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Pregnancy and birth information - East Suffolk & North Essex NHS Foundation Trust (esneft.nhs.uk)

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East Suffolk and North Essex NHS Foundation Trust

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Pregnancy and birth information

Am I pregnant? What should I be eating? Is it normal to be this tired? Whatever you want to know about getting pregnant, being pregnant or caring for your new baby, you should find it on the NHS Choices website and in the useful information links below.

COVID-19 and pregnancy

Current advice about COVID-19

COVID-19 vaccines in pregnancy

NHS app

The NHS Mum & Baby app is free to download on Apple and Android.

NHS information service
NHS Start for Life information service
Websites and videos
Maternity Action Best Beginnings
Flip books

The Clinical Commissioning Groups in Suffolk and North East Essex have produced a series of flip books with information about different stages of your pregnancy journey. These are designed to accompany the information provided in the Mum & Baby app.
Giving birth in Suffolk and North East Essex Your pregnancy Personal care plans Labour and birth After your baby's birth Back to top

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East Suffolk and North Essex NHS Foundation Trust

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Pregnancy and birth information - East Suffolk & North Essex NHS Foundation Trust

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Am I pregnant? What should I be eating? Is it normal to be this tired? Whatever you want to know about getting pregnant, being pregnant or caring for your new baby, you should find it on the NHS Choices website and in the useful information links below.

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Skin to Skin at birth has so many benefits to both you and your baby. These include regulating yours and your babies heartrate and breathing, making you both feel calm, keeping your baby warm, promotes bonding and also boosts your babies immune system by exposing them to the healthy bacteria on your skin. Skin to skin also gives unrestricted access to your breasts so it is a great way to get breastfeeding off to a good start. If you decide to not breastfeed your baby you should still give the first bottle feed in skin to skin.

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If you bring colostrum into hospital please ensure you ask for any you haven't used when you leave as you may find it beneficial in the first few days, weeks or months of your babies life.  Please note that giving colostrum in a syringe or via a cup in the first few days is for supplementation alongside breastfeeding. You should still be offering the breast at every feed and then giving the colostrum following a feed.

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In the first hours and days babies can be reluctant to breastfeed, however here are some tips to help:
- Skin to skin - This helps initiate feeding reflexes, is great for bonding with your baby & can help calm you both. It also provides unrestricted access to the breast.
- Try different positions such as laid-back or side lying position to encourage self attachment and getting a deeper latch
- If your baby keeps slipping off the breast, trying the exaggerated latch and ensure you put baby back on correctly especially if you are experiencing any pain or discomfort throughout the feed.

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Trained breastfeeding counsellors run our:

ABM Breastfeeding Helpline on 0300 330 5453

(9.30am -10.30pm). Our volunteers are happy to talk to mums, partners, families - anyone who has a question or concern about breastfeeding.

We're also partners on the

National Breastfeeding Helpline on 0300 100 0212

(9.30am - 9.30pm). Both helplines are open every day of the year.

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Find a local breastfeeding support group. Enter your location below to get a list of venues and timings of the classes nearer to you.

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Signs Of Good Milk Transfer & What to expect in the first few days

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Signs Of Good Milk Transfer & What to expect in the first few days

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During the first few days and weeks of new life with your baby it can be challenging so here is a few tips to help you. Babies should be responsively fed when they show feeding cues such as sucking their fists and rooting, offer the breast or bottle on demand when they show these feeding cues. We estimate that babies should have 8-12 feeds in a 24 hour period however this may be more if they are having a growth spurt or its a hot day (they may be more thirsty). During the first few days we expect babies to loose a percentage of their birth weight and then to regain their birth weigh by 3 weeks of age. To ensure your baby is feeding well its really important to ensure they are having 8-12 good feeds in each 24 hour periods and they are having wet and dirty nappies. For each day old they are we expect that many wet nappies until day 5 when they stick to 5-6 and stools we expect 1 in the first 24 hours then a minimum of 2 the size of a £2 coin until 6 weeks of age when they will get in their own routine. If you are concerned about your baby please contact your HCP for support and advice.

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Lead - Steph Roberson

Infant Feeding Support Worker - Lisa Walsh-Thorne

For extra feeding support up to 28 days please follow the link

https://forms.office.com/Pages/ResponsePage.aspx?id=58gaefuGGka2WUICx4h--yPnRVbBsDFBuWcLIuIT7nxUNERZT1JXSlNRWVdES0pWWTBYWTNTTUJLRSQlQCN0PWcu

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Easily create surveys and polls to collect customer feedback, measure employee satisfaction, and organize team events.

