel calm and safe? You may be able to use some of those techniques from bedtime. The lovey is there. You can sing your special song and use your special phrases. You may stroke and pat. You may put on a gentle piece of music or white noise. You're going to be finding your own strategies.

There may be tears. It may be tempting to offer the breast because this is too difficult to manage. You have to follow your instincts. You may discover you are not ready to wean and you can cope with just one feed at night. You may decide that some tears of frustration are going to have to happen because you are absolutely ready to end this stage of motherhood. Try and be consistent.

Daddy/partner can be a great help but you also need to develop your boob alternatives now - the way you will show physical love and give your mothering comfort.

Some 18 month olds are verbal enough that they can understand that milkies are sleeping now and they will be awake in the morning - cuddles instead.

What about weaning breastfeeds in the daytime?

Once you have broken the sleep prop, the process will get easier. You will need to ensure of course that naps can happen without breastfeeding. Now the rest of the weaning is about distraction.

We are trying to avoid the need for refusal. This is a key aspect of weaning all older nurslings. You sometimes hear the phrase ' Don't offer, Don't refuse' used as a weaning technique. It will work for everyone in the end but sometimes we need to jiggle our day around so we don't actually get to the point of being asked if we want weaning to happen more quickly.

Once we get to the point of being asked, refusal means rejection. Not just a missing out on milk but a rejection from mummy. The request and breastfeed was a way that toddler communicated with you. He asked and it happened and it was magic. It was a dialogue between you that made him feel empowered and special. Really not just about the milk.

What other things can be ask for? Make a special box of books he can request. Make a snuggly book nest with pillows and beanbags. Instead of asking for a breastfeed, he could lead you by the hand and ask for a 'book cuddle'. Or a dance? Or a big squeezy cuddle with a raspberry on his neck?

You may need to restructure your day for a while - more time outside or at activities. Perhaps meals as a picnic if he normally asks for feed at the dinner table and climbs onto your lap. Perhaps moving the special chair where he normally asks for a feed. In the morning, it's a big hug and a scoop out of bed and a race downstairs to find the little ice cube tray full of fun snacks to avoid the morning feed. Or Thomas The tank Engine says good morning in a silly voice before mummy says a word. Distraction.

You may need to get up a little earlier for a while so you've got the energy to think ahead before he wakes and starts asking.

When you see the glint in his eye that indicates an 'ask' is on its way, think imaginatively. It's really not about offering a cup of cow's milk instead.

Some toddlers will do really well with limits. Some are starting to become fascinated by counting. If you've not managed to avoid 'the ask', how about? "We'll have milkies for as long as it takes mummy to count to ten". Count as fast or as slow as you like. You are in control. Talk about what you will be doing next. If there's a big protest at the end of a feed? "OK, one more. Do you want 'count to ten' or 'count to eleven'?" He is control too.

Pre-schooler Billie

A lot of the techniques will be the same for three-year-old Billie. She'll also need to learn how to drop to sleep without the breast and transition between sleep cycles in another way. It's likely she'll have a much greater understanding of what's going on and you can talk about your plans together.

You may decide to use a token system. Each morning you could give her 2 or 3 (or however many) tokens and she can swap them for breastfeeds at any time but she won't get new tokens until tomorrow. The tokens may be plastic gold coins (that one seems a bit too 'Wolf of Wall Street' for some) or perhaps little stretchy bracelets that she wears in the day and takes off each time she wants to 'buy' a breastfeed.

Again - you are both in control. She gets to decide whether to hold on to her tokens. When she requests a feed you might talk through her decision: "Are you sure? Because that means you only have one left for tonight? It's up to you but maybe check you're really sure." You may well find she gains comfort from keeping that last one 'just in case' and it never gets used. Gradually there are fewer tokens given.

She would also be old enough to talk about a weaning party or special treat. We don't want too much emphasis on the 'you're a big girl now' stuff because that sounds pretty scary. Big girls want cuddles and mummy too - but she might be ready for something new that celebrates her moving on.

It's OK to talk about what's happening. This is her first intimate relationship and you are teaching important lessons about empathy and understanding. Mummy's milkies are getting ready to stop breastfeeding soon. We will find new ways to give cuddles and be close. A three year old may also have ideas about a cosy reading corner and a new bedtime routine.
Remember
This might not be easy but you are allowed to stop. You have given such a magical gift to your child but that doesn't mean you have to continue breastfeeding beyond a point that feels right for you. I once heard a mother of a toddler say she simply couldn't 'bear' breastfeeding anymore. She counted the seconds in her head until each feed finished and felt physically uncomfortable. Is it in that toddler's interest for his mother to carry on?

If we say mothers of older nurslings are not allowed to wean, we will be frightening people of younger children who will feel stuck on a path. We do not want a world where mothers of nine month olds are ending breastfeeding because 'it's easier when they're younger'.

Breastfeeding can continue when it's right for toddler AND mother. It can also end when it feels right.

There are forums and Facebook pages with other mums in your situation who you may be able to share your decision and your journey with. You can make up your own rules. You may decide to pause along the way. Perhaps when you have finished night-weaning, it will suddenly seem more manageable for a while. Just see how you feel.

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Weaning toddler Bob and pre-schooler Billie: how do you stop breastfeeding an older child? - Emma Pickett IBCLC

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Bob is 18 months. He is breastfeeding on demand. This usually means breastfeeding at least 6 times in 24 hours. Billie is 3 years old. She breastfeeds in the morning, at bedtime and usually once during the night. Let's imagine you are Bob or Billie's mum and you want to end breastfeeding.

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Please check with local team that this information is up to date

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Please check with local team that this information is up to date

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Please check with local team that this information is up to date

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Is your baby ready for their first foods

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Is your baby ready for their first foods

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Start For Life Offer in Lambeth & Southwark

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Start For Life Offer in Lambeth & Southwark

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Carum Breastpump Rental

Price - £49.00 for the first 14 days breastpump rental (includes delivery and collection by courier and two pumpsets).

£49 for each additional month. The breastpump rental is continuous and monthly payments are taken until a collection date is booked for the return of the pump.

The Ardo Carum Hospital Grade Breastpump for rent is delivered fully serviced and cleaned and includes two new pumpsets for single or double expressing.

Breastshells - Included with the Carum breastpump are 26mm breastshells. If you require a different size breastshell please click on the link, choose the size you require, and add it to your order. Check out the breastshell sizing guide if you are unsure.

The Carum is suitable for use from birth and is easy to operate and quiet when in use. The suction strength (vacuum) and frequency (cycle) settings can be adjusted individually and independently from one another, in stimulation and expression mode. The pump has a timer/stopwatch and a large colour display with dimmer function.

Hands-Free Pumping - you can buy specifically designed expression bras to double or single pump hands-free. There are lots of choices online to choose from. The bra makes it much easier to operate the breast pump as it securely holds the pump in place. No need to manually hold the pump to your breast, freeing up your hands for all those important tasks! For a more cost-effective option you can make your own - just take an old bra or sports bra, make some horizontal incisions and this will keep the breast shells in place, and you can be hands-free. There are hacks on YouTube for making one!

Sensitive Programme - the pump starts off with a barely detectable vacuum and cycle, which enables ultra-gentle expressing with painful, sore nipples. The settings can also be adjusted in small steps to accommodate the sensitivities of the mum. The gentle expressing programme is available as standard in every Ardo Carum.

Vacuum Seal technology - in all Ardo Pump sets provides a barrier against bacteria and ensures that no breastmilk or impurities can enter the connecting tube or pump. This provides reliable protection against contamination of the breastmilk and prevents infection. Protects Mum, Milk & Baby.

Ardo products are manufactured in Switzerland from premium-quality materials that are free from BPA, Latex and DEHP. Ardo is a trusted supplier to the NHS.
IMPORTANT - DO NOT THROW AWAY THE PACKAGING, IT MUST BE KEPT TO ENSURE THE SAFE RETURN OF THE BREAST PUMP - £10 CHARGEABLE COST FOR REPLACEMENT.

Carum breastpump unit

2 x Pumpsets with 150ml bottles and 26mm breastshells*

2 x lids with removable inserts

Rental agreement

Instructions
UK Mainland only orders (excludes NI & Islands)
*If you require a different size breastshell please click on the link, choose the size you require, and add it to your order. Check out the sizing guide on the breastshell pages if you are unsure.

For orders placed before 2 pm, Monday to Friday, choose from the following delivery options:

Orders under £20 - £4.95 tracked.

Orders over £20 FREE delivery - 2-4 days working days - not tracked.

Next working day delivery is £9.75 - tracked, however, due to incidents that may occur beyond our control we cannot offer a guarantee.

For the Scottish Highland areas, this may be a 2/3-day delivery. AB31 - AB35, AB41 - AB54, AB36 - AB38, AB55 - AB56, FK17 - FK21, IV1 - IV63, KA27, KA28, KW0 - KW14, PA20 - PA78, PH15 - PH18, PH19 - PH29, PH32 - PH33, PH45 - PH48, PH30 - PH31, PH34-44, PH49 - PH50. 2-4 Days: KW15 - KW17HS1 - HS9ZE1 - ZE3.

Saturday delivery is £17.50 - available on orders made before 2 pm on Friday.
IMPORTANT - DO NOT THROW AWAY THE PACKAGING, IT MUST BE KEPT TO ENSURE THE SAFE RETURN OF THE BREAST PUMP - £10 CHARGEABLE COST FOR REPLACEMENT.

Orders are only processed and despatched from Monday to Friday, excluding bank holidays. If you order after 2 pm on a Friday, over a weekend, or on a bank holiday your order will not be processed until the next working day.

Thank you for hiring from Ardo.

When you are ready to return your pump, please use the following link to use our Off Hire Form

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The Ardo Carum double electric rental breast pump is the latest in breast pump technology. This hospital grade breast pump is excellent for exclusively expressing mums.Carum 14 day Rental

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Download the app for breastfeeding, mental health, pregnancy and parenting support

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Pregnancy, baby and parenting

Welcome to Better Health - Start for Life.

We may have a new name and look, but don't worry, you will still find all the trusted NHS advice and guidance you need to help you have a healthy and happy baby during pregnancy, birth and parenthood.

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Get trusted NHS advice during pregnancy, birth and parenthood. Start for Life is your essential guide for having a healthy, happy baby.

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Colic is a very common condition affecting 1 in 5 babies. See our NHS-approved advice on how to soothe a colicky baby.

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Colic is a very common condition affecting 1 in 5 babies. See our NHS-approved advice on how to soothe a colicky baby.

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

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What is posseting or reflux?

Posseting is when babies bring up a small amount of milk (usually a teaspoonful) without seeming to mind (NHS start4life, 2019). Posseting is common in babies under six months old for completely normal physiological reasons and doesn't need medication.

Reflux can occur because the ring of muscle between the oesophagus (food pipe) and stomach is not fully developed. This means food or milk can travel back up the food pipe (NHS, 2019).

Some symptoms of cow's milk protein allergy can be similar to reflux symptoms, especially in babies who have eczema or asthma, or a family history of eczema or asthma (NICE, 2019).

About half of all newborn babies get reflux and it isn't usually cause for concern (Kwok, 2018; NICE, 2019). Almost nine out of every ten babies affected are better by the time they're 12 months old (Kwok, 2018; NHS, 2019; NICE, 2019). That's because over a baby's first 12 months, their digestive system naturally develops and they spend more time upright as they start to sit up(Tighe et al, 2014; NHS, 2019; NICE, 2019).

Is reflux ever a problem?

Baby reflux is different from gastro-oesophageal reflux disease (GORD), which is defined as reflux with 'troublesome symptoms or complications' (NICE, 2019).

Baby reflux signs and symptoms

Many of the common signs of baby reflux can also be signs that a baby is distressed for any number of reasons; for example, they're hungry, need a cuddle or they're cold. So it's good to remember that while there are some recognisable signs of baby reflux, this isn't necessarily a disease that needs to be medicated. Symptoms of a baby having reflux that does not need medication are:

Spitting up milk during or after feeds several times a day, which may upset them.

Hiccups.

Being mildly unsettled, crying or needing to burp after feeds.

Symptoms of GORD:

A baby arching their back and turning their head.

Pain or discomfort in your baby's chest or abdomen.

Crying for long periods and becoming irritable during and after feeds; their crying may sound hoarse.

Choking/gagging or coughing during a feed, or seeming to have a sore throat.

Frequent ear infections.

Fighting feeds or refusing to feed.

Poor weight gain.

Waking very frequently at night.

Signs of pain or discomfort when feeding.

(La Leche League GB, 2019; NHS, 2019; Raising Children, 2019)

Are some babies more likely to get reflux?

Reflux is more common among babies who were born prematurely and babies who had a low birth weight. It's also common in babies or children with some impairment of their muscles and nerves, such as cerebral palsy, or those with a cow's milk allergy (Patient, 2018).

When should you seek medical advice?

Baby reflux isn't usually a cause for concern if your baby is happy and is gaining weight. But if vomiting becomes more forceful, starts after six months of age, continues beyond a year or if your baby has any of the problems mentioned below, it's best to contact your midwife, health visitor or GP:

Spitting up feeds frequently or refusing feeds.

Coughing or gagging while feeding.

