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How to choose the right breast pump according to your needs

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How to choose the right breast pump according to your needs

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How to choose the right breast pump according to your needs

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It is the most personal question that deserves the most taylored personal answer. It’s like you asking me which are the best pair of jeans and me sending you to M&S. They probably won’t fit your bum! I guess that’s not really helping you right now. I get it. But hold on. I’m going

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Essentials you might need

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Inverted or Flat Nipples

The size and shape of nipples and breasts vary from person to person and can change during their feeding journey. It is common for nipples to gradually change shape, become more elastic and protrude more during pregnancy and while breastfeeding. When babies suck at the breast, they stretch the nipple and surrounding breast tissue into their mouth. The more elastic or stretchy the nipple, the easier it will be for your baby to latch. However, even if the nipples don't protrude more during pregnancy, you can still breastfeed. These variations often have very little to do with the baby's ability to breastfeed, because baby latches to the nipple and surrounding breast tissue.

If you have inverted or flat nipples, your baby may need more time and patience to breastfeed. A flat nipple is smooth next to the breast tissue. Inverted nipples withdraw below the surface of the nipple. If you think your nipple may be inverted, try placing your thumb and finger on opposite sides of the areola (the darker area of skin surrounding the nipple) and squeezing gently inwards. Sometimes nipples may be partly inverted, looking dimpled or folded. Severely inverted nipples retract deeply when compressed or stimulated. A nipple that stands out when stimulated is not inverted.

After your baby is born, your nipples may appear flatter than usual but babies often lick the nipple to stimulate it before latching on. Your nipples may also appear flatter if your breasts are very full or engorged.

A deep latch and comfortable position helps your baby latch and breastfeed effectively. In the beginning, the following techniques may help you initiate breastfeeding:

Immediately after birth, place your baby in skin-to-skin contact on your chest. Continue to use skin to skin during early breastfeeding to soothe your baby and to ease frustrations during breastfeeding. Ideally, the breastfeeding dyad is kept together until both are discharged.

Being with your baby helps you to recognize your infant's hunger cues.

Before breastfeeding, express several drops of milk, so the milk is immediately available when your baby latches.

You may massage your breast while breastfeeding to assist your baby in receiving milk.

To help evert the nipple:

Pull back on breast tissue so nipple will protrude more.

Breastfeed in a laidback or side-lying position especially if you have large breasts.

Breast engorgement can contribute to the nipple being less protruded. Massage the nipple and areolar area so milk will move back into the breast or will leak out, softening the areola and everting the nipple. Also try reverse nipple softening. Reverse pressure softening involves using gentle finger pressure around the base of the nipple to temporarily move some of the swelling slightly backward and upward into the breast.

Roll the nipple between the thumb and index finger and immediately afterwards touch the nipple with a moist cold cloth. Avoid making the nipple too cold because it can result in the nipple being numb, and inhibit let down.

Use nipple and breast support to help protrude the nipple. Use both hands on each side of breast to make a "sandwich", to squeeze nipple and areola. Use hands to press in on breast like the way you hold a big sandwich to put in the mouth.

Use a breast pump for several minutes to draw out the nipple. The suction from a pump will often cause the nipple to protrude more.

If you have had assistance with latch and tried the tips in this article and your nipples are still sore, consider trying a nipple shield. The nipple shield is a thin silicone devise that goes on top of your nipple and areola while breastfeeding. It looks like a brimmed hat. The nipple shield is a commercially made product. A nipple shield can be used temporarily to help establish breastfeeding or in some cases to help ensure that breastfeeding continues. A shield provides a firm stimulus at the roof of a baby's mouth where the soft and hard palate meet. This may help your baby suckle more effectively.

Commercial products that are intended to assist in drawing out inverted nipples such as breast shells or everters are best used only with the guidance of a trained lactation consultant.

If Nipple Soreness Occurs

You may experience nipple soreness for about the first two weeks of nursing while your flat or inverted nipple is gradually drawn out by baby's suckling. This discomfort is generally the result of adhesions or skin binding to underlying breast tissue. If the soreness is severe, or continues past the initial two weeks, consult your health professional.

If your nipple retracts after feedings, that skin may remain moist, leading to chapping of the skin. After feeding, pat your nipples dry and apply a moisturizer safe for breastfeeding. You may also want to wear breast shells or other devices to keep your nipple out between feedings so the skin can dry.

When Nipple Soreness is Prolonged
Rarely, sore nipples may persist for a longer period because instead of stretching, the adhesions remain tight. This can create a stress point which may lead to cracks or blisters.

If one breast is easier for your baby to grasp and he nurses well from that breast, you can continue to feed on that side. You can pump the breast with the deeply inverted nipple until the adhesions loosen and the nipple is drawn out. Your baby will get all the milk he needs from one breast if allowed unlimited and unrestricted time at the breast.

If both nipples are deeply inverted, you can pump both breasts simultaneously for 15-20 minutes 8 or more times in 24 hours. You can feed your baby with an alternative feeding device until she is able to latch on effectively and comfortably.

How long you will need to pump in order to draw out your nipples depends upon the strength of the adhesions and the degree of inversion. One pumping may be enough to completely draw out the nipple. If the nipple continues to deeply invert, you may need to continue pumping. When your nipple stays out after pumping, you can resume breastfeeding immediately.

Once your nipple can be drawn into the baby's mouth correctly and the baby can breastfeed effectively, you should be able to discontinue pumping and breastfeed without discomfort.

On rare occasions you may continue to feel some discomfort even after your nipple has been drawn out. This could be due to the correction to the nipple.

The nipple may invert again as your baby pauses during a feeding. In this case, you may need to stop breastfeeding and pump again for a few minutes before putting baby back to the breast.

As a temporary transition to exclusive breastfeeding, breast compressions or the use of a nursing supplementer might help to encourage continuous sucking and swallowing so that the nipple won't be as likely to invert during feeding.

If you do encounter challenges during your breastfeeding journey, support from a La Leche League Leader and other participants in Group meetings may help you to overcome the challenges. ( Find a Leader or meeting.)
Additional Resources
Cotterman, Jean K., Reverse Pressure Softening, http://breastfeedingmadesimple.com/wp-content/uploads/2016/02/SimplerRPSsheet2.pdf

Cotterman, Jean K., Reverse Pressure Softening, http://www.breastfeedingonline.com/rps.shtml#sthash.2MPE4KHE.T3v63FBt.dpbs

Cotterman, Jean K., Engorgement Help: Reverse Pressure Softening
... a technique to aid latching when a mother is engorged, https://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/

Cotterman, Jean K. Reverse Pressure Softening, http://www.health-e-learning.com/articles/RPS_JCotterman_ver2005.htm

Genna, Catherine Watson, Supporting Sucking Skills in Breastfeeding Infants, C. Burlington, MA: Jones & Bartlett, 2012.

La Leche League Great Britain, Nursing Supplementers, https://www.laleche.org.uk/nursing-supplementers/

Mohrbacher, N. Breastfeeding Answers: A guide to helping Families, 2nd edition

( Revised February 2022)

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Inverted and Flat Nipples - La Leche League International

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Inverted or Flat Nipples Prepared by Mary Marine The size and shape of nipples and breasts vary from person to person and can change during their feeding

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I want to induce lactation (adoptive/non pregnant mothers)

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I want to induce lactation (adoptive/non pregnant mothers)

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Breastfeeding Without Giving Birth | La Leche League International

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Alyssa Schnell, St. Louis, Missouri, USA Alyssa Schnell is an International Board Certified Lactation Consultant (IBCLC) based in the United States. She speaks internationally about inducing lactation and relactation and specializes in helping parents who have not given birth (non-gestational parents) to breastfeed their babies.

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You may need to try a few breastfeeding positions before finding a favourite that works best for you and your baby. Check out our picture gallery for inspiration

Discover 11 different breastfeeding positions and find out what is best for you and your baby:

1. Laid-back breastfeeding or reclined position

2. Cradle hold

3. Cross-cradle hold

4. Rugby ball hold

5. Side-lying position

6. Laid-back breastfeeding after a c-section

7. Upright breastfeeding or koala hold

8. Dangle feeding

9. Nursing in a sling

10. Double rugby ball hold

11. Dancer hand nursing position

Whichever breastfeeding position you choose, remember:

Gather everything you need, such as a drink, snacks, your mobile, TV remote, book or magazine, before you start feeding. And don't forget to have a wee first - you may not be able to get up again for some time!

Make sure your baby is comfy. Whatever position you're in, your baby should be stable and supported, while his head, neck and spine should not be twisted.

Ensure you feel relaxed and comfy too. Use cushions, pillows or rolled towels to support your back or arms if you need to.

Check your baby is latching on correctly. A good latch is vital for comfortable breastfeeding.

If your baby struggles to latch or breastfeeding makes you sore, seek support from a lactation consultant or breastfeeding specialist. They will also be able to show you how to support your baby to help you feed more comfortably.

1: Laid-back breastfeeding or reclined position

However, laid-back breastfeeding isn't just for newborns - it can work well with babies of any age. It may be especially useful if your baby struggles to latch in other holds, he doesn't like his head being touched as he feeds, if you have a forceful let down, or if your breasts are large, as mum-of-one Isabel, UK, discovered: "The combination of my big boobs and a small 2.7 kg (6 lb) baby made positioning tricky at first. It took me a few weeks to realise there was no position I 'should' be in. In the end I mainly breastfed lying down with my baby balanced on top of me."

You'll probably be comfier if you're reclining gently rather than lying flat on your back. Use cushions or pillows so you're supported and can see your baby.

2: Cradle hold

"I used the cradle hold because it worked! It felt comfortable and I liked sitting there just looking at my baby," says Rachael, mum of two, Italy.

3: Cross-cradle hold

Julie, mum of two, UK, likes the flexibility of this position: "I normally do the cross-cradle with my newborn. It gives me a hand free to tend to my toddler at the same time."

In the early days, don't hold your baby around his head as you might push his chin on to his chest. This can result in a shallow latch (as your nipple hits the base of his tongue rather than his palate) and sore nipples for you. As your baby gets bigger this technique becomes much easier, and you can rest your baby's head in your hand (as shown in our gallery image above).

4: Rugby ball hold

"With my first daughter I had very large K-size breasts that were double the size of her head," remembers Amy, mum of two, Australia. "I placed a rolled-up towel underneath each breast to help lift them up as they were so heavy, and fed her in a rugby ball hold, but more upright so she wasn't overwhelmed by their size. This position was also good as I had a c-section wound and couldn't rest her across my body."