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If you do decide to give your baby breastmilk or formula from a bottle we still encourage the first feed to be in skin to skin to increase bonding, love hormones, regulate yours and your babies heart rate, temperature and breathing. Skin to skin contact also allows your baby to be on your skin which exposes them to the friendly bacteria on your body and boosts their immune system. If you are unable to have skin to skin straight away it can be done at any time, throughout the whole postnatal period and you can also involve your partner.

If you have any questions on how to make up formula or sterilising equipment please ask your health care professional.

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Maternity (wsh.nhs.uk)

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We aim to provide high quality care, responding to the needs of mothers and their babies, in a friendly and professional environment. We aim to provide continuity of care throughout pregnancy, delivery and in the first days following your baby's birth, at each stage discussing options involving you fully and giving you choice in decisions regarding your care.

Services provided

Virtual tour
To watch the maternity virtual tour please click here.
Location

The maternity department can be found on the first floor in West Suffolk Hospital.

Contact the team

Karen Newbury, Head of Midwifery: 01284 713270

Gill Walsh, Inpatient Maternity Matron: 01284 712799

Karen Bassingthwaighte, Outpatient Maternity Matron: 01284 712995

Antenatal clinic reception: 01284 713254

Maternity day assessment unit: 01284 712723

Labour suite: 01284 713278

Birthing unit: 01284 712758

F11 ward: 01284 713216

Patient Portal

The patient portal (HealtheLife) is an electronic health record. Patients are able to view their health and care details in the portal at a time that is convenient for them, empowering them to take greater responsibility and involvement in their own healthcare.

Currently the portal offers:

a secure space online to view hospital letters and documentation

appointment details

the ability to view and monitor your test results

a record of your procedures and your known allergies

access to useful links

information going back to February 2018.

Please note, signing up to the portal is not a referral to our maternity service. If you are looking to refer please click here.

To register for the patient portal, please click here.

Antenatal group presentations
Pregnancy - birth and beyond Breastfeeding Active birth classes
Maternity flipbooks

The flipbooks below are helpful guides for pregnant women across Suffolk and North East Essex.
Your pregnancy Labour and birth Personal care plans Giving birth After birth
Feeling your baby move

A leaflet on feeling your baby move has been created and can be found here in our top five languages:

Feeling your baby move (English)
Feeling your baby move (Polish) Feeling your baby move (Portuguese) Feeling your baby move (Lithuanian) Feeling your baby move (Romanian)
Patient information

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We aim to provide high quality care in a friendly environment. We aim to provide continuity of care throughout pregnancy, delivery and in the first days after your baby's birth, at each stage giving you choice in decisions with your care.

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Responsive Bottle Feeding & How to make up feeds safely 

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Responsive Bottle Feeding & How to make up feeds safely 

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Lead: Emily Boughton/Nova Capstick
Infant Feeding Support Worker- Becki Fuller
Email: infantfeedingteam@wsh.nhs.uk

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Easily create surveys and polls to collect customer feedback, measure employee satisfaction, and organize team events.

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Early days

After giving birth to your baby, you may prefer to be close to home. Taking things easy and lots of breastfeeding will help you regain your strength and build up a good milk supply while getting to know your baby. When you feel ready to go out, a short walk or drive to your local shops or to visit a friend or relative may be enough. Remember to listen to your body and pace your activity to your energy level. Going out can prevent you from feeling isolated and give structure to your day. Breastfed babies are very portable-with your baby in a sling or carrier, you may only need a nappy or two and away you go. Babies will often sleep contentedly when carried close to their mothers, so you may even get there and back while your baby is asleep.

Public places

Mothers often worry about breastfeeding in public spaces such as shops and cafés. But the law protects you when you breastfeed in a public place and on premises. It is against the law to discriminate against a breastfeeding mother. A crying baby will guarantee an audience so watch for early feeding cues so you have time to find a suitable place. Other people probably won't notice you're breastfeeding if you're relaxed and confident-especially if you continue chatting or reading the menu and avoid eye contact with passers-by. If you prefer to keep covered then lifting your top from the waist means your baby hides your tummy and you remain covered on top. A layered look can help-depending on the weather try an open blouse, shirt or cardigan over a t-shirt. A breastfeeding vest can cover your tummy. Some baby slings and carriers can also hide a feeding baby. Or dress your baby in a sun hat. If you feel self-conscious, try practising in front of your partner, a friend or a mirror.