Frequent projectile vomiting (forceful vomiting that lands some distance away).

Green or yellow vomit (may be bile), or blood in vomit.

Blood in poo or persistent diarrhoea.

Excessive crying or irritability.

Swollen or tender tummy.

A high temperature of 38⁰C or above.

Not gaining weight or losing weight.

(NHS, 2019; NICE, 2019; Raising Children, 2019)

Silent reflux in babies

Sometimes babies don't spit out what comes back up but swallow it instead. Even though there isn't any spitting up, they may show other symptoms similar to reflux, such as crying or being unsettled after feeds, or having a cough or hoarse voice. In severe cases babies may have symptoms similar to GORD. This is known as 'silent reflux' and treatment is similar to that given for GORD (Today's Parent, 2018; NHS start4life, 2019).

How to help your baby's reflux

You can help ease your baby's reflux by making small changes to the way you feed them. If you talk to your midwife or health visitor about it, they might suggest the following:

Continue to breastfeed, if possible, because breastmilk is easier to digest.

Make sure your baby takes breaks during a feed. If you're bottle feeding, you could try to have a responsive/paced feeding approach.

Gently burping your baby regularly throughout feeding.

Giving your baby shorter but more frequent feeds.

Keeping your baby's head higher than their bottom during feeds.

Keeping your baby upright for a bit after feeding.

Changing your baby on their side to avoid any discomfort caused by lifting their legs up towards their stomach.

If your baby has a cow's milk protein allergy, you might need to eliminate dairy from your diet. If you are formula feeding, your doctor might suggest using special formula where the cows' milk is partially broken down.

If you formula feed your baby, your healthcare professional might suggest using a different, thickened or 'anti-reflux' formula. There is no evidence for these formula milks improving the symptoms of reflux; in some cases, they might even worsen the reflux (Kwok, 2018). These formulas need to be mixed with water at a lower temperature than recommended for standard formula, which may not be hot enough to get rid of harmful bacteria.

(First Steps Nutrition Trust, 2018; Patient, 2018; La Leche League GB, 2019; NHS, 2019)

Some parents might be advised to raise the head end of their baby's cot slightly or place a rolled up towel under the mattress. There is no scientific evidence that this works and it might increase the risk of sudden infant death syndrome (SIDS) (Lullaby Trust, 2019). There is also no evidence to support the use of different or specialised bottle teats for preventing colic or reflux (Kreitschmann, 2018).

Diagnosis and treatment

Usually, babies with reflux don't need any tests because the condition can be diagnosed based on their symptoms. Baby reflux doesn't usually need any specific treatment either but you might find the feeding suggestions above helpful. Babies who cry uncontrollably or are in obvious pain may be prescribed an anti-reflux medication (Tighe et al, 2014; NICE 2019).

Where symptoms don't improve with these adjustments, a feeding assessment to rule out other causes might be helpful. In rare cases, and if a healthcare professional thinks they might be helpful, an endoscopy, pH monitoring or barium swallow test can be done (NHS, 2019; NICE, 2019). Surgery might also be recommended for a small number of babies who have underlying medical conditions, such as cerebral palsy (NHS, 2019; NICE, 2019).

The parent's experience

If you have a baby with reflux, it can feel stressful and worrying at times. There's lots of support and information out there to help you though. You can read about other parents' experiences here.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0333 259 6180.

You might find attending one of NCT's 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.

Living with reflux is a UK non-profit for information and support for sufferers of GOR and GORD.

First Steps Nutrition Trust. (2018) Infant milks: a simple guide to infant formula, follow-on formula and other infant milks [page 7]. Available at: https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5b325b5d2b6a28fb4e3d1233/1530026845937/Infant-milks_a_simple_guide_May2018a.pdf [Accessed 26th March 2021]

Kreitschmann M, Epping LC, Hohoff A, Sauerland C, Stamm T. (2018) Sucking behaviour using feeding teats with and without an anticolic system: a randomized controlled clinical trial. BMC Pediatr. 18(1):115. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857083/ [Accessed 26th March 2021]

Kwok TC, Ojha S, Dorling J. (2018) Feed thickeners in gastro-oesophageal reflux in infants. BMJ Paediatr Open. 2(1):e000262. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045726/ [Accessed 26th March 2021]

La Leche League GB. (2017) I think my baby's got reflux. Available at: https://www.laleche.org.uk/i-think-babys-got-reflux/ [Accessed 26th March 2021]

NHS start4life. (2019) Breastfeeding challenges. Available at: https://www.nhs.uk/start4life/baby/breastfeeding/breastfeeding-challenges/reflux/# [Accessed 26th March 2021]

NHS. (2019) Reflux in babies. Available at: https://www.nhs.uk/conditions/reflux-in-babies/ [Accessed 26th March 2021]

NICE. (2019) Gastro-oesophageal reflux disease in children and young people: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng1/ifp/chapter/reflux-in-babies [Accessed 26th March 2021]

Patient. (2018) Childhood gastro-oesophageal reflux. Available at: https://patient.info/health/childhood-gastro-oesophageal-reflux-leaflet [Accessed 26th March 2021]

Raising Children. (2019) Gastro-oesophageal reflux and GORD. Available at: https://raisingchildren.net.au/guides/a-z-health-reference/reflux [Accessed 26th March 2021]

The Lullaby Trust. (2019) The best sleeping position for your baby. Available at: https://www.lullabytrust.org.uk/safer-sleep-advice/sleeping-position/ [Accessed 26th March 2021]

Tighe M, Afzal NA, Bevan A, Hayen A, Munro A, Beattie R. (2014) Pharmacological treatment of children with gastro-oesophageal reflux. Cochrane Syst Rev. (11):CD008550. Available at: https://tinyurl.com/5n7kc3dm [Accessed 26th March 2021]

Today's Parent. (2018) Symptoms and remedies for silent reflux in babies. Available at: https://www.todaysparent.com/baby/symptoms-and-remedies-for-babies-with-reflux/ [Accessed 26th March 2021]

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What is baby reflux? Symptoms and support | Baby & toddler, Feeding articles & support | NCT

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We look at posseting, reflux, gastro-oesophageal reflux disease and silent reflux in babies, with suggestions on how to help soothe your baby's symptoms

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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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Reverse Pressure Softening for Engorgement

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Some breastfeeding women feel negative emotions such as sadness, depressed mood, anxiety, irritability or anger just before their milk lets down and starts to flow. These emotions might continue for a few minutes. The feelings are usually described as either Dysphoric Milk Ejection Reflex (D-MER) or breastfeeding aversion and agitation (Aversion). The two phenomenons are similar but slightly different. Some women may feel nauseous during breastfeeding. This article looks at both D-MER and Aversion and answers frequently asked questions.

What is Dysphoric Milk Ejection Reflex (D-MER)?

D-MER is described as an abrupt drop in emotions just before milk is released from the breast by the milk ejection reflex or let-down reflex. The drop in emotions only lasts for a few minutes and is always associated with the let-down reflex. The negative feelings involved might range from feeling sad to feelings of hating oneself. Three distinct emotions are often described namely depression, anxiety and anger. The strength of these feelings varies between sufferers. D-MER is not connected to postnatal depression.

What causes D-MER?

Physiological not psychological

D-MER is thought to have a physiological cause (a physical and chemical process occurring in the body) over which there is little control. Heise and Wiessinger liken it to a reflex action that you cannot stop:

Imagine tapping your knee to cause a reflexive jerk. Now tell yourself that you are going to resist the reflex with all your will, and tap again. Does your willpower make any difference? This is precisely the problem for the mother with D-MER. The emotions are unavoidable. She can feel them coming, but cannot stop them.

Theories to explain the phenomenon include:

Drop in dopamine

One theory for the cause of the negative feelings of D-MER is a drop in dopamine (a chemical messenger released by the brain) that occurs whenever milk is released. During the let-down, dopamine may fall more than usual in some women causing a temporary deficit or they may be more sensitive to the drop in level (Heise and Wiessinger, 2011).

Oxytocin surge

Another theory suggests the sudden oxytocin surge during the let-down reflex may be the trigger.

Is there any treatment for D-MER?

Avoid stress, dehydration, caffeine

It can be useful for mothers to try and track their own symptoms against life style factors such as stress, dehydration or caffeine as these may exacerbate symptoms of D-MER. Details such as getting more rest, drinking more and having more exercise can be helpful for some mothers. Uvnas-Moberg and Kendall-Tackett explain how lowering stress levels to make the mother feel comfortable and safe might be helpful:

A clean and orderly environment can be helpful in downregulating a mother's stress response-have music the mother enjoys, with a comfortable place to sit, and nice things to look at. Warmth also triggers the oxytocin response. Give the mother a hot pack around her shoulders, or suggest that she soak her feet in warm water. The goal is to use the mother's environment to help her feel comfortable and safe.

Dopamine

Dopamine is an important hormone and messenger (neurotransmitter) in the body. An information sheet on Alia Macrina Heise's Dysphoric Milk Ejection Reflex website discusses prescription treatment for severe cases of D-MER in the form of dopamine supporting medications.

Skin to skin contact

Skin-to-skin contact between mother and baby is another way to increase oxytocin and reduce stress in mother and baby. The power of skin to skin contact may help override the negative feelings of D-MER (Uvnas-Moberg and Kendall-Tackett. 2018).

Mindfulness

Being aware of negative thoughts and focussing on one's breathing is part of mindfulness and may be helpful to cope with the emotions of D-MER. Uvnas-Moberg and Kendall-Tackett explain:

With mindfulness, mothers focus on their breathing, are in the present moment, and treat themselves with compassion. They remind themselves that the negative thoughts they are experiencing are thoughts, not facts. Patient education about the symptoms can also be helpful, so mothers know what these symptoms are and that they will go away soon.

Nutrition and self care

One case study showed that increasing protein in the mother's diet and not pumping beyond her baby's immediate needs helped alleviate symptoms (Uvnas-Moberg and Kendall-Tackett. 2018)

Where can I get help and support?

Most women with D-MER usually find that their symptoms gradually reduce, sometimes disappearing as time goes on but for others symptoms do not completely disappear until their baby is weaned and they are no longer breastfeeding. Finding out as much as possible about D-MER and seeking help and support can make D-MER more manageable. Many mothers find knowing that the phenomenon has a name and has a physiological cause is helpful (Heise, 2011). Three good places for assistance include the D-MER.org website, the book Before The Letdown: Dysphoric Milk Ejection Reflex and a Facebook support group run by Alia Macrina Heise.

Excerpt From

Breastfeeding and Human Lactation, 6e, Wambach and Spencer, 2021

Clinicians can support women with D-MER in several ways; often, simply knowing that it is a recognised phenomenon makes the condition tolerable.

Breastfeeding aversion and agitation

Breastfeeding aversion involves the nursing mother feeling negative emotions. The reasons why are not known and more research is needed. A website dedicated to breastfeeding aversion collated by Zainab Yate explains:

Breastfeeding / Nursing Aversion & Agitation (BAA) is a phenomenon whereby breastfeeding / pumping mothers experience negative emotions triggered whilst breastfeeding, these include anger, rage, agitation and irritability. Women also struggle with an 'overwhelming urge to de-latch', and often a skin itching sensation. BAA or 'aversion' can be experienced by any breastfeeding (or even pumping) person, at any stage of their feeding journey, and it varies in onset, severity and duration.

Anecdotal ideas to help with breastfeeding aversion are listed on Zainab's website. These include making sure baby's attachment at the breast is as good as possible, distracting oneself with other activities during breastfeeding, getting enough sleep, making sure you have enough time for yourself away from breastfeeding and ensuring you have drunk enough and are eating well. For some mothers a hormonal imbalance can trigger the aversion. Finding peer to peer support from others who experience BAA can also be helpful.

Nausea

Feeling nauseous (as if one might be sick) during breastfeeding is not common but may be due to high levels of oxytocin and other hormones active during the let-down reflex. .

Allergic to breastfeeding?

There are occasional case reports in the literature of mothers noticing physical symptoms with breastfeeding similar to those experienced with allergy for example rashes, itching or shortness of breath. The severe form of this occurrence is known as breastfeeding induced anaphylaxis or lactation anaphylaxis and can be managed with antihistamines.

Lawrence and Lawrence also discuss less dramatic rashes/hives (urticaria) associated with the let-down reflex which can be managed with antihistamines or low dose corticosteroids. The reactions are thought to be associated with the let-down (when milk is ejected from the breast), a time when the hormones oxytocin and prolactin are released. However the direct cause of the symptoms is not known and more research is needed.

Summary

Dysphoric Milk Ejection Reflex or D-MER, is a collection of negative emotions-anxiety, depression, anger-experienced by some breastfeeding mothers just before they have a milk let-down (milk ejection reflex). These feelings last for a few minutes. The cause is thought to be due to a sudden drop in dopamine during let down which can affect susceptible women. There are a number of treatments available that can help. Other negative states experienced by some nursing mothers include breastfeeding aversion and agitation or nausea. Very rarely, a mother can experience an allergic reaction to breastfeeding.