5: Side-lying position

"I struggled to sit up in bed during countless night feeds, partly due to having had a c-section, partly due to exhaustion," says Francesca, mum of one, UK. "Then I discovered I could feed my baby lying on my side and relax at the same time."

"Maisie couldn't attach any other way than the side-lying position due to her tongue-tie. A lactation consultant showed me how to do it. It seemed like she could handle the strength of my flow and hold on better in this position. When her mouth grew bigger she became much better at attaching in the regular way," says Sarah, mum of two, Australia.

6: Laid-back breastfeeding after a c-section

7: Upright breastfeeding or koala hold

"When my baby was older I often used the upright hold because it was comfortable for both of us and I could still feel her body close to mine," says Peggy, mum of one, Switzerland. "It was also discreet when we were feeding in public."

8: Dangle feeding

This breastfeeding position involves your baby lying on his back, while you crouch over him on all fours and dangle your nipple in his Some mums say doing this for short periods helps if they have conditions like mastitis and don't want their breasts to be squashed or touched; others claim that gravity helps unplug blocked milk ducts, although there's no scientific evidence to support this yet. You can also dangle feed while you're sitting, kneeling up over your baby on a bed or sofa, or almost lying down but propped up on your arms. You may need to use cushions and pillows to support yourself so you don't strain your back or shoulders.

"I used the dangle feeding position a few times when I had blocked ducts and other methods of easing out the lumps in my breasts hadn't worked. It seemed to help - I think because gravity was in my favour, and because the angle and position of my baby were so different to our normal breastfeeds that she drained my breast differently," says Ellie, mum of two, UK.

Dangle feeding is probably not a breastfeeding position you want to do regularly, but it might just help if you need to mix it up.

"I used a dangle feeding position when my baby was struggling to latch," says Lorna, mum of two, UK. "It wasn't the most comfortable way to breastfeed, but at the time I'd do absolutely anything to get him to latch. It worked - and we're still breastfeeding eight months on!"

9: Nursing in a sling

It may take a little practice, but breastfeeding your baby in a sling can be convenient when you're out and about, looking after older children, or even doing light chores.

It's also handy if your baby dislikes being put down or feeds frequently, as Lindsay, mum of two, US, found: "I used a front carrier often with both my babies. When we were out I tied a sarong around my neck and draped it over the carrier so it worked as a cover. They would nurse like this until they fell asleep."

This method usually works best if your baby is an experienced breastfeeder and can hold his head up by himself.You can breastfeed in all sorts of slings, including stretchy wraps, ring slings and front carriers. Whichever you choose, make sure you can always see your baby's face and his chin is not pressed against his chest.

10: Double rugby ball hold

The double rugby ball hold (also known as the double clutch) is a great breastfeeding position for twins, as you can feed them in tandem while having your hands relatively You'll probably need to use a specially designed twin breastfeeding pillow while feeding like this, especially in the early days. This gives extra support to get both babies into position, and also minimises pressure on your belly if you've had a c-section. You may also find that with your hands freer, you can tend to one baby without disrupting the other's feed.

"When my twins were born they were tiny and needed feeding every two hours, day and night. I soon realised for me to achieve anything other than feeding, I needed to tandem feed," says Emma, mum of two, UK. "I used the double rugby ball hold with a breastfeeding cushion."

Other breastfeeding positions you could try with twins include two cradles crossed across one another, one twin in a rugby ball hold and one in a cradle hold, and double laid-back or double upright breastfeeding positions.

11: Dancer hand nursing position

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You may need to try a few breastfeeding positions before finding a favourite that works best for you and your baby.

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Latching baby on with flat or inverted nipples

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Latching baby on with flat or inverted nipples

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Nipples (and breasts) come in all shapes and sizes and not always in matching pairs. Not all nipples protrude like half a cherry on a cup cake. Some nipples may be quite shallow or flat, perhaps level with the areola (the darker skin around the nipple), others can be dimpled or folded, very long or wide. Some nipples are inverted or retracted-where the nipple points into the breast instead of sticking out. This article looks at whether flat or inverted nipples can affect breastfeeding and how to deal with any challenges.

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Can you breastfeed with inverted nipples or flat nipples?

Many mothers can breastfeed with flat or inverted nipples because breastfeeding relies on a baby having a big mouthful of breast to stimulate the milk glands behind the nipple rather than simply being a matter of hanging on to a nipple. However, while some babies find breastfeeding with inverted nipples or flat nipples quite straightforward, others find it more difficult. Potential issues include:

Latching

The way a baby attaches to the breast is often referred to as latching. A protruding nipple can be easier for a baby to find and grasp and guides a baby's latch. However, a flatter, short shanked nipple may be quite difficult for a baby to find and grasp, especially at first while a baby is learning to breastfeed. The after effects of birth medications or birth trauma can also be causes of difficulty latching or coping with variations in anatomy.

Knowing when to suck

The stimulus of a nipple deep in a baby's mouth triggers the sucking reflex by stroking the baby's hard palate. Faced with a soft, flat nipple, a baby may feel confused and disorientated. Barbara Wilson-Clay explains:

Some parents may notice that the baby will suck strongly on a finger, pacifier or bottle nipple, but appear apathetic, disinterested or frustrated by the breast. This may be because the nipple is not elastic or everted [protruding] enough to reach back to stroke the palate. When this happens the baby doesn't know what to do next. The baby may bob back and forth and seem unable to "locate" the nipple, may pull away and cry, or may fall asleep each time the breast is offered. Skilled help from an IBCLC and close follow-up from the physician will make it easier to overcome this challenge.

Forming a teat

If the nipple is flat and the breast tissue is very firm instead of soft and stretchy, a baby may find it difficult to shape the breast into a teat shape to suckle and stay latched. If a baby is premature, has low muscle tone (floppy) or has high muscle tone, a small mouth, poor latch or has a restrictive tongue-tie, it may compound his difficulties.

Sore nipples

If a baby doesn't have a big mouthful of breast as well as the nipple in their mouth (a shallow latch), a mother's nipples can rub against a baby's hard palate and quickly become sore. Careful attention to the way a baby is held (positioning) can help with this and certain positions may be more helpful than others when a mother has flatter nipples. Reclining while breastfeeding with baby on their tummy may help some mothers, or for others, a more upright position such as cross cradle may give more control for a deeper latch. A couple of weeks of continuous sucking (or pumping with a good pump) can gradually draw out flat or inverted nipples permanently and improve comfort levels for some mothers.

Ongoing nipple pain

Occasionally pain might continue even when breastfeeding is going well because the nipple has undergone major changes or because the bands of tissue that are inverting the nipple stay tight and may crack or blister (Mohrbacher, 2020 p741) .

Risk of low milk supply or low weight gain

If it is difficult for a baby to get a deep latch due to the shape of his mother's nipples, there is a higher risk of having a low milk supply. This is because the breasts may not be emptied thoroughly and efficient breast drainage is the stimulus for a good milk supply. If this is the case, a baby could be at risk of low weight gain.

Sometimes when a baby latches to an inverted nipple, it can compress the buried nipple rather than squeezing the breast tissue behind the nipple as usual. This can prevent the baby getting any milk and will also be painful for the mother. In this situation a breast pump may be helpful as this will tend to draw the nipple out rather than squeezing the buried nipple (Mohrbacher. 2020 p 740).

How flat is a flat nipple?

There is a wide variation of normal, but some authors describe an average nipple diameter as 16mm and height as 7mm. However, whether there will be any problems for your baby if your nipples are much flatter (or much larger) than average will depend on the size of your baby's mouth, how stretchy the breast tissue is and whether you have good help to get breastfeeding started.

What is an inverted nipple?

When a nipple is inverted it points into the breast or lies flat on the breast instead of protruding outwards. This may be due to short milk ducts, tight bands of connective tissue pulling the centre of the nipple into the breast or an absence of connective tissue supporting the nipple. Pressing on the areola either side of and about an inch behind your nipple (sometimes called "the pinch test") can reveal whether a nipple is inverted. An inverted nipple will pull into the breast (retract) but everted or protruding nipples stay out like a cherry on a cake. If you can coax the nipple out, that's a good sign that your baby will be able to do the same if he is latched well.

There can be different degrees of inversion or retraction from mild to severe, descriptions in the breastfeeding literature include;

Retracted.⁶ Some nipples appear "graspable" but on stimulation e.g. with the pinch test, pull into the breast which can make latching difficult. The degree of retraction might be minimal or moderate to severe affecting whether an infant can pull the nipple forward during breastfeeds or not (Wambach and Spencer, 2021 p64).

Pseudo-inverted (Core Curriculum, 2012. p271) or simple inversion (Wambach and Spencer, 2021 p64). Nipples may look inverted but become erect on stimulation which should not present a problem to the breastfed baby.

Dimpled nipples. A dimpled or folded nipple is a partially inverted nipple where only part of the nipple protrudes. This nipple may extend during a breastfeed but after the feed it folds back over and may become damp and sore inside. Patting the nipple dry after a feed or holding it open until it is dry can help avoid soreness or skin breakdown.

Inverted, truly inverted or complete inversion. The inverted nipple that is retracted both before and after stimulation is not common but where present it makes it more difficult for a baby to latch (Core Curriculum, 2012; Wambach and Spencer, 2012 p 64).

Inverted nipples may resolve

Nipples continue to develop during pregnancy under the influence of hormones so that many inverted nipples turn out (evert) by the end of pregnancy and may even protrude a little further with each subsequent pregnancy (Wambach and Spencer, 2012 p 64). If a baby can manage to latch and feed regularly this can loosen the adhesions that keep some nipples inverted. A good pump may also do this.

Tips for breastfeeding with flat or inverted nipples

Some babies may not have any difficulties breastfeeding with inverted nipples or flat nipples. But some will. Paying careful attention to latch and positioning can help your baby breastfeed successfully. Useful articles providing general information to help all babies latch include Breastfeeding Tips for Newborns, Latching Tips, Breastfeeding Positions for Newborns and Why Skin to Skin? Further tips include:

#1 A natural birth (and a breast crawl)

Where possible, a baby will be better able to master latching after birth if he isn't too sleepy and disorientated from drugs such as strong pain killers that have crossed the placenta. Also, in certain positions, a baby's natural breastfeeding instincts and reflexes are primed which helps them to breastfeed. Letting a baby crawl to the breast when first born (and at other times during the first few weeks) can also help with this (Mohrbacher 2020). For videos see Why Skin-to-Skin?