Planning ahead

Handling leaks

Breast pads inside your bra will provide some protection from leaks if you experience them. Some breast pads even prevent leaking. Avoid plastic backed pads, which can trap wetness next to the skin and cause soreness. If you feel the tingling of your milk beginning to flow, pressing hard on your nipples for several seconds can prevent leaking. You can do this by crossing your arms tightly across your chest and pressing firmly on your nipples with the palms of your hands. Hold for a few seconds before releasing and all should be well. If it doesn't work first time, try again for a little longer. If your breasts feel full, this is a sign to take the time to nurse your baby. Patterned fabrics, layered clothing and scarves can all hide evidence of leaks.

Where to breastfeed

If you prefer privacy, many public places have mother and baby rooms where you can sit to nurse and change your baby's nappy. Some clothes shops will make a changing room available to a nursing mother at quiet times. Mothers breastfeed in many public places with seating areas: shopping, leisure and visitor centres, libraries, museums and more. Look out for quiet spots with fewer distractions as some babies insist on looking around instead of feeding when there's a lot of hustle and bustle! A town garden or park may be an option when the weather is good. Or visit a café or the family room of a pub and quench your thirst at the same time. You can also breastfeed while walking with your baby in a sling.

A flexible approach

Some babies find it difficult to cope when travelling, on holiday, visiting family etc if they have a strict routine which can't be followed because of travel arrangements and lack of access to a separate room for sleep. When you follow your baby's natural feeding and sleeping rhythms such problems are less likely and you may feel more relaxed about visiting relatives or taking a family holiday.

Time for social activity

Many new mothers find it helpful to meet up with other breastfeeding mums. Local LLL groups are a good starting point-offering mother-to-mother support and the chance to socialise. You'll also be able to see how other mothers handle breastfeeding in a public place, and gather ideas. You may well develop good friendships to support you in your new mothering role.

Travelling with your baby

Public transport When hopping on and off buses and trains a carrier or sling is a real boon, with or without a pushchair. If you take a pushchair, modern train doors are usually wide enough and many buses have low floors for easy access. A backpack can be a useful handbag, leaving your hands free for your baby.

In the car Plan to stop frequently and give your baby breaks from his car seat. It can help to time long journeys for when he usually sleeps. Avoid rush hour if you can. Place your car seat where you can safely see your baby as you drive. An extra mirror can be useful if your baby travels in the back. Bear in mind that if your baby gets upset this can distract you while driving. Letting someone else drive when possible leaves you free to calm your baby. Babies are usually happier in the car if they can see mum or another adult. You could talk or sing to your baby to reassure him you are there. If your ba by doesn't like the car it may be easier to take public transport so you can hold and nurse him as you travel.

Flying A sling or soft carrier can be really convenient at the airport. It can also give you privacy as you nurse duringthe flight. It can be useful to request a bulkhead seat to give you more space. Alternatively having an aisle seat allows you to get up easily if your baby is restless without disturbing other passengers.

Take a few of your baby's favourite toys and, if possible, familiar snacks if he has started eating solid food. Breastfeeding during take off and landing can help equalize the pressure in your baby's ears, keeping him comfortable. However, to comply with seat belt regulations you may need to nurse in an unusual position. If seat belts make breastfeeding too awkward, offering your baby a finger or suitable toy to suck on may do the trick. When the seat belt light goes out, you can nurse him as normal.

Special Occasions

Written by Karen Butler, Sue Upstone & mothers of La Leche League Great Britain

Further Reading
Supporting Women's Right to Breastfeed
The Womanly Art of Breastfeeding LLLI. London: Pinter & Martin, 2010.
Breastfeeding in Public Spaces

You can buy this information in printed form from the LLLGB Shop

Copyright LLLGB 2016

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Out & About With Your Breastfed Baby - La Leche League GB

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Early days After giving birth to your baby, you may prefer to be close to home. Taking things easy and lots of breastfeeding will help you regain your strength and build up a good milk supply while getting to know your baby.

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding.

Key to achieving the Baby Friendly standards is a workforce able to support mothers to breastfeed effectively. This video provides some guidance on this.

You can see more of the 'From Bump to Breastfeeding' DVD on the Best Beginnings website.

Video not working? Contact us

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Positioning and attachment video - Baby Friendly Initiativ

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding. Watch to learn more.

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East Suffolk and North Essex NHS Foundation Trust

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The Mum and baby app provides extra information and support throughout pregnancy, birth and the postnatal time. It is designed to enhance your maternity experience, including a library of almost 1000 free to download videos covering a wide range of topics.