Footnotes & References

1. Is D-MER Real: Does Breast Milk Letdown Really Cause Depression? Heather Turgeon, 2011

2. Wambach and Spencer. Breastfeeding and Human Lactation. 2021 p. 262

3. Lawrence and Lawrence. Breastfeeding A Guide for the Medical Profession. 8e. 2016 p 619

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Some breastfeeding women feel negative emotions when they breastfeed. This article looks at both D-MER and Aversion and answers frequently asked questions.

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Dual Expression Hospital Grade Breast Pump Rental

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Take the stress out of purchasing a breast pump by using our breast pump rental service. Originally designed for hospital use, we are now able to offer the Ameda Elite Breast Pump for mothers to rent and use within the comfort of their own homes. A safe and effective way of expressing and storing milk for when you are unable to breastfeed, making life a little less complicated.

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Take the stress out of purchasing a breast pump by using our breast pump rental service.

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Hospital Grade Breast Pump Rental

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Rent your hospital grade Symphony Breast Pump from Medela today! Hospitals number 1 choice for expressing breast milk. Used in 75% of UK maternity hospitals.

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Help and Support

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There's been a bit of conversation about tongue tie on social media after the Loose Women episode that highlighted the challenges experienced by Stacey Solomon

We've heard from a lot of women that the feedback that Stacey received on air didn't match their understanding of tongue tie. So we wanted to help clear up any confusion and point mums in the right direction if they need support.

A tongue tie can restrict normal tongue movement in babies and can lead to breastfeeding difficulties. This can include being unable to attach to the breast, or staying attached, pain while feeding and slow weight gain. Some babies can feed without difficulties, others may find feeding easier after a frenotomy.

The key to identifying and dealing with tongue tie is accessing support from somebody appropriately skilled and well informed as soon as possible - such as your local infant feeding team.

Another good place to start is National Breastfeeding Helpline on 0300 100 0212, which is open 9.30am - 9.30pm every single day of the year. Your call will be answered by highly trained volunteers, who are also mums with personal breastfeeding experience.

For more information on tongue tie:
https://www.nhs.uk/conditions/tongue-tie/ https://www.laleche.org.uk/tongue-tie/ https://www.breastfeedingnetwork.org.uk/sams-story-and-ton.../ https://www.tongue-tie.org.uk/ https://www.unicef.org.uk/babyfriend.../support-for-parents/.../ https://gpifn.org.uk/tongue-tie/

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Help and Support on Tongue Tie - The Breastfeeding Network

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There's been a bit of conversation about tongue tie on social media after the Loose Women episode that highlighted the challenges experienced by Stacey Solomon We've heard from a lot of women that the feedback that Stacey received on air didn't match their understanding of tongue tie.

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Tongue Tie oral motor and body exercises

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Tongue Tie oral motor and body exercises

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Tongue tie oral motor and body exercises for young baby

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Suck training exercises for the older baby

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

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

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Read more for support for parents on tongue-tie

Many babies have a piece of membrane under their tongue (the frenulum) which does not usually cause problems. Tongue-tie (ankyloglossia) occurs when the frenulum is abnormally short, stopping the tip of the tongue from protruding beyond the lower gum. This may cause problems with feeding as a result of the inability to move the tongue in a normal way and therefore attach and suck effectively. The frenulum may reach the tip of the tongue and be easily seen, and may be either thin and stretchy or thicker/tighter. A posterior frenulum, which is at the back of the tongue, can be less easy to see and in some cases may only be felt. If you and/or your baby are experiencing feeding difficulties, an assessment of your baby's tongue function and a feeding assessment by a specially trained professional will determine whether a division of the membrane ( frenulotomy) could help.

Many tongue-ties are asymptomatic and do not require treatment, and some may resolve spontaneously over time. In some instances, support to improve attachment is all that is needed. However, if the condition is causing problems with feeding, surgical division of the lingual frenulum can be recommended and carried out as early as possible. This may enable the mother to continue breastfeeding rather than having to switch to artificial feeding.
NICE has approved the division of tongue-tie.

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Many babies have a piece of membrane under their tongue (the frenulum) which does not usually cause problems. Tongue-tie (ankyloglossia) occurs when the frenulum is abnormally short, stopping the tip of the tongue from protruding beyond the lower gum.

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How do you stop breastfeeding an older child

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How do you stop breastfeeding an older child

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Emma Pickett IBCLC

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Billie is 3 years old. She breastfeeds in the morning, at bedtime and usually once during the night. Bob is 18 months. He is breastfeeding on demand. This usually means breastfeeding at least 6 times in 24 hours.
Let's imagine you are Bob or Billie's mum and you want to end breastfeeding.

First, let's take a moment to check this is a decision you are happy about. Am I going to try to talk you out of it? Nope.

I breastfed both my children until they self-weaned and I speak to mothers breastfeeding toddlers every day. I know it isn't for everyone.
You get to choose when you stop.
If you are in the tiny minority of mothers breastfeeding well into the second year and beyond, that is something to be celebrated and praised and baton-twirled.

The job of the breastfeeding support community is to enable each mother to reach her own breastfeeding goals. When it comes to breastfeeding an older child, we are allowed to listen to our own maternal instincts. Not everyone's maternal instincts tell them the same thing.

However this is an important decision so let's do a few checks.
Are you ending breastfeeding because you want to conceive again and you believe weaning will be necessary?
If you are 100% confident with your decision, feel free to skip to the row of asterisks.

Every woman's fertility responds differently to breastfeeding. To conceive, we need oestrogen levels to rise again and ovulation to occur and then we need the womb to receive a fertilised egg and give it enough chance to hang around and implant properly. Most women do not need breastfeeding to end completely for this to happen. However most of us do need at least one gap of 5-6 hours without any breastfeeding in 24 hours.

It might be worth experimenting with night weaning or extending intervals in order to trigger your period before ending breastfeeding entirely if you'd rather not. Get familiar with your cervical fluid (or as my friend Sarah Panzetta, a fertility expert, calls it, 'your lady liquid') and get a sense of what it's likely to look like when you ovulating (stretchy and egg-whitey). Some people are told they need to wean from breastfeeding in order to start another round of IVF. That is a very difficult and personal decision.
Are you ending breastfeeding because you need to take medication and the doctor says you have to?
We can probably say that is likely that you would be maximising your chances of conceiving by ending breastfeeding. You may still decide you'd rather continue breastfeeding.
Are you ending breastfeeding because someone else is putting pressure on you?
Check. Many many women are told this inaccurately. In the UK, the Breastfeeding Network is a great source of information - both their medication factsheets and the 'drugs in breastmilk' helpline. You can also check with LactMed or the resources (book and website) of Dr. Thomas Hale. There are many lactation consultants available through Twitter who would be happy to check for you.

Is this someone who you feel has a right to comment on your body and what you choose to do with it? Is it someone who you feel has as much right to make decisions about your child's health and happiness as you do? If you answer yes to both of those questions, then you may feel you want to listen.

However, you should also feel you have the right to explain very clearly why this matters to you and carry on. You have the right to continue even though other adults in your life are uncomfortable. Just because we live in a society which squirms at the idea of breastfeeding older children, it doesn't mean a push into unhappy weaning is the 'right' opinion. You have science on your side.

This is a decision you will live with for a very long time. You have invested a huge amount in making breastfeeding work up until now. For many women, it has taken literal blood, sweat and tears. You have spent hours and hours and hours breastfeeding. One day, decades from now, you may be a grandmother and breastfeeding will be part in your world again. Wouldn't it be great to look back with no regrets and know that you stopped breastfeeding at a time that was absolutely right for you?
Are you ending breastfeeding because you aren't getting enough sleep?
Your nursling can't speak up. If you are being pressured to wean when you don't want to, you may need to be brave and speak up for them.

One possibility is to night wean and see how that feels. It may enable you to continue breastfeeding for longer than you imagined you would. You can follow the suggestions below and pause at any point in the process.

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So we're going to try and wean Bob. He's breastfeeding a lot. He breastfeeds in the morning and at naptime. He falls asleep breastfeeding at the beginning of the night and breastfeeds during the night several times. He uses the breast for comfort when he feels sad or shy. It's the first thing he wants when he falls over. When you sit together on the sofa, he wiggles over and lifts your shirt with a big smile on his face. He loves it all.

Have you done anything wrong by parenting this way up until now? No, you have not. You have followed your instincts and met his needs and what a lucky little bloke Bob is.

This is clearly going to be tough and Bob may be sad but YOU ARE STILL ALLOWED TO WEAN. This is your choice and you will be able to make it happen with the minimum amount of upset if you are sensitive and careful.

Some things to bear in mind before we start:

This is not about milk - completely. This is about YOU. Bob is connecting with you and being as close to you as he possibly can. He is feeling safe and loved and cosy and warm. Your milk still contains immunological properties and Vitamin A and protein and all the other useful things. However Bob's breastfeeding behaviour is about security and love and not much about Vitamin A.

So don't offer milk in a bottle or sippy cup instead and not in response to a request to breastfeed. Don't offer milk in a cup at bedtime instead of that connection with you. That's like you asking a loved one for a hug and he gives you a sausage roll. You may be a big fan of sausage rolls but right then, in that context, that's a rejection.

We need to talk about ways of trying to avoid the 'rejections'. It may not be entirely possible but we want to minimise them as much as possible.

Don't offer another person instead. Does it seem entirely logical that at the moment we are pulling bits of ourselves away from our nursling, we pull our entire self away?

Does it seem logical to leave your toddler for a night or longer just to wean from breastfeeding when breastfeeding was about connecting with you as much as the milk?

We need to show that you are still there and you are still very much there for connecting - just not at the nipply bits.

You will still be there at bedtime when he feels scared and vulnerable. You will still be there for comfort. You will be there for him when he's going through this really tough transition of losing breastfeeding. Does it seem sensible to pull yourself away when he's potentially going to be losing something that really matters? You are the person he really needs to help him through this.

Of course partners and dads are a key part of this process but in addition to mum - not instead of. I hope daddy/partner is part of the bedtime process and able to comfort your child. I'm just not sure it's brilliantly sensible for you to be stepping away and leaving them entirely to it.

Together - all 3 of you (mum, partner and nursling) - you will be making new routines and patterns and developing a new parenting language.
First steps:
That doesn't take a night and it probably doesn't take a week. It might take a week for the 18 month old who is only breastfeeding a couple of times in 24 hours and falls asleep without the breast in his mouth - but that isn't Bob.

While it's true that this isn't simply about milk, Bob has been having quite a lot of milk which have met a lot of his nutritional demands and provided a portion of his hydration through the day. We need to look at his diet. Is Bob confidently using a cup? Would he be able to indicate if he was thirsty? Can he help himself?

What will be Bob's sources of calcium, protein, vitamins and minerals and good quality fats? It might be that Bob enjoys drinking cow's milk but he also might really not. Does he eat dairy? He would ideally get around 300ml of full-fat cow's milk a day. If he won't drink milk, he can eat cheese and yoghurt and you can use cream and butter in cooking. He might like a yoghurt-based fruit smoothie or a milkshake. There are other sources of calcium and other minerals like green leafy vegetables, nuts and tofu. Bob doesn't need to drink a commercial formula. Full-fat cow's milk is the recommendation.

Take a moment to reflect on what his nutritional sources will be. Do some research. He's been taking a significant portion of his calories overnight so you will need to look at extra snacks and opportunities to offer food once that's gone.

Now it's time to look at sleep skills. This may be the most difficult aspect of the process so we need to address it from the beginning because it could take the longest.
Night weaning
Bob right now has a prop dependency - a loving and comforting prop dependency. He's using the breast to aid his drop-off to sleep and he's using it to transition between sleep cycles at night. As he moves between sleep cycles, he fully rouses and seeks the breast to help him move on to the next sleep cycle. Some babies need dummies replugged or a pat. Bob has a breast as his sleep prop. For lots of mums, this is not really something that bothers them and it can continue until it naturally fades. But if you want to wean from breastfeeding, it's a problem for you.

You can't end breastfeeding until you have helped Bob find a new way to sleep. If we just take breastfeeding away suddenly, it's really not very fair. This has been the way Bob has fallen asleep for a very long time. Sleep time is often when we feel the most vulnerable and when we can really get into habits.

Imagine you'd always fallen asleep by putting your head on a pillow and turning out the light and thinking peaceful thoughts and someone suddenly announces sleep isn't allowed to happen this way anymore and you have to touch your nose with your thumb while whistling the star-spangled banner. You'd quickly become distressed and angry and think the whole thing was entirely unreasonable. You literally wouldn't know how to do it.

You would probably prefer to make any transition gradually and with the support of someone you love.

A really good resource for this stage is 'The No-cry Sleep Solution for Toddlers and Pre-schoolers' by Elizabeth Pantley. You may already have read about her 'pull-off' method in her book aimed at babies. You would start a feed as normal but then resist the temptation to feed right to the end when your toddler is in a deep sleep and absolutely out for the count. You would use your little finger and break the latch just before they completely fall asleep. The first time, it really would only be seconds before. You want them to do the final drop-off from drowsy to deep sleep without the breast actually being in their mouth. You are right there but the breast has been removed. If your nursling fully rouses at this point and searches for the breast, you may gently place your hand on their chin to see if they might still settle. If not, and they wake further, you latch them back on again and try a few moments later. Then, over several nights, you would gradually detach them earlier and earlier in the process. After a while, you may feed them and after the feed they may still pretty much be awake. It has been a gentle and slow process. They learn how to fall asleep without actually sucking. What then often starts to happen is the nursling who can do the final drop-off without the breast being in their mouth is less likely to rouse between sleep cycles during the night. They semi-wake (as we all do between sleep cycles at night) but feel safe about moving onto the next sleep cycle without needing their prop.