#2 Getting a good latch

A breastfeeding specialist such as an IBCLC lactation consultant can help to get breastfeeding off to a great start and can help you one-to-one with latching techniques and helpful positions whether reclining or using more upright holds. Ideas to help a baby latch to a flat or inverted nipple include:

Help baby to use their reflexes

Holding a baby in skin-to-skin contact to breastfeed, removing scratch mittens and trying reclining positions can enable a baby to use their feeding reflexes to help them latch.

Shaping or flattening the breast

In more upright breastfeeding positions, variations of breast shaping, sometimes called an assisted latch, nipple tilt, flipple or breast sandwich may help a baby get a deeper latch. Ensure your fingers are far enough back from your nipple so your baby can get a big mouthful of breast. See Latching Tips for a description and video clips. You may need to continue to support the breast through the feed if the latch is fragile.

A nipple shield

A nipple shield can help some babies to latch to a very flat or inverted nipple. See Nipple Shields Good or Bad? for further information about shields. If used, it's important that the nipple shield fits well. Listen for your baby's swallows and keep an eye on his weight gain and dirty nappies to ensure he is getting enough milk. Pumping regularly will protect your milk supply until you're sure feeding is going well. Wetting the shield can help keep them in place either with breast milk or some mothers use a little lanolin around the edges of the shield. Avoid using a shield during the first few days before your milk comes in as thick and sticky colostrum doesn't flow well through a shield; hand express instead and feed this to your baby by cup, spoon or syringe.

#3 Try to bring your nipples out before a feed

Some flat nipples or inverted nipples can protrude with a little stimulation and provide the latching focus a baby is looking for. To bring out the nipple before a feed try:

Stimulation

Rolling the nipple between your finger tips, cold stimulation, or letting baby lick and bob about on the breast can help a flat nipple become erect or protrude.

Pulling back on the breast tissue or areola during a latch

Pulling back on the breast tissue as baby gapes to latch can help a nipple to protrude more (Mohrbacher, 2020 p739).

The "nipple nudge"

This involves pushing up into the breast through the areola and behind the nipple to help expose the nipple for the latch i.e. push it inside out.

Commercial gadgets

In addition to using a breast pump prior to feeding, there are a number of purpose built gadgets that can help bring out a nipple before a feed. See below for further details.

#4 Keep breasts soft

Nipples can flatten out when breasts are very full or engorged and nipples that were already quite flat may seem to disappear completely. It can help to practice latching in the days before your milk comes in while your breasts are still soft. A little hand expressing, pumping or reverse pressure softening can help soften an engorged breast so your baby can latch.

#5 Avoid bottles and dummies

Bottles and dummies differ from the average human nipple and are very differently shaped to a flat nipple. Using bottles and teats can cause nipple confusion or bottle preference for some babies and can be a particular issue for the baby who is learning to breastfeed with inverted nipples or very flat nipples. A baby may quickly favour the bottle-particularly if he associates the breast with frustration and hunger. Try using a cup, spoon or syringe for top-ups to keep your baby well fed if he can't latch. If you do need to use a bottle see our Tips to Bottle Feed a Breastfed Baby.

Preferring one nipple over another

If one nipple is inverted or very flat and the other sticks out, a baby may prefer the easier breast with the protruding nipple. A nipple shield on the inverted nipple helps some mothers to use both breasts. Alternatively, pumping the side baby refuses can stimulate the milk supply to supplement back to your baby and it may help evert the nipple. Some mothers allow milk production from the side with the inverted nipple to dry up while continuing to feed on the other breast. The breast that is still used will compensate by increasing milk production.

Gadgets to evert nipples

If the ideas in #3 above do not help to evert nipples before a breastfeed, and baby is struggling to latch on, the use of breastfeeding gadgets may help some mothers. Devices that temporarily draw out the nipple may be particularly helpful when a mother has flat nipples or pseudoinverted nipples. Some devices have been designed to provide more sustained suction over a longer time period (weeks to months) to modify the nipple shape when nipples are inverted or tethered. Bear in mind the success or otherwise of some of these devices hasn't been proven, and care should be taken not to cause nipple damage by over use of suction.

A breast pump

A breast pump can help pull out a flat or inverted nipple and can help stretch and break any underlying adhesions with repeated use. Sometimes however the adhesions under the nipple will remain tight and repeated pumping or latching could create cracks or blisters (Mohrbacher, 2020 p741).

Suction devices

Various commercial suction devices (nipple everters) are available to buy and it is possible to make a homemade version using a syringe. Popular commercial brands often cited in breastfeeding books include Supple Cups, Latch Assist, Evert-it Nipple Enhancer and the Niplette. Some of these specific brands may not be available outside USA. Follow manufacturers safety instructions carefully and read customer reviews for further information. As noted above, care must be taken not to cause nipple damage by too much suction.

Homemade device: the modified syringe

The authors of The Womanly Art of Breastfeeding discuss making your own suction gadget from a plastic syringe that is a little larger in diameter than your nipple:

Take the plunger out. Using a serrated knife, cut the needle end off and put the plunger in the "wrong" end. Now you have a little suction device with a smooth end that you can put over your nipple. Pull out on the plunger far enough to draw your nipple out, but not so far that it's uncomfortable, and keep the suction up for about a minute

Commercial devices

Lactation consultant Catherine Watson Genna provides more comprehensive information about suction devices in Selecting and Using Breastfeeding Tools Improving Care and Outcomes.She notes that:

The Evert-it Nipple Enhancer is a commercial version of the homemade syringe to temporarily evert flat nipples.

The Latch Assist uses a bulb syringe device to evert flat nipples prior to a feed and is based on the same principle as using a breast pump briefly before a feed.

Supple cups are small flexible cups made of silicone. The cups attach to the breast by suction and the negative pressure inside the cup draws out the nipple. One small study showed positive results when the cups were worn for up to four hours a day after 37 weeks of pregnancy in women with inverted nipples, and prior to a breastfeed postnatally in women with flat nipples.

The Niplette uses a syringe to remove air from a hard plastic cup to create a vacuum around the nipple. The syringe is then removed and the cups can stay on for several hours providing sustained pressure to help evert the nipples and encourage the ducts to lengthen. This product cannot be used in late pregnancy as the pressure will remove colostrum, fill the cup with fluid and break the vacuum, the Niplette could also potentially increase the risk of premature labour. (Watson Genna, 2009)

Breast shells

Worn inside the bra these used to be recommended to provide pressure around the base of the nipple to encourage it to protrude. However a research study found they weren't helpful and shells caused pain, discomfort, skin problems, and embarrassment. Another study also found no advantage to using breast shells. Some mothers may find them useful but if used, breastfeeding charity La Leche League GB says:

If you decide to try breast shells, wear them for no longer than 30 minutes before feeds to reduce the risk of nipple soreness due to lack of air circulating around the nipple and blocked ducts due to pressure. You may need a bra with a larger cup size than normal. Breast shells need to be washed daily and any milk collected should be discarded because of the risk of bacterial growth.

The Hoffman technique or Hoffman exercises

This technique involves placing a thumb either side of the base of the nipple and pressing into the breast while you move your thumbs apart and stretch the nipple. It can be tried in pregnancy as long as it isn't painful but the research by Alexander et al did not find the exercises were beneficial.

Your partner

Your partner may be able to help draw out your nipples with gentle oral suction.

Other nipple variations

Other nipple variations are possible in addition to flat or inverted nipples. A mother may have quite different nipples on each breast. Very large or long nipples can fill a baby's mouth and not leave any room for a good mouthful of breast tissue. However after a few weeks, baby's mouth will have grown to accommodate these normal nipple variations. An IBCLC lactation consultant can be a helpful partner to get breastfeeding working smoothly with more unusual nipple anatomy.

Summary

Some babies can breastfeed quite happily with flat or inverted nipples, but others, such as a premature baby or a baby with a small jaw or poor tongue function may find it very difficult. If your baby can't latch, hand expressing initially, followed by frequent pumping will stimulate your milk supply and provide a supplement to keep your baby well fed until you can get skilled help with positioning and latch. Latching may naturally improve once your baby's mouth has grown or your nipple becomes more stretchy. It's a good idea if possible to avoid bottles and dummies while your baby learns to breastfeed so that he doesn't develop a preference for the bottle teat.

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Breastfeeding With Inverted Nipples and Flat Nipples

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Nipples (and breasts) come in all shapes and sizes and not always in matching pairs. Not all nipples protrude like half a cherry on a cup cake. Some nipples may be quite shallow or flat, perhaps level with the areola (the darker skin around the nipple), others can be dimpled or folded, very long or wide.

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I want to know about paced bottle feeding

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I want to know about paced bottle feeding

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Paced Bottle Feeding For The Breastfed Baby

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also know as combine feeding or mixed feeding

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When it comes to feeding their baby, some parents decide to exclusively breastfeed and some to exclusively formula feed. Many families decide to combine breastfeeding and formula feeding; this often called combination feeding or mixed feeding (NHS, 2019).

What is mixed feeding?

Mixed feeding usually means mixing breast and bottle feeding. The content of the bottle can be either breastmilk or formula milk.

Watch our video to find out more about mixed/combination feeding.

Why do some families combination feed?

You might start mixed feeding for a variety of reasons.

If you and your baby have some difficulties getting breastfeeding established or if there are concerns about your baby's weight, you might be advised to give some formula feeds alongside breastfeeding.

You might need to leave your baby for periods of time (for example, if you are returning to work).

Your partner might want to be involved with feeding.

You might be bottle feeding and want to start or resume breastfeeding.

It can be helpful to talk to a breastfeeding counsellor, a midwife or health visitor about your options and the potential impact on breastfeeding of mixed feeding (see below). You could also call our infant feeding line on 0300 330 0700.

How do I combine bottle feeding and breastfeeding?

Some families choose to express milk and feed it to their babies through a bottle. They might do this if someone else would like to feed the baby or if the mum has to be away from their baby for a while.

Others choose to substitute some breastfeeds for formula. If you want to do this, you and your baby will adjust more easily if you reduce the number of feeds gradually (NHS, 2019).