You can search for your local maternity unit and compare to others in the area. You will be able to self-refer, complete personal care plans and access information throughout your maternity journey.

The app is free to download on Apple and Android.
Flipbooks to accompany the app: Back to top

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East Suffolk and North Essex NHS Foundation Trust

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The Mum and Baby app - East Suffolk & North Essex NHS Foundation Trust

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The Mum and baby app provides extra information and support throughout pregnancy, birth and the postnatal time. It is designed to enhance your maternity experience, including a library of almost 1000 free to download videos covering a wide range of topics. You can search for your local maternity unit and compare to others in the area.

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

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

Find more useful organisations.

Breastfeeding is the healthiest way to feed your baby. If you decide not to breastfeed or to stop breastfeeding, it is possible to restart. Giving infant formula to a breastfed baby will reduce your milk supply. You do not need to eat any special foods while breastfeeding, but it is a good idea for you, just like everyone else, to eat a healthy diet.

Resources to support you

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

Overcoming breastfeeding problems

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

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

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

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Support for parents - Baby Friendly Initiative

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Resources and information for parents to support with feeding and developing close and loving relationships with their baby.

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Breastfeeding after returning to work or study

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Breastfeeding after returning to work or study

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National Breastfeeding Helpline - Helpline

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Skin-to-skin contact - Baby Friendly Initiative

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Skin-to-skin contact is important for babies and mothers to develop close, loving parent-infant relationships and to initiate breastfeeding.

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In this video, we explore how best to support new mothers with feeding.

Exclusive breastfeeding for the first six months ensures the best outcomes for babies, and mothers need support to get this off to the best start. Ongoing help with positioning, attachment and skin-to-skin contact help mothers to maintain their milk supply and avoids disruption to breastfeeding.

If mothers wish to bottle feed, the impact on milk supply should be discussed so that they can make informed choices. A sensitive, non-judgmental approach is key.

For more information:

Problems viewing this video? Contact us.

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Maximising breastmilk video - Baby Friendly Initiative

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In this video, we explore how best to support new mothers with feeding, including positioning, attachment and skin-to-skin contact.

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inourplace | Solihull Approach - Online courses for emotional health and wellbeing.

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inourplace | Solihull Approach | Online courses for parents

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inourplace | Solihull Approach : Online courses dedicated to improving emotional health and wellbeing in parents, children, teenagers, adults and grandparents.

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Many mothers breastfeed their twins, triplets or more. Twins Trust is here to support you with whichever feeding choice is best for your family.

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Essex Child and Family Wellbeing Service

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Breastfeeding Out and About - Essex Child and Family Wellbeing Service

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Get tips on breastfeeding when out and about and search for local breastfeeding welcome businesses

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Essex Child and Family Wellbeing Service

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After around the first 6 months of life your baby will be ready for start of the next phase of their nutritional development. The current NHS guidelines state that solid food should be introduced at 6 months. This is because at this age your baby's gut has matured and developmentally they are ready.

If your child is having prescribed milk or has intolerances/allergies it is important to seek health visitor advice before commencing introducing solid foods.

1. Signs of being ready for solid food

2. Guidance and helpful information

Articles

Check if this service is available in your area

Signs of being ready for solid food

There are 3 signs that your baby may be ready to start solid foods:

1. Your baby has good hand eye coordination - your baby can see, reach and put food to their mouth

2. They can stay in the sitting position and can hold their head steady

3. Your baby is able to swallow without pushing food back out of their mouth

Guidance and helpful information

First foods

Baby's first foods can include mashed or soft cooked fruit and vegetables. You can use a mixture of feeding your baby from a spoon and giving them finger foods to hold and chew. When preparing finger foods a good way to determine the right size is to have a piece big enough to fit into your baby's fist. It is always best to prepare finger foods length ways into baton sized pieces and cut round foods into quarters (for example, grapes and tomatoes).

Next foods

Once your child has got use to eating they can have soft cooked meats, mashed fish, pasta, toast, noodles, well-cooked eggs, full fat dairy products (such as yogurts and cheese). Food can be full of flavour and textures and the more variety your child has the less likely they are to become fussy.

What to avoid

Whole nuts are not recommended for under 5s due to the risk of choking

Honey should not be given to children under the age of 1. This is because it contains a bacteria they can be harmful.