At the same time as working on the pull-off technique, you can work on introducing a different structure for bedtime. Before you even start, you could introduce a lovey - a comfort object that could become associated with sleep and bedtime. It could be cuddled between you during night time breastfeeds. Then as the feeds start to change, the lovey is still there. You could also think about singing a little song that is your 'bedtime song'. This is a song that you initially sing during the breastfeed and as the breastfeed fades, it's a new part of your routine. It might happen during the final cuddle or if they appear to rouse and be looking for comfort. It's calm and soothing and - this is the important bit - you don't mind singing it every night for a while. If you are feeling very creative, choose a tune you know well and write your own lyrics about your day and your loved ones. Or choose a little poem and phrase that says, 'this is sleep time now'.

As the breastfeeds end, the song or the poem is still there. It remains consistent. It's the sign that it's sleep time now. You are still there and we're just removing the prop of the breast.

As your nursling finishes a breastfeed more and more awake, you've got the chance to insert other things as your new 'final stage'. You could read a story. It is sometimes said that sharing a book with your toddler is more similar to breastfeeding than offering a cup or bottle of milk. You are devoting yourself to your child. You are sharing a connection. They have your attention and a cuddle.

There are even some books on the process of weaning and night weaning that you might find useful. I don't mean books for you about technique but picture books for both of you that will usually have illustrations of jolly toddlers and rested mothers greeting the sunrise. 'Nursies when the sun shines' is a classic example.

You could also make your own book. Make a photo book using one of the online photo companies about your night weaning journey. Toddlers at this age love seeing photos of themselves and their friends and family. It could just be something as simple as saying 'goodnight' to all the things he loves. And I dare you to have 'good night mummy's boobs' on the last page. 'See you in the morning!'

So the breastfeeding moves back further. After it comes the story and the song (bored of it yet?). Then one day, breastfeeding happens in a different room and then before bath and one day, it gets dropped. Perhaps that night something exciting happens instead - a new toy in the bath, some ice cubes to play with. The breastfeed is something that he will want to get out of the way to get onto the fun stuff.

Some people prefer to leave the bedtime breastfeed as the very last one that gets dropped when full weaning happens. You may have been working on daytime feeding while this whole process was going on. The point is though that we may need to start AND finish with the weaning the bedtime feed because the process of setting up a new routine could take a while.

When a nursling wakes up in the middle of the night, we can hopefully develop new techniques that help them transition without using breastfeeding. Ideally now that we've done the pull-off, we are getting fewer night wakings but we may still see some. What else will make your toddler feel calm and safe? You may be able to use some of those techniques from bedtime. The lovey is there. You can sing your special song and use your special phrases. You may stroke and pat. You may put on a gentle piece of music or white noise. You're going to be finding your own strategies.

There may be tears. It may be tempting to offer the breast because this is too difficult to manage. You have to follow your instincts. You may discover you are not ready to wean and you can cope with just one feed at night. You may decide that some tears of frustration are going to have to happen because you are absolutely ready to end this stage of motherhood. Try and be consistent.

Daddy/partner can be a great help but you also need to develop your boob alternatives now - the way you will show physical love and give your mothering comfort.
What about weaning breastfeeds in the daytime?
Some 18 month olds are verbal enough that they can understand that milkies are sleeping now and they will be awake in the morning - cuddles instead.

Once you have broken the sleep prop, the process will get easier. You will need to ensure of course that naps can happen without breastfeeding. Now the rest of the weaning is about distraction.

We are trying to avoid the need for refusal. This is a key aspect of weaning all older nurslings. You sometimes hear the phrase ' Don't offer, Don't refuse' used as a weaning technique. It will work for everyone in the end but sometimes we need to jiggle our day around so we don't actually get to the point of being asked if we want weaning to happen more quickly.

Once we get to the point of being asked, refusal means rejection. Not just a missing out on milk but a rejection from mummy. The request and breastfeed was a way that toddler communicated with you. He asked and it happened and it was magic. It was a dialogue between you that made him feel empowered and special. Really not just about the milk.

What other things can be ask for? Make a special box of books he can request. Make a snuggly book nest with pillows and beanbags. Instead of asking for a breastfeed, he could lead you by the hand and ask for a 'book cuddle'. Or a dance? Or a big squeezy cuddle with a raspberry on his neck?

You may need to restructure your day for a while - more time outside or at activities. Perhaps meals as a picnic if he normally asks for feed at the dinner table and climbs onto your lap. Perhaps moving the special chair where he normally asks for a feed. In the morning, it's a big hug and a scoop out of bed and a race downstairs to find the little ice cube tray full of fun snacks to avoid the morning feed. Or Thomas The tank Engine says good morning in a silly voice before mummy says a word. Distraction.

You may need to get up a little earlier for a while so you've got the energy to think ahead before he wakes and starts asking.

When you see the glint in his eye that indicates an 'ask' is on its way, think imaginatively. It's really not about offering a cup of cow's milk instead.
Pre-schooler Billie
Some toddlers will do really well with limits. Some are starting to become fascinated by counting. If you've not managed to avoid 'the ask', how about? "We'll have milkies for as long as it takes mummy to count to ten". Count as fast or as slow as you like. You are in control. Talk about what you will be doing next. If there's a big protest at the end of a feed? "OK, one more. Do you want 'count to ten' or 'count to eleven'?" He is control too.

A lot of the techniques will be the same for three-year-old Billie. She'll also need to learn how to drop to sleep without the breast and transition between sleep cycles in another way. It's likely she'll have a much greater understanding of what's going on and you can talk about your plans together.

You may decide to use a token system. Each morning you could give her 2 or 3 (or however many) tokens and she can swap them for breastfeeds at any time but she won't get new tokens until tomorrow. The tokens may be plastic gold coins (that one seems a bit too 'Wolf of Wall Street' for some) or perhaps little stretchy bracelets that she wears in the day and takes off each time she wants to 'buy' a breastfeed.

Again - you are both in control. She gets to decide whether to hold on to her tokens. When she requests a feed you might talk through her decision: "Are you sure? Because that means you only have one left for tonight? It's up to you but maybe check you're really sure." You may well find she gains comfort from keeping that last one 'just in case' and it never gets used. Gradually there are fewer tokens given.

She would also be old enough to talk about a weaning party or special treat. We don't want too much emphasis on the 'you're a big girl now' stuff because that sounds pretty scary. Big girls want cuddles and mummy too - but she might be ready for something new that celebrates her moving on.

It's OK to talk about what's happening. This is her first intimate relationship and you are teaching important lessons about empathy and understanding. Mummy's milkies are getting ready to stop breastfeeding soon. We will find new ways to give cuddles and be close. A three year old may also have ideas about a cosy reading corner and a new bedtime routine.

This might not be easy but you are allowed to stop. You have given such a magical gift to your child but that doesn't mean you have to continue breastfeeding beyond a point that feels right for you. I once heard a mother of a toddler say she simply couldn't 'bear' breastfeeding anymore. She counted the seconds in her head until each feed finished and felt physically uncomfortable. Is it in that toddler's interest for his mother to carry on?

If we say mothers of older nurslings are not allowed to wean, we will be frightening people of younger children who will feel stuck on a path. We do not want a world where mothers of nine month olds are ending breastfeeding because 'it's easier when they're younger'.

Breastfeeding can continue when it's right for toddler AND mother. It can also end when it feels right.

There are forums and Facebook pages with other mums in your situation who you may be able to share your decision and your journey with. You can make up your own rules. You may decide to pause along the way. Perhaps when you have finished night-weaning, it will suddenly seem more manageable for a while. Just see how you feel.

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Weaning toddler Bob and pre-schooler Billie: how do you stop breastfeeding an older child?

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Billie is 3 years old. She breastfeeds in the morning, at bedtime and usually once during the night. Bob is 18 months. He is breastfeeding on demand. This usually means breastfeeding at least 6 times in 24 hours. Let's imagine you are Bob or Billie's mum and you want to end breastfeeding.

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Is my baby getting enough milk

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A common concern of a new mother is whether her baby is getting enough milk. This video shows signs to tell whether the baby is feeding well. About the Breastfeeding Series " DOWNLOAD

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding success and what a mother can do to deeply attach her baby to her breast.

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Attaching Your Baby at the Breast - Video - Global Health Media Project

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding

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The way a mother holds her baby affects how easy it is for her baby to feed effectively. This video shows basic points important for any position and then demonstrates several common positions that have worked well for many mothers and babies.

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Positions for Breastfeeding - Video - Global Health Media Project

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The way a mother holds her baby affects how easy it is for her baby to feed effectively. This video shows basic points important for any position and then demonstrates several common positions that have worked well for many mothers and babies.

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It is now widely recognised that what happens in the first 1001 days of life are incredibly important. Children's brains develop fastest and are at their most 'plastic' or adaptable in the womb and early years of life. During this time, many millions of neural connections are made and then pruned. This builds the architecture of the brain upon which other forms of development will rest.

Babies' development is strongly influenced by their experiences of the world. These are shaped by their primary caregivers (usually their parents). Parent-infant relationships are vitally important.

" Young children experience their world as an environment of relationships, and these relationships affect virtually all aspects of their development."

Babies are reliant on parents to respond to their needs. Parents who are tuned-in and able to respond to babies' needs sensitively in an appropriate and timely way, support their early development in profound ways:

Parents' responses shape how babies experience their emotions and how they learn to regulate and express these emotions. If someone responds sensitively to a baby when they cry, for example, the baby learns that they matter, that they can rely on their parents to help them when they are upset, and how difficult emotions can be brought under control.

When babies receive appropriate comfort and care, they can feel safe and begin to explore the world around them, to play and learn.

When parents provide positive, playful interactions, and when they engage in play and activities such as singing and reading to their baby, this provides stimulation that helps a child to learn and develop.

Nurturing relationships begin before birth. The foetal brain is developing rapidly during pregnancy and is influenced by the physical environment of the mothers' womb, and the environment beyond it. Babies can experience adversity in the womb. For example, where domestic abuse is occurring, research shows that babies' stress regulation systems adapt accordingly, leaving them more responsive to threat but consequently more irritable and difficult to settle once they are born.

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Building Babies' Brains - Parent-Infant Foundation

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Early relationships between babies and their parents are incredibly important for building healthy brains The first 1001 days of life, from conception to age two, is a time of unique opportunity and vulnerability. It is a period of particularly rapid growth, when the foundations for later development are laid. "The...

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Free breastfeeding support and a space for friendship.                  Fridays 10am - 12pm  

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StartWell @ SE5 - breastfeeding support in Southwark

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StartWell @ SE5 - breastfeeding support in Southwark

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A mother may sometimes notice blisters or white spots on her nipples during breastfeeding. Friction blisters and blocked nipple pores (milk blisters or blebs) are the most common causes. This article discusses the types of blisters or white spots on nipples that a breastfeeding mother may encounter and gives ideas to avoid or resolve them. Contacting your health professional will help confirm the cause of the white spot or blister if you are not sure.

Friction blisters

A clear blister or red/brown "blood blister" on the nipple is usually caused by friction or high vacuum just like a blister anywhere else on the body. Possible reasons for friction blisters on nipples include:

A shallow latch. If a baby is not attached (latched) deeply on the breast with plenty of breast tissue in their mouth as well as the nipple it is called a "shallow latch". If a baby is in a shallow latch, there is more chance for the mother's nipple to rub against the roof of her baby's mouth and cause a blister at the point of contact. See our articles Breastfeeding Positions for Newborns and Latching Tips for help to improve your baby's positioning and attachment, or find a breastfeeding expert to help you.

A poorly fitted nipple shield or pump flange. Blisters on nipples may also form from a badly fitted nipple shield or pump.

Differences in anatomy preventing a deep latch. Individual anatomy such as a larger nipple, flat nipple or a baby with a small mouth or restricted tongue function can make it more difficult for a baby to get a deeper more comfortable latch and blisters may be more likely.

Once the source of the friction has been found and corrected, blisters should quickly heal on their own. If a blister bursts before it has healed beneath and you have sore broken skin on your nipple check out Treatments for Sore Nipples and Kelly Bonyata has some Healing Tips for Nipple Cracks or Abrasions.

Milk blisters or blebs

If thickened milk or a thin layer of skin blocks one of the openings of the nipple, it may cause a white spot on the nipple. This is often called a bleb or milk blister. A bleb that doesn't hurt may disappear on its own in a few weeks or months. But if the bleb is stopping milk flow it can cause pain or be associated with engorgement or mastitis.

A bleb is a little white spot on the tip of a nipple that looks as if there's milk stuck in a nipple pore. Maybe there's a bit of skin over the surface of it, maybe not. Maybe there's a plugged duct in your breast behind it, maybe not. but it can hurt when your baby nurses, like squeezing a pimple. Ow! When you get rid of a a bleb, the contents may come out as little granules that you can feel between your fingers, or as a tiny ribbon like toothpaste. Or it may just disappear during a nursing (going harmlessly into the baby). Once it's gone, any backed-up milk generally clears quickly.