You can offer formula feeds before, during, after or instead of a breastfeed. Talk to your midwife, health visitor or a breastfeeding counsellor about this, as different options will suit different circumstances. And will also depend on what you wish to achieve ultimately.

There are some cases when formula might be given before a breastfeed (for example, with babies who are not breastfeeding well). In other cases, the formula feed might be given instead of a breastfeed. This might happen if you're not with your baby and can't breastfeed or if someone else is sharing the feeding.

Gradually cutting down breastfeeding reduces the chance of your breasts becoming uncomfortably engorged. It will also reduce your risk of developing mastitis (NHS, 2019). It helps to reduce the number of breastfeeds slowly, starting with the one which is convenient for you (NHS, 2020). If you substitute a breastfeed with a formula feed, it may take around five to seven days for the amount of milk your breasts are producing to adjust to missing that one feed (NHS, 2017).

If you 'top up' with formula during one or more feeds, rather than replacing an entire feed, this is likely to extend the gap between breastfeeds. It will also signal to your breasts to make less milk (NHS, 2020).

On the other hand, if you've been advised to 'top up' as a temporary measure and want to return to exclusive breastfeeding, it is important to express milk between feeds to prevent a decrease in the amount of milk you make (NICE, 2017). Try and feed your baby any available breastmilk before each formula feed.

What effect will combining breastfeeding and formula feeding have?

Your baby will enjoy the benefits of breastmilk, even if you're not exclusively breastfeeding. For instance, they will still gain some of the antibodies that will protect them against infection (NHS, 2019).

If you want to feed your baby with both breastmilk and formula milk, it is recommended to wait until feeding is firmly established before introducing a bottle (NHS, 2019). This can take up to a month (La Leche League, 2019).

It's best to wait until breastfeeding is established because breastmilk supply is generally driven by frequent, effective removal of milk from the breasts. Giving your baby formula reduces your milk supply, which is particularly important when you are both getting used to breastfeeding. If your baby breastfeeds less often, your breasts produce less milk (Daly and Hartmann, 1995).

You might have heard that babies can get 'nipple confusion' but there is no evidence that this exists (Kotowski et al, 2020).

How many breastfeeds does an older combination-fed baby need?

Older babies, beyond the newborn stage, can maintain your breastmilk supply alongside formula feeding as long as you breastfeed several times a day. Much older babies - from eight or nine months - can breastfeed just a handful of times a day, and there is still a supply.

Very well-established breastfeeding, with a baby who is one year or older, can continue with as few as one or two feeds in 24 hours.

If your baby is over six months they can use a beaker or cup rather than a bottle (NHS, 2020).

Tips to introduce a bottle to a breastfed baby

You might find your baby does not want to take a bottle at first. The different sensations may confuse them and they don't know the bottle contains food. But there are lots of different things you can try to help your baby:

Offer a bottle when your baby is relaxed and happy, rather than very hungry.

Maybe ask someone else to offer a bottle so they can't smell their mother's milk.

Try softening the teat with warm, boiled water.

Hold your baby in a different position from their usual breastfeeding one. It might help your baby get used to the new way of feeding.

Try a different bottle or teat, this might make a difference.

(La Leche League, 2019)

Unicef (2016) recommend feeding responsively, which means following your baby's cues, whether breastfeeding or bottle feeding. They also recommend using paced bottle feeding. The way a baby is fed with the bottle can affect their comfort, their control of the amount of milk they drink, and the transition between breast and bottle (Kotowski et al, 2020).

Tips for paced bottle feeding

Hold your baby upright, close to your body. (If your baby is lying back, they are less able to control how much milk they swallow, so they can overfeed.)

Touch the teat against the baby's top lip to encourage them to pull it into their mouth.

Hold the bottle horizontal, so that when the baby is actively sucking, they get milk and when the baby is pausing, they don't get milk.

Give the baby several breaks by removing the bottle from their mouth.

Watch what the baby is doing, rather than how much milk they have drunk. End the feed when the baby is no longer drinking.

(UNICEF, 2016; La Leche League, 2019)

This all helps to build a close, loving relationship, a responsive feeding relationship, and avoids overfeeding your baby.

Where can I go for breastfeeding support?

If you have questions, concerns or need support, you can speak to one of our breastfeeding counsellors by calling our infant feeding line on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions.

Further information

Healthtalkonline.org has a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.

Best Beginnings has video clips from the 'Bump to Breastfeeding' DVD.

UNICEF have produced a summary guide for parents on how to responsively bottle feed babies.

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Mixed feeding: combining breastfeeding and bottle feeding | Baby & toddler, Feeding articles & support | NCT

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When it comes to feeding their baby, some parents decide to exclusively breastfeed and some to exclusively formula feed. Many families decide to combine breastfeeding and formula feeding; this often called combination feeding or mixed feeding (NHS, 2019). Mixed feeding usually means mixing breast and bottle feeding.

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I need to take some medication while breastfeeding?

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I need to take some medication while breastfeeding?

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Drugs in Breastmilk factsheets - The Breastfeeding Network

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These factsheets have been compiled by our Drugs in Breastmilk information service team of pharmacists. If you are unable to find the information you are looking for below, or you still have questions, you can contact the team by sending a private message via our Facebook page or via email. Please provide as much information as possible (age […]

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Graphic of a baby attaching on the breast

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Find out how to make sure your baby is attaching well at the breast.

The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole:

From Bump to Breastfeeding

From Bump to Breastfeeding extra films

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Find out how to make sure your baby is attaching well at the breast. Vimeo Video http://www.vimeo.com/11692547 The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole: From Bump to Breastfeeding 1.

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Call me on
+44 777 264 4449
Email me:
chrisduret.nct@gmail.com

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Essential guide to feeding & caring for your baby

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Essential guide to feeding & caring for your baby

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Essential guide to feeding & caring for your baby

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The way you hold your baby or position them will affect how easy it is for them to breastfeed effectively. You can breastfeed your baby in many different positions, so it's good to try different ones. This helps you find what's most comfortable for you and allows your baby to get just the right mouthful of breast to feed effectively and easily.

Breastfeeding positions for newborns

When you first start breastfeeding, you and your baby may take a while to master this new skill. Patience and trying different positions will help you find a position that works for you both.
Our video has some great tips on different ways to hold your baby.
If you're having problems breastfeeding, or with latching or attachment, do call our infant feeding support line on 0300 330 0700 to talk to a breastfeeding counsellor. Your midwife or health visitor may know about local breastfeeding support groups.

Getting some support with breastfeeding can help you to get comfortable in one or more of the breastfeeding positions that we describe in this article.

Here's how to get started...

Preparing to feed

Your baby will be happier and will latch more easily if you can identify and respond to their early feeding cues. If they are crying or upset, they need to be calmed before they are ready to feed.

Holding them against you, talking to them, walking around or gently rocking might help if they need to be calmed. Most babies like to have their hands free to touch and stroke your breast; this helps to reassure them that they are in the right place.

Read more about getting started with breastfeeding in our article here.

Laid-back position

Sitting upright

Lying down

Underarm or rugby ball

Holding your baby under your arm may be suggested to women who have given birth by caesarean, to avoid pressure on the wound. This position might also be suggested to mothers of twins. However, it can be difficult to maintain this position as the baby's weight is being taken by the mother's hand. Babies soon outgrow this position, and it doesn't allow them to use their instincts and reflexes to attach on to the breast (NHS, 2020; La Leche League, 2022).

Breastfeeding positions for a fast milk flow

If you have a fast milk flow, this could be due to a large supply of breast milk. A fast milk flow can make your baby cough, splutter and come off the breast, which is sometimes similar to reflux symptoms. If they're having problems, it could be that the baby needs more control when they're feeding. If this is the case, laid-back feeding, where the baby is more in control, could be useful as it helps your baby to attach better and pull back if they need to take a break.

Breastfeeding your baby as they grow

As your baby grows, they become more active in getting themselves into position, and they're longer and heavier. So you might need to adjust you and your baby's position to continue to feed comfortably and effectively.

A laid-back breastfeeding position could be useful with larger or older babies as you do not have to use your arms to hold their weight. You can always ask a breastfeeding counsellor for support with finding positions that suit you and your baby.

Breastfeeding position tips

Whichever breastfeeding position you choose, remember...

Get comfortable before you start.

Tuck your baby in closely to you.

Bring your baby to your breast or let them attach themselves rather than leaning towards them.

Avoid putting the breast in your baby's mouth; let them take it in themselves.

Check that their ear, shoulder and hip are all in a line - not twisted round.

If you are bringing your baby to your breast, make sure they are turned towards your breast, with your nipple level with baby's nose - they shouldn't have to turn their head.

Cushions, special breastfeeding pillows and other supports can prevent your baby's body from getting close enough to your body or may raise your baby's body too high for effective attachment. It's best to get your baby attached to the breast, then if support is needed tuck a pillow in under your arm at the point where you are feeling strain from the weight of the baby.

(UNICEF and NHS, 2022)

Many women and babies take a while to get used to breastfeeding and it can take a while to find the position(s) that work best for you. Experimenting with different positions can help you find the ones that work best for you and your baby.
Page last reviewed December 2022.
Further information

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

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

For further information on how to breastfeed, including positioning and breastfeeding attachment, and a section on expressing your breastmilk by hand, visit Unicef's Baby Friendly Initiative support area for parents.

Bump to Breastfeeding DVD: available from your midwife or library - see more at www.bestbeginnings.org.uk

Coulson S. (2012) Biological nurturing: the laid-back breastfeeding revolution Midwifery today. 101. Available at: https://midwiferytoday.com/mt-articles/biological-nurturing/ [Accessed 7th November 2022]

La Leche League. (2022) Positioning. Available at: https://www.llli.org/breastfeeding-info/positioning [Accessed 7th November 2022]

Milinco M, Travan L, Cattaneo A, Knowles A, Sola MV, Causin E, et al. (2020) Effectiveness of biological nurturing on early breastfeeding problems: a randomized controlled trial. Int Breastfeed J. 15(1):21. Available at: https://doi.org/10.1186/s13006-020-00261-4

NHS. (2020) How to breastfeed. Available at: https://www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/how-... [Accessed 7th November 2022]

UNICEF; NHS. (2022) Off to the best start. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfe... [Accessed 25th November 2022]

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Breastfeeding positions: which are best for you? | Baby & toddler, Feeding articles & support | NCT

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Here we provide tips on breastfeeding positions, including laid-back, lying down, sitting upright and underarm positions.

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http://tinyurl.com/bmproduction

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It's hard to describe to anyone how much having a baby flips your life - and your mind - upside down. Your emotions are likely to be all over the place after you give birth and leap between utter joy and complete despair in the space of two minutes. A whopping 81% of women said they'd experienced a maternal mental health problem after giving birth (RCOG, 2017).

As with all things mental health related, it's great to share your feelings, though that can be daunting. Here's how you could make a start on working through things...

How to lessen the load

Try talking to your partner, friends and family or to other new parents who might be going through the same thing.

Try to open up to your health visitor as well about things and see your GP if you need to. Your six-week postnatal check is a chance to talk about how you are feeling as well as talking about your baby.

The good thing is that treatment does help, with 82% of women treated for mental health problems after their babies were born saying treatment had helped (NCT, 2017). So don't delay asking for help.

Emotions you might be experiencing

The baby blues

No matter how much you love or are grateful for your baby, the baby blues can affect you. The baby blues usually arrive in the first week after you give birth (NHS, 2018a).

A lot of new mums find themselves feeling weepy and irritable and not knowing why. But if it happens to you, don't worry, most new mums go through it (NICE, 2014). The baby blues is not an illness and you should see the back of it without any medical treatment. This'll probably happen by the time your baby is around 10 days old (MIND, 2018).

If you're still feeling low after this, speak to your GP or midwife as it might be something more serious. Read more about the baby blues here.

Postnatal depression (PND)

Depression can affect both mums and dads in the weeks and months after birth, so it's something to be aware of and look out for (NHS, 2018a).

No single answer tells us why some new parents are affected and not others (NHS, 2018a). However, emotional and stressful events can bring on depression, and having a baby can definitely be both of those things.

If you are concerned that you or your partner may have PND, speak to your GP or health visitor. The recovery from PND is gradual but with help and support you can get better (NHS, 2018a). Read more about PND here.

Postpartum or puerperal psychosis

Postpartum psychosis (also known as puerperal psychosis) is a serious mental illness that will require psychiatric treatment and a stay in hospital. This condition is rare, affecting only one or two mums in every 1,000. It most commonly occurs in the first month after having a baby (NICE, 2014).

The main symptoms of puerperal psychosis are delusions, hallucinations, confused thoughts and a lack of self-awareness (NHS, 2017). In very severe cases, a woman may try to harm her baby and/or herself. If you are, or know someone who may be, suffering from puerperal psychosis, you should get medical help from your GP, midwife or health visitor immediately.

How to help someone who is low or depressed

You might find living with your partner or seeing your family member who's depressed hard, sad and frustrating (MIND, 2018). Try to never blame them or be judgemental though: instead, try to support them and listen. That way you understand a bit more what they're going through.

Perhaps the most important thing to recognise is that someone suffering from depression may need encouragement to seek help, and support to get it (MIND, 2018). You can also reassure them that they will feel better, in time.

Helping yourself feel better

Share your feelings with people you trust. It's important to feel understood and supported so speak to a friend or family member, or a counsellor or health visitor, who you know will listen and won't judge.

Talking to other mums and dads can be super reassuring and make you feel a lot less alone and isolated.

Try and get help with the childcare and grab a bit of you time, even if it's just an hour here or there.

It's a cliché but a true one: exercise really does help, so head out for a brisk walk with the baby in the pram or go for a swim. You'll notice a mood improvement when the endorphins kick in.

Try as much as you can not to grab cake as a short-term fix: eating badly or skipping meals can make you feel tired and irritable, so try to eat simple and nutritious meals. Foods rich in omega 3 oils (oily fish, seeds and nuts) might help with depression. Though we're not ruling out the occasional chocolate brownie.

Learn to say yes to all offers of help and support. Whether offers involve whizzing a vacuum around, walking your dog or arriving with a home-cooked pie (never say no to pie) - just say yes please.

Give yourself time to adjust. Parenthood is a huge change in your life so go easy on yourself and be patient while you go through the transition.

Further information

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

You might find attending one of 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.

You might also like to try one of our NCT Yoga for Pregnancy classes, which aim to help improve your physical and emotional wellbeing, as well as feel more confident and positive.

Mind, a leading mental health charity, provides information on a range of mental health topics including postnatal depression and has an infoline for support: 0300 123 3393.

#PNDHour is an online peer support group that runs every Wednesday at 8pm via the Twitter account @PNDandMe. Anyone can join in to discuss topics about antenatal and postnatal depression, such as self-care, medication and seeking help. It's run by a mum called Rosey who also blogs about her own experiences with antenatal and postnatal depression, as well as raising awareness of perinatal mental illness, at PND and me.

We are grateful to Dr Andrew Mayers, a psychologist specialising in child and family mental health (particularly perinatal mental illness) and sleep (especially children), for his help in reviewing the information on this page.

The Association for Postnatal Illness is a charity that provides support to mothers suffering from postnatal illness and increases public awareness of the illness.

NHS Choices has information on postnatal depression.

The Royal College of Psychiatrists has information on postnatal depression.

Effective psychotherapeutic treatments may be found in your area. Check out the British Association for Counselling & Psychotherapy, the United Kingdom Council for Psychotherapy (UKCP) and the British Psychoanalytic Council (BPC) for a list of recommended therapists. Well Scotland or Niamh (in Northern Ireland), leading providers of mental health information in their regions, for further information on PND.

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Postnatal depression, baby blues and emotions after giving birth | Life as a parent articles & support | NCT

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It's hard to describe to anyone how much having a baby flips your life - and your mind - upside down. Your emotions are likely to be all over the place after you give birth and leap between utter joy and complete despair in the space of two minutes.

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By Kelly Bonyata, BS, IBCLC

Is your milk supply really low?

First of all, is your milk supply really low? Often, mothers think that their milk supply is low when it really isn't. If your baby is gaining weight well on breastmilk alone, then you do not have a problem with milk supply.
It's important to note that the feel of the breast, the behavior of your baby, the frequency of nursing, the sensation of let-down, or the amount you pump are not valid ways to determine if you have enough milk for your baby.
What if you're not quite sure about baby's current weight gain (perhaps baby hasn't had a weight check lately)? If baby is having an adequate number of wet and dirty diapers then the following things do NOT mean that you have a low milk supply:

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Your baby nurses frequently. Breastmilk is digested quickly (usually in 1.5-2 hours), so breastfed babies need to eat more often than formula-fed babies. Many babies have a strong need to suck. Also, babies often need continuous contact with mom in order to feel secure. All these things are normal, and you cannot spoil your baby by meeting these needs.

Your baby suddenly increases the frequency and/or length of nursings. This is often a growth spurt. The baby nurses more (this usually lasts a few days to a week), which increases your milk supply. Don't offer baby supplements when this happens: supplementing will inform your body that the baby doesn't need the extra milk, and your supply will drop.

Your baby nurses more often and is fussy in the evening.

Your baby doesn't nurse as long as she did previously. As babies get older and better at nursing, they become more efficient at extracting milk.

Your baby is fussy. Many babies have a fussy time of day - often in the evening. Some babies are fussy much of the time. This can have many reasons, and sometimes the fussiness goes away before you find the reason.

Your baby guzzles down a bottle of formula or expressed milk after nursing. Many babies will willingly take a bottle even after they have a full feeding at the breast. Read more here from board-certified lactation consultant Kathy Kuhn about why baby may do this and how this can affect milk supply. Of course, if you regularly supplement baby after nursing, your milk supply will drop (see below).

Your breasts don't leak milk, or only leak a little, or stop leaking. Leaking has nothing to do with your milk supply. It often stops after your milk supply has adjusted to your baby's needs.

Your breasts suddenly seem softer. Again, this normally happens after your milk supply has adjusted to your baby's needs.

You never feel a let-down sensation, or it doesn't seem as strong as before. Some women never feel a let-down. This has nothing to do with milk supply.

You get very little or no milk when you pump. The amount of milk that you can pump is not an accurate measure of your milk supply. A baby with a healthy suck milks your breast much more efficiently than any pump. Also, pumping is an acquired skill (different than nursing), and can be very dependent on the type of pump. Some women who have abundant milk supplies are unable to get any milk when they pump. In addition, it is very common and normal for pumping output to decrease over time.

See also Is my baby getting enough milk?

Who to contact if you suspect low milk supply

If you're concerned about your milk supply, it will be very helpful to get in touch with a trained breastfeeding counselor or a board certified lactation consultant. If your baby is not gaining weight or is losing weight, you need to keep in close contact with her doctor, since it's possible that a medical condition can cause this. Supplementing may be medically necessary for babies who are losing weight until your milk supply increases. If supplementing is medically necessary, the best thing to supplement your baby with is your own pumped milk.

Potential causes of low milk supply

These things can cause or contribute to a low milk supply:

Supplementing. Nursing is a supply & demand process. Milk is produced as your baby nurses, and the amount that she nurses lets your body know how much milk is required. Every bottle (of formula, juice or water) that your baby gets means that your body gets the signal to produce that much less milk.

Bottle preference. A bottle requires a different type of sucking than nursing, and it is easier for your baby to extract milk from a bottle. As a result, giving a bottle can either cause your baby to have problems sucking properly at the breast, or can result in baby preferring the constant faster flow of the bottle.

Pacifiers. Pacifiers can affect baby's latch. They can also significantly reduce the amount of time your baby spends at the breast, which may cause your milk supply to drop.

Nipple shields can be a useful tool in some cases, but they can also reduce the stimulation to your nipple or interfere with milk transfer, which can interfere with the supply-demand cycle.

Scheduled feedings interfere with the supply & demand cycle of milk production and can lead to a reduced supply, sometimes several months later rather than immediately. Nurse your baby whenever she is hungry.

Sleepy baby. For the first few weeks, some babies are very sleepy and only ask to nurse infrequently and for short periods. Until baby wakes up and begins to breastfeed well, nurse baby at least every two hours during the day and at least every 4 hours at night to establish your milk supply.

Cutting short the length of nursings. Stopping a feeding before your baby ends the feeding herself can interfere with the supply-demand cycle. Also, your milk increases in fat content later into a feeding, which helps baby gain weight and last longer between feedings.

Offering only one breast per feeding. This is fine if your milk supply is well-established and your baby is gaining weight well. If you're trying to increase your milk supply, let baby finish the first side, then offer the second side.