Treatment

The Womanly Art of Breastfeeding has lots of ideas to free the blockage including making the plug smaller with vinegar, softening the nipple pore, opening the skin over the pore and treating the plug higher up. The authors suggest washing once a day with soap and water and using a little antibiotic ointment for a few days may be helpful:

Make the plug smaller. Soak a cotton ball in vinegar and wear it over your nipple inside a bra. Milk has a lot of calcium in it, and vinegar dissolves calcium deposits.

Make the nipple pore softer. Soak in the tub or shower, then soak a cotton ball in water, olive oil, or canola oil (corn or peanut oil could encourage allergies) and wear it in your bra over your nipple. Putting some gentle heat over the cotton ball-a sock filled with rice and heated in the microwave, for instance-may help. Or soak your nipple in a cup of warm water to which you've added 2 teaspoons (10g) of Epsom salts. Then see if nursing, gentle manipulation, or pressure from behind will squeeze the thickened milk out.

Open the skin over the pore. You can ask your health care provider to open it gently with a sterile needle, or do it yourself with a well-sterilised (in a candle flame, for instance) needle. Pick carefully at it from the side; that top layer of skin should have no feeling in it, but the skin underneath may be sensitive. You can use sterile tweezers to peel back any tiny flaps of skin that cover the opening. Manipulate your nipple or have your baby nurse to remove the bleb.

Stubborn cases

Nipple blebs may be an inflammatory reaction to nipple damage in some women. In Are There Any Cures for Sore Nipples? Marsha Walker discusses a study that looked at blebs that didn't respond to traditional treatment. In this study the author recommended a short course of a mid range topical steroid to penetrate into the inflamed tissue around the bleb .

Sometimes the cause of the nipple bleb could be associated with a blocked duct deeper in the breast see Blocked Milk Duct for ideas for treating a blocked duct.

White nipple spots that aren't blebs?

There can be other causes of white spots on nipples including a build up of dead skin or a wound; for example saliva and milk moisture under the skin from baby biting the nipple.

Thrush and white spots?

Occasionally thrush (a fungal infection) may look like little white blisters on the nipple. Check with your Health Professional and find further reading in our Thrush on Nipples article. Kelly Bonyata discusses how thrush can occasionally cause milk blisters in the following article:

Thrush (yeast), can also cause milk blisters. Thrush occasionally appears as tiny white spots on the nipple, but can also appear as larger white spots that block one or more milk ducts. If you have more than one blister at the same time, suspect thrush as the cause. Yeast is often accompanied by a "burning" pain, and the pain tends to be worse after nursing or pumping (whereas a plugged duct generally feels better after the breast has been emptied).

Herpes simplex viruses 1 (cold sores) and 2 (genital herpes)

Herpes could cause blisters on the nipple. Symptoms of herpes include small, painful, fluid filled, red-rimmed blisters containing viral material that dry after a few days and form a scab. As these viruses are spread by simply touching the sores, it is important that your baby doesn't come into contact with them. Observe careful hygiene to protect your baby. Lesions can appear anywhere on the body including the breast e.g. genital herpes sores can be spread by touching the sores and then touching the breast. If the sores (blisters) are on your nipple or close by your nipple this will mean avoiding breastfeeding from that breast until they heal. For more information see Herpes and Breastfeeding.

Summary

Blisters on nipples or white spots on nipples during breastfeeding can have a number of causes. A regular friction blister may be caused by a poorly fitted nipple shield or pump flange or if the nipple is rubbing inside baby's mouth (usually due to a shallow latch). White spots on nipples may be due to thickened milk or a thin layer of skin blocking a nipple pore-often called a bleb or milk blister. A thrush infection or the herpes virus are also possible causes of blisters on nipples. Your health professional will help diagnosis the nature of a white spot or blister and your breastfeeding expert can offer ideas to avoid them in future if they are caused by positioning or breastfeeding gadgets. For more possible reasons for sore nipples see Causes of Sore Nipples.

Excerpts from The Womanly Art of Breastfeeding reproduced by permission from Pinter & Martin.

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Blisters on Nipples - Breastfeeding Support

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A mother may sometimes notice blisters or white spots on her nipples during breastfeeding. Friction blisters and blocked nipple pores (milk blisters or blebs) are the most common causes. This article discusses the types of blisters or white spots on nipples that a breastfeeding mother may encounter and gives ideas to avoid or resolve them.

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Lymphatic Massage in pregnancy and when breastfeeding

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Lymphatic Massage in pregnancy and when breastfeeding

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Can I Breastfeed In It? 31,014 likes · 8 talking about this. To help breastfeeding women find clothing which is not only practical but also fashionable! Companion to the Can I Breastfeed In It? UK...

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Find out about mastitis, including what the symptoms are, how to treat it and why it happens.

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Breast milk is made and stored in small milk producing sacs (alveoli) in the breast and delivered to the nipple via little tubes (milk ducts). When a baby begins to breastfeed, release of the hormone oxytocin triggers the let down reflex which causes the cells around the alveoli to contract forcing breast milk into the milk ducts towards the nipple. Milk is released through the holes in the nipple (nipple pores). This article looks at the phenomenon of a "blocked milk duct" that is associated with breast inflammation and how to prevent and relieve it.

What is a blocked milk duct?

In the past a blocked (or plugged) milk duct has been described as one through which milk can't flow due to a blockage of some kind such as a plug or clog of milk leading to local engorgement of milk. Newer thinking moves away from the idea of thickened milk blocking a milk duct. Instead it is thought that excess milk in the breast causes inflamed and swollen breast tissue that can surround and close a duct. Some authors also hypothesise that ducts can narrow from an overgrowth of pathogenic bacteria in the breast coined "mammary dysbiosis" (ABM, 2022) but others say there is no evidence at all for this theory (Douglas, Vol 18: 1-20 2022).

Whatever the exact cause, if an area of the breast becomes engorged this can press on and narrow other ducts close by-creating a local blockage and slower milk flow from that area of the breast. A useful comparison can be to liken this to a traffic jam; once heavy traffic blocks the main road into the town centre, all roads leading to the town will quickly be affected. Once milk is not flowing in one area of the breast it can quickly become uncomfortably engorged and affect a wider area, and, if this is not relieved, it could develop into mastitis.

Causes of a blocked milk duct

Blocked milk duct is a type of breast inflammation along with engorgement and mastitis and is caused in the same way. Anything that hinders milk flowing easily from all areas of the breast (ie good breast drainage) could cause breast inflammation e.g. poor positioning (the way baby is held to breastfeed) and latch (the way baby attaches to the breast), a tight bra or shoulder bag/back pack strap pressing on breast tissue, or even breastfeeding to a schedule instead of on demand. Previous breast surgery, scar tissue, a finger pressing into the breast, nipple piercing or a blocked nipple pore could also cause blocked ducts (breast inflammation).

Preventing a blocked milk duct

Ideas to prevent blocked milk ducts include:

Check that breast milk can flow freely from all areas of the breast-a baby's position and latch are important as they can help or hinder this. Contact a breastfeeding specialist if breastfeeding is not comfortable and pain free or you have any concerns about positioning and attachment.

Breastfeed at frequent intervals on demand and avoid long periods without feeding or expressing-see How Often Should a Newborn Feed?

Let your baby finish the first breast first before offering the second side but do not try to stay on one breast to "reach the hindmilk"

Check nothing is cutting into the breast such as tight clothing, a finger, poorly fitted bras-including nighttime bras, or whether baby carriers, slings or heavy bags are causing any pressure on the breast.

Signs of a blocked milk duct

Symptoms of a blocked milk duct often include local pain and tenderness in the breast in the engorged area. If close to the surface of the breast, there may be an obvious breast lump due to a build up of milk. The mother will usually feel well in herself and won't have a temperature unless the breast inflammation has progressed to mastitis. Some mothers notice that milk expressed from "blocked areas" may look like strings of spaghetti and mucus may also be present and some may observe milk with lumps in it. Theories for thickened milk are described further in Mastitis Symptoms and Treatment.

How to clear a blocked milk duct

Since engorgement, blocked duct and mastitis are all stages of breast inflammation, management strategies are the same for them all. However not all authors agree on best practice and more research is needed to arrive at a consensus. Most practitioners agree with the following strategies:

Feed your baby often to keep milk flowing, at least every two hours (Douglas, Vol 18: 1-20 2022; Mitchell et al, 2022). If baby isn't breastfeeding, hand express or pump frequently instead. If milk won't seem to flow and the breast is very hard and engorged see Engorgement Relief When Milk Won't Flow.

Check your baby is latching deeply (has a big mouthful of breast tissue as well as the nipple in their mouth) and is emptying the breast thoroughly (Douglas, Vol 18: 1-20 2022; Mitchell et al, 2022). A lactating breast is never truly empty so in practice this means removing or draining most of the available milk until you are comfortable again. If you're not sure about this contact an IBCLC lactation consultant for help.

Don't over pump (regularly pump more milk than your baby needs) as this could worsen the engorgement (Mitchell et al, 2022)

Check whether you have a blocked nipple pore-a bleb or milk blister-on your nipple which is contributing to or causing the blocked milk duct. A bleb may be an inflammatory response to nipple trauma, see Blisters on Nipples for more information.

Cold therapy. If there is a lot of accompanying engorgement, heat can bring more swelling to the area whereas cold therapy between breastfeeds, can reduce pain, swelling and inflammation. See Engorged Breasts for more information about using cold compresses to relieve pain and engorgement.

Pain relief. There are medications compatible with breastfeeding that can be taken for pain or to help reduce inflammation where needed. The Breastfeeding Network has a fact sheet discussing pain killers and breastfeeding. However, one author notes that over dependence on medications to bring down a fever can interfere with the body's own mechanisms to down regulate the inflammatory response (Douglas, Vol 18: 1-20 2022).

Rest. It's important to look after yourself, rest where possible, and remember to eat and drink.

Check with a health professional and breastfeeding specialistifthere is no improvement in symptoms after 24-48 hours (Newman, 2017), and be vigilant for signs of mastitis.

Strategies over which some practitioners disagree include:

Trying unusual breastfeeding positions to help clear the blockage. Unusual positions such as kneeling on all fours to feed a baby lying flat on the floor (dangling the breast over the baby), or having the baby's chin pointing towards the blockage are often suggested to help mothers. Trying different positions may help mothers whose regular feeding position is suboptimal however Mitchell et al say the unusual positions highlighted are not evidence-based and may be unsafe (Mitchell et al, 2022) while Douglas states they could worsen inflammation (Douglas, Vol 18: 1-20 2022).

Warmth. Some mothers find it helpful to use warm compresses or a heated pad over the blocked milk duct either just before a breastfeed/before pumping or during a breastfeed/pumping session. Lactation consultant and author Marsha Walker mentions combining a warm compress with direct massage over the blocked area during a breastfeed. Note that although warmth can provide pain relief it can also widen blood vessels and worsen symptoms (Mitchell et al, 2022; Douglas, Vol 18: 1-20 2022).

Lecithin. Lecithin is an oily substance which is said to help prevent blocked ducts when taken as a dietary supplement by the mother. It is said to reduce the constituency (thickness) of breast milk and therefore the tendency for milk to thicken in the ducts. However the idea of thickened milk as a cause of blocked ducts has fallen out of favour, and Dr Tom Hale of Hale's Medications and Mothers' Milk [paywall] says lecithin would be broken down in the stomach and intestines long before being absorbed. Lawrence and Lawrence mention rubbing lecithin into the nipple after feeds if there are blocked nipple pores (sometimes called blebs or milk blisters) If considered, Dr Jack Newman, a Canadian paediatrician and breastfeeding author, discusses a dose of 1200mg four times a day (Newman. 2017) while authors Wambach and Spencer mention 1600mg lecithin daily (Wambach and Spencer, 2021, p 283). See below and Best Breastfeeding Diet and Foods to Avoid for more on diet and inflammation.

Gentle breast massage before or during breastfeeding/pumping is sometimes advocated to help release milk. While natural breast movement or "breast gymnastics" are generally accepted as helpful, too much pressure or rough handling could cause further damage or inflammation to the breast tissue. Some practitioners advise against massage altogether (Douglas, Vol 18: 1-20 2022). If used, a massage should only involve the same kind of finger tip pressure used when applying a lotion or moisturising cream. Different authors advocate slightly different approaches to massage, see below for a discussion of these and for more information see Engorged Breasts and Nursing Bras FAQ.

Applying steady pressure or breast compression to the area with the blocked duct (hard lumpy area) during a breastfeed or pumping session may help to release milk (Newman, 2017) but care must be taken not to increase inflammation by vigorous handling of the delicate breast tissue and some practitioners are not in favour of this strategy (Douglas, Vol 18: 1-20 2022).

Massage techniques

Not everyone agrees with using breast massage techniques to provide relief for a blocked duct or engorgement (Douglas, Vol 18: 1-20 2022). If used, it is very important to be gentle and not bruise or further inflame breast tissue by rough handling or vigorous deep massage. Techniques sometimes suggested include:

Lymphatic breast drainage therapy

The lymphatic system is a waste drainage system for the body. Gentle massage of the lymphatic drainage system in the breast is said to help redistribute excess fluids that are unrelated to milk, moving them towards the lymphatic drainage system via the arm pits (Walker, 2017). This is thought to help relieve severe engorgement or blocked ducts and assist milk to flow. Lactation consultant (and breast surgeon) Katrina Mitchell has developed a handout Lymphatic Massage in Breastfeeding showing how to do this type of massage using very light touch circular movements similar to that used to stroke a cat.

Therapeutic breast massage

This is a type of massage useful for engorged breasts involving a combination of techniques. Lymphatic breast drainage is used to help move fluid towards the armpits alongside alternating massage and hand expression. Maya Bolman and Ann Witt of Breastfeeding Medicine of Northeast Ohio discuss therapeutic breast massage in lactation (TBML) in the clip below. A mother can sit up as in the video, or she may find lying on her back to do the massage is more effective.

Wide toothed comb

Using a wide toothed comb to gently stroke/massage the affected breast is sometimes suggested and has helped some mothers. This is thought to improve circulation and reduce congestion similar to the traditional art of gua-sha therapy.

Cicular movements

The following clip from Global Health Media discusses using circular hand movements on the breast from the armpit to the nipple to help clear a blocked duct (watch from 3:00 to 5:00)

Six step recanalization manual therapy (SSRMT)

Zhao et al. describe a six step manual therapy for resolving blocked ducts. This involves preparing the breast to widen the ducts and unblock any nipple pores (steps one to four) and then relieving the congestion by manual therapy to expel blocked milk from the ducts (steps five and six). The six steps together are said to take five minutes per breast with the authors reporting good results... out of 3497 women with plugged ducts 98.5% responded positively to the treatment.

1. Preparation. Wash hands and have clean towels and a clean collection container available

2. Nipple pores. Check the nipples for any blocked nipple pores. Wipe with a dry towel to remove any dried milk or flakes of skin. Stretch the nipple as needed to facilitate the process.

3. Nipple manipulation. Hold and lift the nipple to stimulate the let down of milk (milk ejection reflex)

4. Push and press the areola from different directions

5. Push and knead the breast from the base towards the nipple (milk will spurt from the nipple if this is successful!)

6. Check the breast thoroughly section by section for engorged areas (milk stasis).

Further ideas for persistent blocked milk ducts

Ultrasound and other therapies

Mogensen et al discuss the possibility of using ultrasound to treat blocked milk ducts and engorgement and share a suggested ultrasound frequency, intensity and duration of treatment. Therapeutic ultrasound is thought to act as a deep-heating agent that can increase cell activity, reduce pain and increase circulation (Mogensen et al, 2020). However Douglas says there is no evidence to support the use of therapeutic ultrasound for breast inflammation (Douglas, Vol 18: 1-20 2022).

Some mothers have tried to mimic the effects of ultrasound with the vibrations from the flat end of an electric toothbrush held against the blocked duct (Newman, 2017) but mechanical gadgets could damage delicate breast tissue and increase bruising or inflammation. Mogensen et al also discuss other physical therapy techniques such as kinesiology taping, and the traditional Chinese medicine technique of cupping therapy (Mogensen et al, 2020).

Probiotics and vitamin C

Vitamin C and probiotic supplements are sometimes mentioned as possibly helping the mother who suffers from blocked ducts or mastitis. See Mastitis Symptoms and Treatment and Vitamin C and Breastfeeding for more information.

Recurring blocked milk ducts

Sometimes a mother may find she keeps getting the symptoms of blocked milk ducts or mastitis, no sooner has one episode cleared than another takes its place. As with recurring mastitis, there are a number of risk factors to be aware of that can increase your chances of recurring breast inflammation:

Poor positioning and/or a shallow latch (with or without sore nipples) leading to poor breast drainage

Oversupply of breast milk

Restricting breastfeeds to a schedule instead of on demand

Using a nipple shield if it affects how well milk is removed from the breast

Using a breastfeeding pillow if it is interfering with good positioning

Previous breast surgery includingbreast reduction surgery, breast implants, a biopsy, nipple piercing or any scarring in the breast

A previous episode of mastitis that hasn't cleared properly

Diet. Breast inflammation may be associated with a diet that is high in refined sugars and/or a diet that is very high in omega 6 fatty acids compared with anti-inflammatory omega 3 fatty acids.

Stress , exhaustion or fatigue (Lawrence, 2016)

A mother who has allergies may be more susceptible to blocked milk ducts. And, if a baby has allergies/tummy ache this may increase the chance of blocked ducts or mastitis due to a suboptimal feeding technique.

Immunoglobulin A deficiency was linked with blocked ducts in one study.

A breastfeeding specialist is the ideal person to help identify causes of recurring mastitis and see the section "Recurrent mastitis" in Mastitis Symptoms and Treatment for further discussion of treatment ideas.

If your blocked milk duct is still there...

A blocked milk duct that isn't getting better after several days of trying the ideas above should be checked with your doctor for a firm diagnosis. If any engorgement is not relieved this could lead to mastitis or even to an abscess if left unchecked. Some breast lumps might not be blocked milk ducts after all e.g. a galactoceole is a milk cyst-your doctor can help with a diagnosis. Most medical tests for diagnosis are compatible with breastfeeding. Work with your doctor and IBCLC lactation consultant to help solve your breast inflammation and prevent it from returning.

Summary

Breast milk is carried to the nipple by tiny tubes or milk ducts. Inflamed breast tissue around the ducts could narrow or close them making it difficult for milk to flow freely and create engorgement. Treatment for a blocked milk duct is the same as for mastitis or engorgement; to prioritise milk removal from the breast and keep milk flowing. If a blocked milk duct isn't cleared promptly within a few days, check with your health care professional for a firm diagnosis. A blocked duct could lead to painful engorgement and mastitis.

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Breast milk is made and stored in small milk producing sacs (alveoli) in the breast and delivered to the nipple via little tubes (milk ducts). When a baby begins to breastfeed, release of the hormone oxytocin triggers the let down reflex which causes the cells around the alveoli to contract forcing breast milk into the milk ducts towards the nipple.

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More than mild engorgement in the breasts is usually a sign that the breastfeeding is not going very well. It is due to the combination of milk stasis (the milk is not coming out) and oedema (swelling due to water retention in the area). Severe engorgement about the third or fourth day after the baby is born can usually be prevented by getting the baby latched on well and drinking well from the very beginning. See the information sheets Breastfeeding-Starting Out Right and The Importance of Skin to Skin Contact, and Protocol for Managing Breastmilk Intake. See also nbci.ca for videos to help use the Protocol for Managing Breastmilk Intake. If you do become engorged, please understand that engorgement goes away within 1 or 2 days even without any treatment, but can be uncomfortable during that time. Massaging the breasts in a downward motion is not recommended as a treatment for engorgement. Continue to breastfeed the baby, making sure he gets on well and nurses well and the engorgement will resolve. However, if you should get engorged to the point where the baby is not able to take the breast, or if there is more than minimal discomfort in the breast and/or areola (the coloured part surrounding the nipple), then there is a simple way to temporarily move swelling away from the areola:

How to do REVERSE PRESSURE SOFTENING

Developed by K. Jean Cotterman RNC-E, IBCLC

Try this if pain, swelling, or fullness creates problems during the early days of learning to breastfeed. The key is making the areola very soft right around the base of the nipple, for better latching.

A softer areola protects the nipple deep in baby's mouth helping his tongue remove milk better. Mothers say curved fingers work best. (Fig. 1 or 2)

Press inward toward the chest wall and count slowly to 50.

Pressure should be steady and firm, and gentle enough to avoid pain.

If mom wishes, someone else may help, using thumbs (Fig. 5).

(For long fingernails, try another way shown below.)

If breasts are quite large or very swollen, count very slowly, with mom lying down on her back. This delays return of swelling to the areola, giving more time to latch.

Soften the areola right before each feeding (or pumping) till swelling goes away. For some mothers, this takes 2-4 days.

Make any pumping sessions short, with pauses to re-soften the areola if needed.

Use medium or low vacuum, to reduce the return of swelling into the areola.

Cabbage Leaves and Compresses

Cabbage leaves may also be used to help decrease the engorgement, as can ice packs and cold compresses. Some studies suggest cabbage may accomplish this more quickly. If you are unable to get the baby latched on, start cabbage leaves, start expressing your milk, and give the expressed milk to the baby by spoon, cup, finger feeding or eyedropper and get help quickly.

1. Use green cabbage

2. Crush the cabbage leaves with a rolling pin if the leaves do not take the shape of your breast.

3. Wrap the cabbage leaves around the breast and leave on for about 20 minutes. Twice daily is enough. It is usual to use the cabbage leaf treatment less than two or three times. Some will say to use the cabbage leaves after each feeding and leave them on until they wilt. Some are concerned that using them too often will decrease the milk supply

4. Stop using as soon as engorgement is beginning to go away and you are becoming more comfortable.

5. You can use acetaminophen (Tylenol™, others) with or without codeine, ibuprofen, or other medication for pain relief. As with almost all medications, there is no reason to stop breastfeeding when taking analgesics

6. Ice packs also can be helpful

7. Some women get a large lump in the armpit about 3 or 4 days after the baby's birth. Cabbage leaves may be used in that area as well to help the lump go away.

Epsom salts

(Please note: We have not had much experience with this approach but have heard some good things about it. We include it to provide an alternative to the above). (This technique is adapted from handout Patient's Treatment for Engorgement, by A. Stolz, with notes from Lawrence, R; Ingle, B; Hunt, A)

The breasts may be soaked in a tub or basin of epsom salts for a few minutes to help with engorgement.

1. Fill a small container or basin with warm water, deep enough that the breast can be submerged (You may need about 1 litre of water, or more).

2. Place 1-2 handfuls (what fits into the palm of the hand or about 30 to 60 grams), of Epsom's salts crystals (magnesium sulphate, MgSO4) and dissolve before putting the breast in the water

3. Mother can lean over the basin so her breasts soak in the solution

4. This should not be painful and any cuts or trauma can be covered with All Purpose Nipple Ointment

5. Leave soaking in very warm water until water is cool or at least 5-10 minutes

6. Wash off solution with plain water after, to wash away salty taste for baby

7. The salts may act as a diuretic for excess fluids in the breast

8. Repeat before each feed or 3 or more times a day as Mother wishes

9. Usually good results can be felt in 24 hours

10. Mother can do this treatment for up to 3 days if desired

The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don't know what this means, please email us to ask!

©IBC, updated July 2009

Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.

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International BreastFeeding Centre | How to prevent and treat breast engorgement after birth

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Breast engorgement after birth can and should be prevented. Often due to overly enthusiastic infusions of fluids to the woman in labour and after birth, a method to treat is shown. It is best to avoid significant engorgement by getting the baby breastfeeding well.

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By Kelly Bonyata, BS, IBCLC

What is Normal?

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

How to prevent or minimize engorgement

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

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

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

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

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

Signs & Symptoms of Engorgement

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

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

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

You may also have a low-grade fever.

Moms' experiences of engorgement differ. Engorgement:

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

May occur in one or both breasts;

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

Tips for treating engorgement

Before nursing

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

Cool compresses for up to 20 minutes before nursing.

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

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

While nursing

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

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

Between feedings

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

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

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

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

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

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

Cabbage leaf compresses can also be helpful.

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

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

AVOID:

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

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

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

Contact your lactation consultant or health care provider if:

Engorgement is not relieved by these measures.

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

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

You have any questions.

Other treatments for engorgement

Cabbage

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

What are cabbage compresses used for?

Engorgement.

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

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

Sprains or broken bones, to reduce swelling.

To use cabbage leaves:

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

Wash cabbage leaves and apply to breasts between feedings.

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

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

For further information on how to use cabbage leaves:

"Juice Jar" breast pump

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

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

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

Pour all the water out of the jar.

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

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

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

Repeat for the other breast.

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

Fenugreek seed poultice

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

Additional Resources

@

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

@ other websites

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

References:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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New Mastitis Management Information from BFN

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New Mastitis Management Information from BFN

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Written by Jack Newman, MD, FRCPC

Some of the molecules and cells in human milk actively help infants stave off infection.

Doctors have long known that infants who are breast-fed contract fewer infections than do those who are given formula. Until fairly recently, most physicians presumed that breast-fed children fared better simply because milk supplied directly from the breast is free of bacteria. Formula, which must often be mixed with water and placed in bottles, can become contaminated easily. Yet even infants who receive sterilized formula suffer from more meningitis and infection of the gut, ear, respiratory tract and urinary tract than do breast-fed youngsters.

The reason, it turns out, is that mother's milk actively helps newborns avoid disease in a variety of ways. Such assistance is particularly beneficial during the first few months of life, when an infant often cannot mount an effective immune response against foreign organisms. And although it is not the norm in most industrial cultures, UNICEF and the World Health Organization both advise breast-feeding to "two years and beyond." Indeed, a child's immune response does not reach its full strength until age five or so.