Health or anatomical problems with baby (including, jaundice, tongue-tie, etc.) can prevent baby from removing milk adequately from the breast, thus decreasing milk supply.

Mom's health (uncontrolled anemia or hypothyroidism, retained placenta, postpartum hemorrhage...), previous breast surgery/injury, hormonal problems (e.g. PCOS), anatomical problems, medications she is taking (hormonal birth control, sudafed...), or smoking also have the potential to affect milk supply.

Increasing your milk supply

Milk production is a demand & supply process. If you need to increase milk supply, it's important to understand how milk is made - understanding this will help you to do the right things to increase production.

To speed milk production and increase overall milk supply, the key is to remove more milk from the breast and to do this frequently, so that less milk accumulates in the breast between feedings.

OK, now on to things that can help increase your milk supply:

Make sure that baby is nursing efficiently. This is the "remove more milk" part of increasing milk production. If milk is not effectively removed from the breast, then mom's milk supply decreases. If positioning and latch are "off" then baby is probably not transferring milk efficiently. A sleepy baby, use of nipple shields or various health or anatomical problems in baby can also interfere with baby's ability to transfer milk. For a baby who is not nursing efficiently, trying to adequately empty milk from the breast is like trying to empty a swimming pool through a drinking straw - it can take forever. Inefficient milk transfer can lead to baby not getting enough milk or needing to nurse almost constantly to get enough milk. If baby is not transferring milk well, then it is important for mom to express milk after and/or between nursings to maintain milk supply while the breastfeeding problems are being addressed.

Nurse frequently, and for as long as your baby is actively nursing. Remember - you want to remove more milk from the breasts and do this frequently. If baby is having weight gain problems, aim to nurse at least every 1.5-2 hours during the day and at least every 3 hours at night.

Take a nursing vacation. Take baby to bed with you for 2-3 days, and do nothing but nurse (frequently!) and rest (well, you can eat too!).

Offer both sides at each feeding. Let baby finish the first side, then offer the second side.

Switch nurse. Switch sides 3 or more times during each feeding, every time that baby falls asleep, switches to "comfort" sucking, or loses interest. Use each side at least twice per feeding. Use breast compression to keep baby feeding longer. For good instructions on how to do this, see Dr. Jack Newman's Protocol to manage breastmilk intake. This can be particularly helpful for sleepy or distractible babies.

Avoid pacifiers and bottles when possible. All of baby's sucking needs should be met at the breast (see above). If a temporary supplement is medically required, it can be given with a nursing supplementer or by spoon, cup or dropper (see Alternative Feeding Methods).

Give baby only breastmilk. Avoid all solids, water, and formula if baby is younger than six months, and consider decreasing solids if baby is older. If you are using more than a few ounces of formula per day, wean from the supplements gradually to "challenge" your breasts to produce more milk.

Take care of mom. Rest. Sleep when baby sleeps. Relax. Drink liquids to thirst (don't force liquids - drinking extra water does not increase supply), and eat a reasonably well-balanced diet.

Consider pumping. Adding pumping sessions after or between nursing sessions can be very helpful - pumping is very important when baby is not nursing efficiently or frequently enough, and can speed things up in all situations. Your aim in pumping is to remove more milk from the breasts and/or to increase frequency of breast emptying. When pumping to increase milk supply, to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. However, adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.

Consider a galactagogue. A substance (herb, prescription medication, etc.) that increases milk supply is called a galactagogue. See What is a galactagogue? Do I need one? for more information.

Additional information

@

@ other websites

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Increasing Low Milk Supply * KellyMom.com

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First of all, is your milk supply really low? Often, mothers think that their milk supply is low when it really isn't. If your baby is gaining weight well on breastmilk alone, then you do not have a problem with milk supply.

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Good hygiene is very important when making up a formula feed.
Your baby's immune system is not as strong as an adult's. That's why bottles, teats and any other feeding equipment need to be washed and sterilised before each feed.

This will reduce the chance of your baby getting an infection, in particular diarrhoea and vomiting.

Step-by-step guide to preparing a formula feed

Step 1: Fill the kettle with at least 1 litre of fresh tap water (do not use water that has been boiled before).

Step 2: Boil the water. Then leave the water to cool for no more than 30 minutes, so that it remains at a temperature of at least 70C.

Step 3: Clean and disinfect the surface you are going to use.

Step 4: It's important that you wash your hands.

Step 5: If you are using a cold-water steriliser, shake off any excess solution from the bottle and the teat, or rinse them with cooled boiled water from the kettle (not tap water).

Step 6: Stand the bottle on the cleaned, disinfected surface.

Step 7: Follow the manufacturer's instructions and pour the amount of water you need into the bottle. Double check that the water level is correct. Always put the water in the bottle first, while it is still hot, before adding the powdered formula.

Step 8:

Credit:

Pete Titmuss / Alamy Stock Photo

https://www.alamy.com/stock-photo-young-mothers-hands-preparing-powdered-milk-drink-for-her-baby-54213147.html?pv=1&stamp=2&imageid=5FDDEEA6-841C-4900-8A1D-277900301545&p=78384&n=0&orientation=0&pn=1&searchtype=0&IsFromSearch=1&srch=foo%3dbar%26st%3d0%26pn%3d1%26ps%3d100%26sortby%3d2%26resultview%3dsortbyPopular%26npgs%3d0%26qt%3dD45HBR%26qt_raw%3dD45HBR%26lic%3d3%26mr%3d0%26pr%3d0%26ot%3d0%26creative%3d%26ag%3d0%26hc%3d0%26pc%3d%26blackwhite%3d%26cutout%3d%26tbar%3d1%26et%3d0x000000000000000000000%26vp%3d0%26loc%3d0%26imgt%3d0%26dtfr%3d%26dtto%3d%26size%3d0xFF%26archive%3d1%26groupid%3d%26pseudoid%3d788068%26a%3d%26cdid%3d%26cdsrt%3d%26name%3d%26qn%3d%26apalib%3d%26apalic%3d%26lightbox%3d%26gname%3d%26gtype%3d%26xstx%3d0%26simid%3d%26saveQry%3d%26editorial%3d1%26nu%3d%26t%3d%26edoptin%3d%26customgeoip%3d%26cap%3d1%26cbstore%3d1%26vd%3d0%26lb%3d%26fi%3d2%26edrf%3d0%26ispremium%3d1%26flip%3d0%26pl%3d

Loosely fill the scoop with formula powder, according to the manufacturer's instructions, then level it using either the flat edge of a clean, dry knife or the leveller provided. Different tins of formula come with different scoops. Make sure you only use the scoop that comes with the formula.

Step 9: Holding the edge of the teat, put it into the retaining ring, check it is secure, then screw the ring onto the bottle.

Step 10: Cover the teat with the cap and shake the bottle until the powder is dissolved.

Step 11: It's important to cool the formula so it's not too hot to drink. Do this by holding the bottle (with the lid on) under cold running water.

Step 12: Test the temperature of the formula on the inside of your wrist before giving it to your baby. It should be body temperature, which means it should feel warm or cool, but not hot.

Step 13: If there is any made-up formula left in the bottle after a feed, throw it away.

Dos and don'ts of making up formula feeds

Do follow the manufacturers' instructions very carefully, as they vary as to how much water and powder to use.

Do not add extra formula powder when making up a feed. This can make your baby constipated or dehydrated. Too little powder may not give your baby enough nourishment.

Do not add sugar or cereals to your baby's formula.

Never warm up formula in a microwave, as it may heat the feed unevenly and burn your baby's mouth.

Reducing the risk of infection

Even when tins and packets of powdered infant formula are sealed, they can sometimes contain bacteria.

Bacteria multiply very fast at room temperature. Even when a feed is kept in a fridge, bacteria can still survive and multiply, although more slowly.

To reduce the risk of infection, it's best to make up feeds 1 at a time, as your baby needs them.

Use freshly boiled drinking water from the tap to make up a feed. Do not use artificially softened water or water that has been boiled before.

Leave the water to cool in the kettle for no more than 30 minutes. Then it will stay at a temperature of at least 70C. Water at this temperature will kill any harmful bacteria.

Remember to let the feed cool before you give it to your baby. Or you can hold the bottle (with the lid on) under cold water from the tap.

Do not use bottled water to make up formula feeds

Bottled water is not recommended for making up feeds, as it's not sterile and may contain too much salt (sodium) or sulphate.

More information

Find out more about bottle feeding and answers to common questions about formula feeds.

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Good hygiene is very important when making up a formula feed. Your baby's immune system is not as strong as an adult's. That's why bottles, teats and any other feeding equipment need to be washed and sterilised before each feed. This will reduce the chance of your baby getting an infection, in particular diarrhoea and vomiting.

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Guide on expressing and storing your breastmilk

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This leaflet is designed to give parents comfort and confidence in the care of their sick or premature baby.

This leaflet covers a wide range of issues and provides a useful tool to help conversations with parents on the neonatal unit.

Printed copies are available for £15 per pack (1-9 packs) or £11 per pack (10 or more packs). There are 50 leaflets per pack and this price includes P&P within UK. Order using the Baby Friendly Resources order form, which you can download from our Resources page.

You and your baby: Supporting love and nurture on the neonatal unit

More neonatal resources to support you

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You and your baby leaflet - Baby Friendly Initiative

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This leaflet covers a wide range of issues and provides a useful tool to help conversations with parents on the neonatal unit. Printed copies are available for £15 per pack (1-9 packs) or £11 per pack (10 or more packs). There are 50 leaflets per pack and this price includes P&P within UK.

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Here is a guide on feeding twins and multiples.

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There's something going on with my breasts?

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There's something going on with my breasts?

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Engorgement, mastitis, blocked ducts, etc...

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Having a sore breast can be a painful and alarming experience and can occur when the milk flow in your breast is blocked. Your breast may feel tender, there may or may not be redness or a hard spot or sore lump in your breast. Treat any engorgement promptly to avoid developing blocked ducts or mastitis.

Whether you have a sore breast, a blocked duct or a breast infection, the initial care is similar: nurse frequently, rest and apply heat to the tender area.

Blocked Ducts

Milk flows through a duct system in your breasts. Sometimes an area of the ducts becomes blocked and milk stops flowing well. A section of your breast may or may not be redder than usual. If you have a plugged duct, your breast will usually be tender though the pain will be localised. If the blockage is not treated, the area may become infected.