All human babies receive some coverage in advance of birth. During pregnancy, the mother passes antibodies to her fetus through the placenta. These proteins circulate in the infant's blood for weeks to months after birth, neutralizing microbes or marking them for destruction by phagocytes-immune cells that consume and break down bacteria, viruses and cellular debris. But breast-fed infants gain extra protection from antibodies, other proteins and immune cells in human milk.

Once ingested, these molecules and cells help to prevent microorganisms from penetrating the body's tissues. Some of the molecules bind to microbes in the hollow space (lumen) of the gastrointestinal tract. In this way, they block microbes from attaching to and crossing through the mucosa-the layer of cells, also known as the epithelium, that lines the digestive tract and other body cavities. Other molecules lessen the supply of particular minerals and vitamins that harmful bacteria need to survive in the digestive tract. Certain immune cells in human milk are phagocytes that attack microbes directly. Another set produces chemicals that invigorate the infant's own immune response.

Breast Milk Antibodies

Antibodies, which are also called immunoglobulins, take five basic forms, denoted as IgG, IgA, IgM, IgD and IgE. All have been found in human milk, but by far the most abundant type is IgA, specifically the form known as secretory IgA, which is found in great amounts throughout the gut and respiratory system of adults. These antibodies consist of two joined IgA molecules and a so-called secretory component that seems to shield the antibody molecules from being degraded by the gastric acid and digestive enzymes in the stomach and intestines. Infants who are bottle-fed have few means for battling ingested pathogens until they begin making secretory IgA on their own, often several weeks or even months after birth.

The secretory IgA molecules passed to the suckling child are helpful in ways that go beyond their ability to bind to microorganisms and keep them away from the body's tissues. First, the collection of antibodies transmitted to an infant is highly targeted against pathogens in that child's immediate surroundings. The mother synthesizes antibodies when she ingests, inhales or otherwise comes in contact with a disease-causing agent. Each antibody she makes is specific to that agent; that is, it binds to a single protein, or antigen, on the agent and will not waste time attacking irrelevant substances. Because the mother makes antibodies only to pathogens in her environment, the baby receives the protection it most needs-against the infectious agents it is most likely to encounter in the first weeks of life.

Second, the antibodies delivered to the infant ignore useful bacteria normally found in the gut. This flora serves to crowd out the growth of harmful organisms, thus providing another measure of resistance. Researchers do not yet know how the mother's immune system knows to make antibodies against only pathogenic and not normal bacteria, but whatever the process may be, it favors the establishment of "good bacteria" in a baby's gut.

Secretory IgA molecules further keep an infant from harm in that, unlike most other antibodies, they ward off disease without causing inflammation-a process in which various chemicals destroy microbes but potentially hurt healthy tissue. In an infant's developing gut, the mucosal membrane is extremely delicate, and an excess of these chemicals can do considerable damage. Interestingly, secretory IgA can probably protect mucosal surfaces other than those in the gut. In many countries, particularly in the Middle East, western South America and northern Africa, women put milk in their infants' eyes to treat infections there. I do not know if this remedy has ever been tested scientifically, but there are theoretical reasons to believe it would work. It probably does work at least some of the time, or the practice would have died out.

An Abundance of Helpful Molecules

Several molecules in human milk besides secretory IgA prevent microbes from attaching to mucosal surfaces. Oligosaccharides, which are simple chains of sugars, often contain domains that resemble the binding sites through which bacteria gain entry into the cells lining the intestinal tract. Thus, these sugars can intercept bacteria, forming harmless complexes that the baby excretes. In addition, human milk contains large molecules called mucins that include a great deal of protein and carbohydrate. They, too, are capable of adhering to bacteria and viruses and eliminating them from the body.

The molecules in milk have other valuable functions as well. Each molecule of a protein called lactoferrin, for example, can bind to two atoms of iron. Because many pathogenic bacteria thrive on iron, lactoferrin halts their spread by making iron unavailable. It is especially effective at stalling the proliferation of organisms that often cause serious illness in infants, including Staphylococcus aureus. Lactoferrin also disrupts the process by which bacteria digest carbohydrates, further limiting their growth. Similarly, B12 binding protein, as its name suggests, deprives microorganisms of vitamin B12. Bifidus factor, one of the oldest known disease-resistance factors in human milk, promotes the growth of a beneficial organism named Lactobacillus bifidus. Free fatty acids present in milk can damage the membranes of enveloped viruses, such as the chicken pox virus, which are packets of genetic material encased in protein shells. Interferon, found particularly in colostrum-the scant, sometimes yellowish milk a mother produces during the first few days after birth-also has strong antiviral activity. And fibronectin, present in large quantities in colostrum, can make certain phagocytes more aggressive so that they will ingest microbes even when the microbes have not been tagged by an antibody. Like secretory IgA, fibronectin minimizes inflammation; it also seems to aid in repairing tissue damaged by inflammation.

Cellular Defenses

As is true of defensive molecules, immune cells are abundant in human milk. They consist of white blood cells, or leukocytes, that fight infection themselves and activate other defense mechanisms. The most impressive amount is found in colostrum. Most of the cells are neutrophils, a type of phagocyte that normally circulates in the bloodstream. Some evidence suggests that neutrophils continue to act as phagocytes in the infant's gut. Yet they are less aggressive than blood neutrophils and virtually disappear from breast milk six weeks after birth. So perhaps they serve some other function, such as protecting the breast from infection.

The next most common milk leukocyte is the macrophage, which is phagocytic like neutrophils and performs a number of other protective functions. Macrophages make up some 40 percent of all the leukocytes in colostrum. They are far more active than milk neutrophils, and recent experiments suggest that they are more motile than are their counterparts in blood. Aside from being phagocytic, the macrophages in breast milk manufacture lysozyme, increasing its amount in the infant's gastrointestinal tract. Lysozyme is an enzyme that destroys bacteria by disrupting their cell walls.

In addition, macrophages in the digestive tract can rally lymphocytes into action against invaders. Lymphocytes constitute the remaining 10 percent of white cells in the milk. About 20 percent of these cells are B lymphocytes, which give rise to antibodies; the rest are T lymphocytes, which kill infected cells directly or send out chemical messages that mobilize still other components of the immune system. Milk lymphocytes seem to behave differently from blood lymphocytes. Those in milk, for example, proliferate in the presence of Escherichia coli, a bacterium that can cause life-threatening illness in babies, but they are far less responsive than blood lymphocytes to agents posing less threat to infants. Milk lymphocytes also manufacture several chemicals-including gamma-interferon, migration inhibition factor and monocyte chemotactic factor-that can strengthen an infant's own immune response.

Added Benefits

Several studies indicate that some factors in human milk may induce an infant's immune system to mature more quickly than it would were the child fed artificially. For example, breast-fed babies produce higher levels of antibodies in response to immunizations. Also, certain hormones in milk (such as cortisol) and smaller proteins (including epidermal growth factor, nerve growth factor, insulinlike growth factor and somatomedin C) act to close up the leaky mucosal lining of the newborn, making it relatively impermeable to unwanted pathogens and other potentially harmful agents. Indeed, animal studies have demonstrated that postnatal development of the intestine occurs faster in animals fed their mother's milk. And animals that also receive colostrum, containing the highest concentrations of epidermal growth factor, mature even more rapidly.

Other unknown compounds in human milk must stimulate a baby's own production of secretory IgA, lactoferrin and lysozyme. All three molecules are found in larger amounts in the urine of breast-fed babies than in that of bottle-fed babies. Yet breast-fed babies cannot absorb these molecules from human milk into their gut. It would appear that the molecules must be produced in the mucosa of the youngsters' urinary tract. In other words, it seems that breast-feeding induces local immunity in the urinary tract.

In support of this notion, recent clinical studies have demonstrated that the breast-fed infant has a lower risk of acquiring urinary tract infections. Finally, some evidence also suggests that an unknown factor in human milk may cause breast-fed infants to produce more fibronectin on their own than do bottle-fed babies.

All things considered, breast milk is truly a fascinating fluid that supplies infants with far more than nutrition. It protects them against infection until they can protect themselves.

Further Reading

Slade HB, Schwartz SA. Mucosal immunity: the immunology of breast milk.
J Allergy Clin Immunol 1987 Sep;80(3 Pt 1):348-58.

Immunology of Milk and the Neonate. Edited by J. Mestecky et al. Plenum Press, 1991.

Cunningham AS, Jelliffe DB, Jelliffe EF. Breast-feeding and health in the 1980s: a global epidemiologic review. J Pediatr 1991 May;118(5):659-66.

Goldman AS. The immune system of human milk: antimicrobial, antiinflammatory and immunomodulating properties. Pediatr Infect Dis J 1993 Aug;12(8):664-71.

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How Breast Milk Protects Newborns * KellyMom.com

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Doctors have long known that infants who are breast-fed contract fewer infections than do those who are given formula. Until fairly recently, most physicians presumed that breast-fed children fared better simply because milk supplied directly from the breast is free of bacteria. Formula, which must often be mixed with water and placed in bottles, can become contaminated easily.

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Why you might want to put the baby books down

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Why you might want to put the baby books down

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Prof Amy Brown

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School of Health & Social Care, Swansea University

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Why you might want to put the baby books down...

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This video looks at both the theory and practice of relationship building and responsive breastfeeding, supporting families to get their relationship with their baby off to the best start.

Hear mothers and professionals give tips and advice on what it can mean to have a close and loving relationship with your new baby.

Find more relationship building resources

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Breastfeeding and relationships in the early days video - Baby Friendly Initiative

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Baby Friendly's video on breastfeeding and relationship building covers views and tips from both mothers and health professionals.

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Recent News: Dutch researchers find Covid-19 antibodies in human milk

'We think when drinking the milk, the antibodies attach themselves to the surface of our mucous membranes,' Hans van Goudoever, head of the Emma children's hospital at the UMC, said. 'Then they attack the virus particles before they force their way into the body.' The UMC has now started a campaign to find 1,000 women who are willing to donate 100ml of breast milk for the research project. 'Women who may have had coronavirus without noticing it may also have made antibodies which can be found in milk,'

Here you'll find references and research supporting the information in the advert.

"Nature has been researching your milk for hundreds of millions of years"

"Your milk contains ingredients that kill cancerous cells"

"Your milk contains stem cells. These are cells that create and repair the body, and are being researched worldwide to cure conditions like Alzheimers and diabetes."

"Your body identifies bacteria and viruses found in your baby's body and environment. You then produce antibodies specifically tailored for those infections, and deliver them to your baby through your milk. The more milk she drinks, the more antibodies she receives."

"Your milk appears to switch on a gene in your baby's body, which produces a hormone called Leptin. This hormone tells your baby when his tummy is full, protecting him against over eating."

"Your milk contains Oxytocin, a hormone that induces relaxation, and feelings of well-being in your child and in you."

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The science of human milk and breastfeeding

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Skin-to-skin contact is a key part of the UNICEF UK Baby Friendly Initiative standards. It helps babies adjust to life outside the womb and supports mothers to initiate breastfeeding and develop close, loving relationships with their baby.

What is skin-to-skin contact?

Skin-to-skin contact is usually referred to as the practice where a baby is dried and laid directly on the mother's bare chest after birth, both of them covered in a warm blanket and left for at least an hour or until after the first feed. Skin-to-skin contact can also take place any time a baby needs comforting or calming and can help boost a mother's milk supply. Skin-to-skin contact is vital in neonatal units where it is often known as 'kangaroo care'. Here it helps parents bond with their baby and supports better physical and developmental outcomes for the baby.

Why is skin-to-skin contact important?

There is a growing body of evidence that skin-to-skin contact after the birth helps babies and their mothers. The practice:

calms and relaxes both mother and baby

regulates the baby's heart rate and breathing, helping them to better adapt to life outside the womb

stimulates digestion and an interest in feeding

regulates temperature

enables colonisation of the baby's skin with the mother's friendly bacteria, thus providing protection against infection

stimulates the release of hormones to support breastfeeding and mothering.

Skin-to-skin contact also provides benefits for babies in the neonatal unit, in that it:

improves oxygen saturation

reduces cortisol (stress) levels, particularly following painful procedures

encourages pre-feeding behaviour

assists with growth

may reduce hospital stay

improves milk volume if the mother expresses following a period of skin-to-skin contact, with the expressed milk containing the most up-to-date antibodies.

What happens during skin-to-skin contact?

When a mother holds her baby in skin-to-skin contact after birth, it initiates strong instinctive behaviours in both. The mother will experience a surge of maternal hormones and begin to smell, stroke and engage with her baby. Babies' instincts after birth will drive them to follow a unique process, which if left uninterrupted will result in them having a first breastfeed. If they are enabled to familiarise themselves with their mother's breast and achieve self-attachment, it is very likely that they will recall this at subsequent feeds, resulting in fewer breastfeeding problems.

After birth, babies who are placed skin-to-skin on their mother's chest will:

briefly cry a very distinctive birth cry

enter a stage of relaxation where they display very little movement as they recover from the birth

start to wake up, opening their eyes and showing some response to their mother's voice

begin to make small movements of the arms, shoulders and head; as these movements increase, the baby will draw up their knees and appear to move or crawl towards the breast

often rest once they have found the breast (this can often be mistaken as the baby not being hungry or not wanting to feed)

begin to familiarise with the breast after a period of rest, perhaps by nuzzling, smelling and licking around the area (this familiarisation period can last for some time and is important, so should not be rushed; try to remain patient and allow the baby to work out how to best attach themselves)

self-attach and begin to feed (it may be that mother and baby need a little help with positioning at this stage)

come off the breast once they have had a chance to suckle for a period of time. Following this, often both mother and baby will fall asleep.

Most term healthy babies will follow this process, providing it is not interrupted by anything, for example taking the baby away to weigh or the mother going for a shower. Interrupting the process before the baby has completed this sequence or trying to hurry them through the stages may lead to problems at subsequent breastfeeds. If the mother has been given a lot of analgesia during labour, the baby may be drowsy and this process can take longer.

Skin-to-skin contact in the Baby Friendly standards

The Baby Friendly standards require that skin-to-skin contact is valued and supported in hospitals.

Maternity units are required to ensure that:

all mothers have skin-to-skin contact with their baby after birth, at least until after the first feed and for as long as they wish

all mothers are encouraged to offer the first feed in skin contact when the baby shows signs of readiness to feed

mothers and babies who are unable to have skin contact immediately after birth are encouraged to commence skin contact as soon as they are able, whenever or wherever that may be.

Neonatal units are required to ensure that:

parents have a conversation with an appropriate member of staff as soon as possible about the importance of touch, comfort and communication for their baby's health and development

parents are actively encouraged to provide comfort and emotional support for their baby, including prolonged skin contact, comforting touch and responsiveness to their baby's behavioural cues

mothers receive care that supports the transition to breastfeeding, including the use of skin-to-skin contact to encourage instinctive feeding behaviour.

Safety considerations

Vigilance of the baby's well-being is a fundamental part of postnatal care immediately following and in the first few hours after birth. For this reason, normal observations of the baby's temperature, breathing, colour and tone should continue throughout the period of skin-to-skin contact in the same way as would occur if the baby were in a cot (this includes calculation of the Apgar score at 1, 5 and 10 minutes following birth). Care should always be taken to ensure that the baby is kept warm. Observations should also be made of the mother, with prompt removal of the baby if the health of either gives rise to concern.

Staff should have a conversation with the mother and her companion about the importance of recognising changes in the baby's colour or tone and the need to alert staff immediately if they are concerned.

It is important to ensure that the baby cannot fall on to the floor or become trapped in bedding or by the mother's body. Mothers should be encouraged to be in a semi-recumbent position to hold and feed their baby. Particular care should be taken with the position of the baby, ensuring the head is supported so the infant's airway does not become obstructed
Notes - Mothers

Observations of the mother's vital signs and level of consciousness should be continued throughout the period of skin-to-skin contact. Mothers may be very tired following birth and so may need constant support and supervision to observe changes in their baby's condition or to reposition their baby when needed.

Many mothers can continue to hold their baby in skin-to-skin contact during perineal suturing, providing they have adequate pain relief. However, a mother who is in pain may not be able to hold her baby safely. Babies should not be in skin-to-skin contact with their mothers when they are receiving Entonox or other analgesics that impact consciousness.

Notes - Babies
All babies should be routinely monitored whilst in skin-to-skin contact with mother or father. The following observations should be included.

Checking that the baby's position is such that a clear airway is maintained - observe respiratory rate and chest movement. Listen for unusual breathing sounds or absence of noise from the baby.

Colour - the baby should be assessed by looking at the whole of the baby's body, as the limbs can often be discoloured first. Subtle changes to colour indicate changes in the baby's condition.

Tone - the baby should have a good tone and not be limp or unresponsive.

Temperature - ensure the baby is kept warm during skin contact.

Always listen to parents and respond immediately to any concerns raised

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Skin-to-skin contact - Baby Friendly Initiative

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Skin-to-skin contact is usually referred to as the practice where a baby is dried and laid directly on the mother's bare chest after birth, both of them covered in a warm blanket and left for at least an hour or until after the first feed.

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Within the first few hours after birth, most healthy newborns will instinctively move to their mother's breast and attach on their own. This video shows early breastfeeding initiation through the journeys of 3 newborns and ways to ensure the success of this vital practice for any new mother and baby.

Join the Conversation

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Breastfeeding in the First Hours - Video - Global Health Media Project

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Within the first few hours after birth, most healthy newborns will instinctively move to their mother's breast and attach on their own. This video shows early

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Find out what to expect from breastfeeding in the first few days after birth, including what colostrum is, what happens when your milk ‘comes in’ and what the let-down reflex feels like.

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Meeting baby for the first time video - Baby Friendly Initiative

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Baby Friendly’s video on skin-to-skin contact and how it can help mothers and babies get their relationship off to the best start.

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Mothering is about building relationships and nurturing the love and trust that enables babies and children to thrive. And mothering through breastfeeding is a normal, natural and effective way of doing this. Breastfeeding helps you nurture your relationship with your baby and meet their individual needs. It's nature's way of satisfying a baby's need for food, love, comfort and connection.

It can take time to learn what a baby needs. Some childcare experts promote strict routines for babies and young children. They claim that if a mother follows their rulebook, her baby will be perfectly content. But every baby is different. While we may feel reassured if our day follows a predictable pattern, strict routines for feeding and sleeping often fail to meet the needs of individual babies.

Difficulties with routines
Full breasts slow down their rate of milk production, which may lead to:
Problems caused by expressing
Breastmilk: a balanced meal, a drink, a snack
Breastfeeding: comfort and connection too
Frequent breastfeeds: day and night
One breast or two
Breastfeeding patterns adjust
Finding your own rhythms: a sense of freedom
Think of breastfeeds as minor events
Expect the unexpected
Establishing helpful patterns
Babies are little for such a short time

Difficulties with routines

Some babies will object strongly to an imposed routine that doesn't meet their needs. Others are easy going, and give only subtle signals that a particular routine isn't right for them. Early feeding cues include hand sucking, lip smacking, turning their head towards you, or fussing. Don't wait until they are desperate-crying is a late sign of hunger. Trying to 'stretch' the gaps between feeds is hard work and stressful for you both and can reduce your baby's overall intake of milk.

A well-drained breast makes milk faster than a full one. Encourage your baby to nurse frequently enough to keep your breasts soft and comfortable.

Full breasts slow down their rate of milk production, which may lead to:

A baby gaining weight slowly or needing supplements to maintain adequate weight gain.

A sleepy baby who needs to be roused and encouraged to breastfeed actively to get the food they need.

Lengthy feeds.

A fussy baby.

Engorgement, blocked ducts or mastitis.

Expressing milk (pumping) can cause problems

Some childcare experts advise pumping to keep milk supply one step ahead of a baby's needs. However, expressing can interfere with the delicate balance that happens when your baby and body are in tune with each other. Making more milk than your baby needs increases your risk of mastitis. You may experience fast flow and/or oversupply causing your baby to gag, splutter or come on and off the breast. Your baby might also have colic or be fussy.

Breastmilk: a balanced meal, a drink, a snack

Just like adults, babies feed irregularly-none of us eats the same amount at every meal, nor do we always follow a set timetable for eating and drinking. With easy access to the breast, babies will balance their intake of fluids, calories, proteins, fats and other nutrients so they receive exactly what they need. All that is usually needed is the confidence to let your baby take the lead.

Breastfeeding: comfort and connection too

Breastfeeding isn't just food and drink. It also helps you and your baby maintain that connection and closeness with each other. So when your baby is tired or unhappy or upset, theyinstinctively ask to nurse because it helps them regain a sense of rightness with the world. Many breastfeeding mothers say that the ability to calm and comfort a baby just by nursing is one of the main reasons for carrying on. It makes life easier and more peaceful for everyone.

Frequent breastfeeds: day and night

Your baby needs to nurse frequently to establish and maintain your milk production, especially in the early weeks. While breastfeeds may be further apart in the morning, it's very common for babies to nurse frequently (or 'cluster feed') in the evening. Babies receive fattier milk when they nurse more often. Your baby is stocking up for the night and putting in their order for tomorrow! (See here for more on coping with Fussy evenings with a newborn.)

One breast or two

Sometimes your baby will want one breast, at other times both. Your baby knows what they need-let them nurse actively from the first breast until they come off looking satisfied or sleepy. Then offer the second breast. After the first few months babies often become really efficient feeders-so don't be surprised if they've finished in 10 minutes or so! Their nappy output and continuing weight gain will reassure you they are getting enough. ( Is my baby getting enough milk?)

Breastfeeding patterns adjust

A baby's growth rate and mother's breast storage capacity will affect their nursing pattern. Even the weather can make a difference-a thirsty baby will probably nurse more in hot weather. When babies have growth spurts and seem extra hungry, most mothers find there's no need to pump to keep up milk production-more frequent feeds will do the trick. Milk production quickly adapts to meet your baby's needs and feeding patterns settle down within a few days.

Finding your own rhythms: a sense of freedom

Combining some predictability with flexibility can give you a sense of freedom and stop you feeling tied down. At first, life with a new baby can seem quite chaotic, but if you relax and observe your baby you will find gentle patterns emerging. You can build on these patterns, creating a daily rhythm to suit you both.

Strict routines don't necessarily make life easier for you. Being tied to particular routines, nap-times and sleep places can make getting out and about, visiting friends or taking holidays more complicated.

Your needs and those of your baby will change with time and from day to day. Following your baby's rhythms will help you meet their needs when they have has growth spurts or are ill. It will also give you confidence to adapt when necessary, for example for a doctor's appointment or holiday travel arrangements. When your baby is attached to you, rather than their routine, problems are less likely and you may feel more relaxed about managing the day.

Think of breastfeeds as minor events

Just as with your own tea-breaks, try thinking of feeds as minor and flexible events that fit in with everyday life rather than major events which have to be planned for.

Expect the unexpected

Whatever your baby's usual pattern is, there will always be times when they surprise you. They might sleep at a different time, sleep longer, or not at all. They might go longer between feeds, or suddenly want to feed more frequently. But there's no need to panic-this is how babies are! We may never know the reason for such changes. Life will either settle back into the original pattern or a new one will establish itself. Your baby will continue to grow and surprise you over the coming years.

Establishing helpful patterns

Morning - Having a reasonably regular time and pattern for getting up and dressed can be a springboard for your day.
Going out - Going out can help structure your day, entertain your baby and give you a sense of purpose. You can develop a routine for getting everyone fed, ready, and out of the house. Prepare what you'll need the evening before if you need to get out early.
Afternoon - Babies are often ready to have a sleep somewhere around the middle of the day. Babies are all different and patterns change as they grow and develop. Try to tune in to your own baby's natural rhythms of feeding, alertness and sleep and adjust your activities to match them. A nap or a rest for yourself, too, can help boost your energy for the rest of the day.
Night-time - A gentle evening routine, eg bath, rocking, singing and nursing can help a tired baby wind down to sleep. Watch for fussing, yawning and rubbing of eyes and start your wind down pattern promptly. Some babies are natural 'night owls', taking a late afternoon nap and being alert during the evening.

Household tasks - Developing the ability to be 'interruptible' is a real help. Completing housework in small 'bites' while being prepared to pause and attend to children can be a successful way to meet everyone's needs. Seeing the world through your baby's eyes can help you slow down and enjoy the present rather than rushing to get things done. Mothering babies and young children is a full-time job-it's ambitious to expect to be a cleaner, cook and gardener at the same time. Concentrate on essentials. Do those things you can do with a baby around and save really tricky jobs for times when you have help. It's unlikely you'll look back in years to come and wish you had done more housework!

Babies are little for such a short time

You can't spoil a baby with love and attention. The easiest way to care for a baby is to accept and meet their need for closeness. Remember, you know your baby best; take the information, advice and the ideas that are helpful to you and ignore those suggestions that don't feel right. You can develop rhythms and routines that are in tune with your needs, and those of your baby and family.

For support in meeting your baby's needs contact an LLL Leader by calling our Helpline or visiting our website. It can be helpful to share experiences with others at your local LLL group where you can exchange practical tips.

Written by Karen Butler, Sue Upstone and mothers of LLLGB.

Pages you might also be interested in:
Is My Baby Getting Enough Milk?
Adjusting to Motherhood
Breastfeeding Basics
The Unhappy Baby
Safe Sleep and the Breastfed Baby
Fussy evenings with a newborn

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
How Mothers Love and How Relationships Are Born. Stadlen, N. London: Piatkus Books, 2011.
What Mothers Do, Especially When It Looks Like Nothing. Stadlen, N. London: Piatkus Books, 2005.
Why Love Matters: How affection shapes a baby's brain. Gerhardt, S. London: Routledge, 2004.
Kiss me! How to raise your children with love. Carlos Gonzalez. London: Pinter & March 2020

The information sheet is available to buy in printed format from our shop.
Rhythms & Routines is dedicated to all LLL Leaders who have given their time generously to support breastfeeding mothers and families over the past sixty years and continue to do so.
Copyright LLLGB 2020

Updated June 2022

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Rhythms and Routines - La Leche League GB

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Mothering is about building relationships and nurturing the love and trust that enables babies and children to thrive. And mothering through breastfeeding is a normal, natural and effective way of doing this. Breastfeeding helps you nurture your relationship with your baby and meet their individual needs.