You may also hear people refer to clogged or plugged ducts.

Treatment for blocked ducts is similar to that for mastitis. Try the following ideas:

Apply wet or dry heat to the affected area, and remove any dried milk secretions on your nipple by soaking with plain warm water.

Fill a basin with warm water and lean over to soak your breasts. Massage the area gently while warm, and then see if your baby will nurse.

Use gentle breast massage on any hard lumpy areas while your baby feeds.

Massage gently above the blocked duct and then hand express behind your nipple.

Try to feed your baby on the affected side frequently, changing positions so that his chin and nose are alternately pointing in the direction of the plugged duct. Experiment with positions including kneeling on all fours and dangling your breast above your baby while he lies flat on the floor.

If possible, loosen constrictive clothing or go bra-less for a few days.

A more unusual treatment which is successful for some mothers is to hold the flat end of an electric toothbrush against their blocked duct, and use the vibrations to clear it.

Ensure your breasts are soft and comfortable at the end of feeds to avoid further engorgement which can lead to blocked ducts.

Check your positioning and attachment (latch) to help with optimal draining of your breasts and to stop the problem happening again.

Applying cabbage leaves is often recommended as a treatment for mastitis - it is not recommended as treatment for blocked ducts.

If you have recurrent blocked ducts that are not helped by adjusting positioning and attachment (latch), try reducing saturated fat in your diet and take one tablespoon per day of lecithin. You can also reduce sodium (salt) intake (sodium can cause fluid retention, which can make women susceptible to infections of any kind, including mastitis).

Blocked ducts can occur when your baby's 'schedule' becomes less predictable due to illness or life changes, meaning he isn't emptying your breasts as often as usual. If your baby has recently started to sleep for longer periods at night, or is nursing less due to teething, this can also leave you with overly full breasts. If this is the case you can help by ensuring you feed or express a little to avoid further problems.

Milk Blisters (Blebs)

A milk blister (or bleb) is usually a painful white dot on the nipple or areola. Thickened milk may block milk flow near the opening of the nipple, or sometimes a tiny bit of skin overgrows a milk duct opening and milk backs up behind causing the blister. They can be associated with mastitis.

A milk blister is not the same as a blister caused by friction, either from incorrect latch or a badly fitting nipple shield or breast pump flange. Milk blisters do not always hurt and may resolve over several weeks without any treatment. If you have a painful milk blister:

Apply moist heat using warm compresses and then feed your baby-suckling may open the blister.

Soak your nipple in warm water.

Wear a cotton ball soaked in olive oil in your bra to soften the skin and then attempt to peel away the thickened layer of skin.

Compress your nipple behind the blockage to try and express the blockage. Sometimes it is possible to express a thickened string of milk, which helps open the duct and keep it open. Work back from the nipple to make sure there isn't a blockage further back.

If these don't work, ask your healthcare professional for help. Avoid opening the blister yourself; it may bring relief but could also result in infection. Once a blister is open, help prevent infection by washing the wound with mild, unperfumed soap and rinsing well once a day.

Mastitis

Mastitis (inflammation of the breast)  can occur when a blocked duct doesn't clear, or more generally when the build up of milk in your breast causes swelling and inflammation.  As well as having a tender breast, you are likely to feel achy, run-down and feverish; you may have flu-like symptoms.

Mastitis is usually caused by backed up milk in a section of the breast. This can progress to an infection if not treated. Delayed nipple wound healing, stress, chronic engorgement and persistent breast pain increase the risk of mastitis. Areas of the breast that remain undrained or that experience blocked ducts may be focal points for bacteria to take hold and start an infective process. Milk production may drop from your affected breast for a few days during the worst of the symptoms, but it is important for your baby to continue breastfeeding from that side to help prevent the infection from turning into an abscess. The milk from the affected breast will not harm your baby.

If you have mastitis you can try all of the treatments listed in the section on blocked ducts, as well as the following care plan.

Care Plan for Mastitis
Signs, Symptoms, and Treatment
If you:

Can see red/reddish patches on your breast

Can feel a hard sore lump in your breast

Feel achy and run down

Have a low grade fever (less than 38.4° C [101° F])

Then:

Rest as much as you can

Continue to feed your baby 8-12 times each 24 hours from both breasts

If your baby does not drain the affected breast, hand express or pump that side to thoroughly drain it

Use alternate massage (massage and compress the breast and hard area each time baby pauses between sucks)

Apply heat prior to feedings to promote breast drainage

Ask your doctor or nurse practitioner if you can use a medication such as ibuprofen to reduce the inflammation

If:

You do not see results or feel better in 8-24 hours

You continue to run a fever or suddenly spike a high fever (38.4° C [101° F]) or higher

Your breast becomes redder than usual, hot, and swollen

You see pus or blood in your milk

You see red streaks on your breast from the areola to the underarm

A cracked nipple looks infected

You have chills and continue to feel worse

Then:

Call your doctor

If medication is prescribed, take the full course

Rest and drink plenty of fluids

Continue to nurse frequently on the affected side (or pump if your baby is unwilling or unable to feed well on that side)

Use alternate massage on the affected side to help it drain better

Contact your local LLL Leader or group, or find local support here, to help you find out what is causing the mastitis so that it does not recur

Note:
It is a myth that it is unhealthy for your baby to breastfeed when you have a breast infection - the antibacterial properties of human milk actually protect your baby from infection. Continuing to breastfeed when experiencing a sore breast, plugged duct or breast infection will speed recovery.

Nursing frequently helps to provide comfort, reduce inflammation and encourage opening of the blocked area. Many mothers find that varying breastfeeding positions drains all areas of the breast more effectively. For example, if you most commonly use the cradle hold, try the clutch ('football' or 'rugby') hold or lying down to breastfeed.

Rest is an important component in recovery from sore breasts, plugged ducts or breast infections. Try resting in bed with your baby cuddled next to you. Link safe sleep post This will also encourage frequent breastfeeding sessions to drain your breast. Keep supplies such as diapers, toys, books, your phone, a drink of water nearby to minimize trips out of bed.

Applying wet or dry heat with a heating pad or hot water bottle and gently massaging the sore area of your breast before breastfeeding can assist it in further emptying. Many mothers find that taking showers or baths and gently massaging with a warm cloth on the sore breast is a relaxing treatment during a stressful time. Another technique is to lean over a basin of warm water and soak the sore breast for about 10 minutes three times a day. This will also remove any dried milk secretions that may be blocking the flow of milk out of the nipple. Breastfeed immediately, while your breast is warm, to help unplug the blocked duct.
Sometimes mastitis is the result of poor positioning and attachment meaning your baby doesn't drain milk from your breast efficiently. An LLL Leader can help you explore improvements you can make to help prevent the condition recurring. Get local support.
Recurring Blocked Ducts and/ or Mastitis

In order to prevent future plugged ducts or breast infections, you may find it helpful to be cautious of sudden long stretches between nursings. When breastfeeding, periodically changing your baby's position, while maintaining good positioning will help to empty all the ducts around your breast. Maintaining general health through your diet and getting extra rest may help keep your breast from becoming sore again.

Mastitis most frequently recurs when the bacteria are resistant or not sensitive to the antibiotic you have been prescribed, when antibiotics are not continued long enough, when an incorrect antibiotic is prescribed, when the mother stops nursing on the affected side, or when the initial cause of the mastitis has not been addressed (such as milk stasis - ie milk is not removed from the breast). If mastitis recurs, request that your doctor conduct a culture and sensitivity test on your milk to discover exactly what organism is involved and what antibiotic will eliminate it. Many organisms are resistant to common antibiotics and repeated use of ineffective medications increases the risk of an abscess. Mastitis caused by methicillin resistant Staph aureus (MRSA) is becoming more prevalent. Increased risk for hospital-acquired MRSA, a virulent and difficult to treat situation, is seen in mothers with a caesarean delivery, administration of antibiotics in the peripartum period, mothers with multiple gestation, and mothers who have experienced in vitro fertilization. Outpatient infection with MRSA is also becoming more common.

Other Causes of Mastitis

If either of your nipples is sore, cracked or bleeding, this can be a point of entry for infection. If sore nipples are a recurrent problem, be vigilant about positioning and attachment (latch). Contact your local Leader to talk through what might be causing your sore nipples.

Nipple shields can slow down milk flow and encourage infection. Use of pacifiers and artificial nipples can affect how baby sucks and contribute to nipple soreness and development of mastitis.

Some babies are reluctant to breastfeed or refuse the breast periodically, perhaps due to sensitivity or other factors. Irregular breastfeeding patterns may contribute to repeated breast infections. Your local Leader may be able to help you troubleshoot and determine possible causes for this.

Make sure your clothing isn't too tight-fitting, paying special attention to your bra. Some bras and bathing suits, especially underwire types, may put too much pressure on your breast. Even a heavy shoulder strap purse or frequent use of a baby carrier can cause problems. Frequently changing sides with bags/purses or baby carriers may help.

The shoulder strap of a seat belt can also cause a sore breast. A too tight strap could apply pressure to your breast. Also, the shoulder strap's pressure from a sudden stop may cause a sore breast. Other types of injuries can result in sore breasts such as a kick or hit from a rambunctious toddler. These may result in blocked milk flow and so should be treated with rest, heat and frequent nursings.

Any history of breast surgery, breast lumps or injury to the breast can increase risk of infection.

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Mastitis | La Leche League International

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Having a sore breast can be a painful and alarming experience and can occur when the milk flow in your breast is blocked. Your breast may feel tender, there may or may not be redness or a hard spot or sore lump in your breast.

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What is a tongue-tie?

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

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

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

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

Tongue-tie assessment

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

The decision on whether or not a tongue-tie is impacting on feeding and whether it is appropriate to offer to divide it should be made after a detailed feeding history has been taken. This will usually include information about the pregnancy and birth and the medical history of both mum and baby. The baby is usually observed at the breast. This may be done by the person who divides tongue-ties or by someone who has been supporting you with feeding, prior to you being referred for division, such as a MW, HV or breastfeeding counsellor/lactation consultant. The function of the tongue will also be assessed to establish if the baby is tongue-tied and if this is impacting on feeding.
Assessment of a Tongue Tie video curtesy of Sarah Oakley
Assessment for tongue-tie requires training and skill and involves placing a finger in the baby's mouth. It cannot be done by just taking a look. Assessment is usually carried out with the baby on the assessor's lap or a flat surface such as a table or couch. It involves observing how the baby uses their tongue.

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

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

The video clip shows part of an assessment for tongue-tie.

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

Sore/damaged nipples

Nipples which look misshapen or blanched after feeds

Mastitis

Low milk supply

Exhaustion from frequent/constant feeding

Distress from failing to establish breastfeeding

Baby:

Restricted tongue movement

Small gape resulting in biting/grinding behaviour

Unsettled behaviour during feeds

Difficulty staying attached to the breast or bottle

Frequent or very long feeds

Excessive early weight loss/ poor weight gain/faltering growth

Clicking noises and/ or dribbling during feeds

Colic, wind, hiccoughs

Reflux (vomiting after feeds)

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

For more detail please see our ATP 'Breastfeeding and Tongue Tie' leaflet click here

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Tongue-tie Information - Association of Tongue-tie Practitioners

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

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NCT: +44 300 330 0700 - National Breastfeeding Line: +44 300 100 0212

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Remember wet & dirty nappies!

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When you first start breastfeeding, you may wonder if your baby is getting enough milk.
It may take a little while before you feel confident your baby is getting what they need.

"Your baby will generally let you know, but wet and dirty nappies are a good indication, as well as hearing your baby swallow," says Zoe Ralph, an infant feeding worker in Manchester and Fellow of the Institute of Health Visiting.

Exclusive breastfeeding (breast milk only) is recommended for around the first 6 months of your baby's life. Introducing bottle feeds will reduce the amount of breast milk you produce.

See Unicef's checklist How can I tell if breastfeeding is going well? (PDF, 77kb) for more guidance.

Credit:

IAN BODDY/SCIENCE PHOTO LIBRARY

https://www.sciencephoto.com/media/294115/view

Signs your baby is well attached

Your baby has a wide mouth and a large mouthful of breast.

Your baby's chin is touching your breast, their lower lip is rolled down (you can't always see this) and their nose isn't squashed against your breast.

You don't feel any pain in your breasts or nipples when your baby is feeding, although the first few sucks may feel strong.

You can see more of the dark skin around your nipple (areola) above your baby's top lip than below their bottom lip.

Signs your baby is getting enough milk

Your baby starts feeds with a few rapid sucks followed by long, rhythmic sucks and swallows with occasional pauses.

You can hear and see your baby swallowing.

Your baby's cheeks stay rounded, not hollow, during sucking.

They seem calm and relaxed during feeds.

Your baby comes off the breast on their own at the end of feeds.

Their mouth looks moist after feeds.

Your baby appears content and satisfied after most feeds.

Your breasts feel softer after feeds.

Your nipple looks more or less the same after feeds - not flattened, pinched or white.

You may feel sleepy and relaxed after feeds.

Other signs your baby is feeding well

Your baby gains weight steadily after the first 2 weeks - it's normal for babies to lose some of their birth weight in the first 2 weeks.

They appear healthy and alert when they're awake.

From the fourth day, they should do at least 2 soft, yellow poos the size of a £2 coin every day for the first few weeks.

From day 5 onwards, wet nappies should start to become more frequent, with at least 6 heavy, wet nappies every 24 hours. In the first 48 hours, your baby is likely to have only 2 or 3 wet nappies.

It can be hard to tell if disposable nappies are wet. To get an idea, take an unused nappy and add 2 to 4 tablespoons of water. This will give you an idea of what to look and feel for.

Ways to boost your breast milk supply

Ask your midwife, health visitor or breastfeeding specialist to watch your baby feeding. They can offer guidance and support to help you properly position and attach your baby to the breast.

Avoid giving your baby bottles of formula for the first 6 months or a dummy until breastfeeding is well established.

Feed your baby as often as they want and for as long as they want.

Expressing some breast milk after feeds once breastfeeding is established will help build up your supply.

Offer both breasts at each feed and alternate which breast you start with.

Keep your baby close to you and hold them skin to skin. This will help you spot signs your baby is ready to feed early on, before they start crying.

See more ways to boost your milk supply.

Things that can affect your milk supply

Poor attachment and positioning.

Not feeding your baby often enough.

Drinking alcohol and smoking while breastfeeding - these can both interfere with your milk production.

Previous breast surgery, particularly if your nipples have been moved.

Having to spend time away from your baby after the birth - for example, because they were premature: "Frequent gentle hand expression will help," Zoe Ralph advises.

Illness in you or your baby.

Giving your baby bottles of formula or a dummy before breastfeeding is well established.

Using nipple shields - although this may be the only way to feed your baby with damaged nipples and is preferable to stopping feeding.

Some medications, including dopamine, ergotamine and pyridoxine. Read more about breastfeeding and medicines.

Anxiety, stress or depression.

Your baby having a tongue tie that restricts the movement of their tongue.

With skilled help, lots of these problems can be sorted out. If you have concerns about how much milk your baby is getting, it's important to ask for help early. Speak to your midwife, health visitor or a breastfeeding specialist. They can also tell you where you can get further support.

"They can offer suggestions to make sure your baby is properly positioned and attached at the breast and is feeding well," says Zoe Ralph.

Got a breastfeeding question?

Sign in to Facebook and message the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

Video: Is my baby getting enough milk?

In this video, a health visitor talks about the signs your baby is getting enough milk.

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Breastfeeding: is my baby getting enough milk?

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When you first start breastfeeding, you may wonder if your baby is getting enough milk. It may take a little while before you feel confident your baby is getting what they need.

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+44 345 120 2918

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Friendly breastfeeding support from pregnancy onward.

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+44 300 330 5453

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Browse support in our Information Library by stage, need, family member. Our most popular leaflet is Relactation: restarting breastfeeding after a gap.

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Can I see Natural Breastfeeding positions in action?

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Why good attachment is important when breastfeeding your baby

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Why good attachment is important when breastfeeding your baby

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

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

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Baby feeding cues

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This Unicef UK Baby Friendly Initiative video, covers both the theory and practice of skin to skin, but most importantly, what it can mean to mothers and babies meeting each other for the first time.

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This video explores skin-to-skin contact, a practice at the heart of the Baby Friendly standards which supports feeding and relationship-building.

Skin-to-skin contact as soon as possible after the birth is a special time for mother and baby and is a fantastic opportunity for helping them both recover from the birth and to get to know each other through all the senses.

This video, produced by the Unicef UK Baby Friendly Initiative, covers both the theory and practice of skin to skin, and what it can mean to mothers and babies meeting each other for the first time.

Find more relationship building resources

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Meeting baby for the first time video - Baby Friendly Initiative

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Skin-to-skin contact as soon as possible after the birth is a special time for mother and baby and is a fantastic opportunity for helping them both recover from the birth and to get to know each other through all the senses.

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A postnatal doula supports parents at home after the child is born.

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years NCT has been campaigning as the voice for parents on the issues they care about

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Facebook group

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Log into Facebook to start sharing and connecting with your friends, family, and people you know.

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Watch purified YouTube videos. Just for teachers, professors, social influencers, homeschoolers, and parents...like you.

How To Use ViewPure?

Let's use the actual video below to see the differences. We have always felt that videos speak louder than words. See below.

As you have seen, ViewPure removes all distracting comments and side-bar related videos. Which makes the videos you use for your school or social media group purified without all the distractions or "inappropriate content".

What can it be used for?

Honestly, what can it not be used for? Common uses include:

Removing inappropriate ads and comments from videos to show kids

Removing unwanted related videos at the end to show students

Memorable URLs (youtube.com/watch?v=_JmA2ClUvUY vs viewpure.com/BabyDebate)

YouTube search with a cleaner UI and filtered results

Cleaner interface to view YouTube videos

The list goes on and on - but you will find a use for ViewPure.

ViewPure has been used by teachers, students, college professors, educators, parents, homeschoolers, social influencers, organizers, and more.

How do I purify a video?

Step 1: Find a YouTube video you like.
Step 2: Paste it into the field on the homepage that says "Enter YouTube URL or search term..."
Step 3: Click Purify and enjoy.

Take the tour for more information.

How do I purify a video using the Bookmarklet?

Step 1: Install the Bookmarklet into your Bookmarks in your Browser (Chrome, Safari, Firefox, Microsoft Edge, Opera, Android, and more)

Purify Youtube: Drag this Purify button to your bookmarks. Click the bookmark on any Youtube page to purify!

Step 2: Find a YouTube video you like and click the ViewPure Bookmarklet
Step 3: The Bookmarklet will take you to the "purified" page on ViewPure.com to watch your video...free of YouTube distractions. Yeah!

Why are there still ads?

Our videos don't have ads. But some other parts of the site do. They help pay for domain fees, server costs, Clicky Analytics, and other maintenance costs so we can keep ViewPure going.

Some videos will always have ads, no matter where they are viewed or embedded. Unfortunately, there is nothing that can be done from ViewPure, however, at least there aren't trolls and distasteful comments, right?

What is the Viewpure Membership Area?

The Viewpure Members Area is the place where viewpure can give you additional tools and resources. The Members Area is FREE. There is a lot of cool stuff in there for clean viewing of videos. You'll love it.

This is the link to the FREE Signup Here: https://members.viewpure.com/signup

Why was my custom URL rejected?

Your custom URL has to be both alphanumeric (A-Z, 0-9, no special characters) and available. In addition it cannot be exactly 11 characters, to avoid conflicts with YouTube IDs (which are 11 characters long).

If you are sure your custom URL follows the rules, then it's likely that somebody else already took the custom URL you wanted, in which case try variations such as viewpure.com/TheCustomURL or viewpure.com/CustomURL2.

How do I use the filters?

Click the dropdown select menu to select between the three main filters for searches:

SafeSearch: Controls the content you want shown in search results (default: strict)

Sort By: Controls how the results are sorted (default: relevance)

Results Per Page: Controls how many results are shown at once (default: 12)

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Watch purified YouTube videos. Just for teachers, professors, social influencers, homeschoolers, and parents...like you. Let's use the actual video below to see the differences. We have always felt that videos speak louder than words. See below. As you have seen, ViewPure removes all distracting comments and side-bar related videos.

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Baby Café @ Bumps & Babies in Reading:

Tuesday 1-3pm with Chris @ the Biscuit Factory, 1 Queens Walk, Reading RG1 7QE

Find your nearing group here: https://www.nct.org.uk/local-activities-meet-ups