Low fat foods should not be given as your child needs the vitamins and calories from fat for their growth and development

All raw shellfish should be not be given to children as there is a high risk of food poisoning. Some fish such as marlin, shark and swordfish have high mercury levels and can cause damage to children's nervous system

All under-cooked and raw eggs should not be given due to the risk of salmonella poisoning

Salt, sugar and saturated fats should be avoided. Sugar can cause tooth decay in young children so it is best to limit sweet treats. Salt can be harmful for the kidneys. Be careful of stocks and gravies as these can be salty. If you share your meal with your child, make sure you have not added salt or sugar

See our Introducing Solid Foods FAQ >

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Introducing Solid Foods - Essex Child and Family Wellbeing Service

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After around the first 6 months of life your baby will be ready for start of the next phase of their nutritional development. The current NHS guidelines state that solid food should be introduced at 6 months. This is because at this age your baby's gut has matured and developmentally they are ready.

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Skip to main content

The most important thing is to include a wide variety of fresh, healthy foods in your breastfeeding diet.

If you think something you're eating is affecting your baby through your breast milk, talk to your GP or health visitor, or call the National Breastfeeding Helpline on 0300 100 0212.

Food and drinks to include

You don't need a special diet while you're breastfeeding - just try to include a well-balanced, healthy variety of the following:

Aim to eat at least 5 portions of fruit and veg a day. Fresh, frozen, tinned, dried or juiced can be part of your daily allowance - avoid anything with added salt or sugar.

Starchy foods are an important source of energy, certain vitamins and fibre. This includes bread, potatoes, breakfast cereals, rice, pasta and noodles. Go for wholemeal, instead of refined starchy (white) versions, as much as possible.

Foods in this group include meat, fish, poultry, eggs, beans, pulses and nuts. Aim to have 2 portions of fish each week - make one of them an oily fish like salmon, sardines or mackerel. Shark, swordfish and marlin can contain more mercury than other types of fish, so avoid eating more than 1 portion per week.

Eggs produced under the British Lion Code of Practice (stamped with the red lion) are considered very low risk for salmonella, and safe to eat raw or partially cooked.

Dairy includes milk, cheese and yoghurt. It contains calcium and other essential nutrients. When possible, choose low-fat varieties, such as semi-skimmed, one per cent fat or skimmed milk, low-fat yoghurt and reduced-fat hard cheese. If you prefer dairy-free alternatives, such as soya drinks and yoghurts, go for the unsweetened, calcium-fortified versions.

Breastfeeding Friend from Start for Life

The Breastfeeding Friend, a digital tool from Start for Life, has lots of useful information and expert advice to share with you - and because it's a digital tool, you can access it 24 / 7.

For confidential breastfeeding information and support, call the National Breastfeeding Helpline on 0300 100 0212. Lines are open 9:30am to 9:30pm every day.

Sign up now for our pregnancy, baby and toddler guide

Get personalised emails for trusted NHS advice, videos and tips on your pregnancy week by week, birth and parenthood.
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It's important to eat a variety of healthy foods while breastfeeding - have a look at our healthy diet guide

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Skip to main content The most important thing is to include a wide variety of fresh, healthy foods in your breastfeeding diet. If you think something you're eating is affecting your baby through your breast milk, talk to your GP or health visitor, or call the National Breastfeeding Helpline on 0300 100 0212.

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Do you have any breastfeeding questions? Get NHS trusted advice from the Breastfeeding Friend available on Google Home. Find out more

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Do you need breastfeeding support & advice? There is a lot of help available - including the Breastfeeding Friend from Start for Life on Google Home. Click to find out more.

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It's never too early to start thinking about how you're going to feed your baby. But you do not have to make up your mind until your baby is born.
Some of the benefits of breastfeeding are:

your breast milk meets all of your baby's nutritional needs

breast milk protects your baby from infections and diseases

breastfeeding provides health benefits for you

breast milk is available for your baby whenever your baby needs it

breastfeeding can build a strong emotional bond between you and your baby

Formula milk does not provide the same protection from illness and does not give you any health benefits.

Health benefits of breastfeeding for your baby

Breastfeeding has long-term benefits for your baby, lasting right into adulthood.

Any amount of breast milk has a positive effect. The longer you breastfeed, the longer the protection lasts and the greater the benefits.

Breastfeeding can help to reduce your baby's risk of:

Giving nothing but breast milk is recommended for about the first 6 months (26 weeks) of your baby's life.

After that, giving your baby breast milk alongside solid foods for as long as you and your baby want will help them grow and develop healthily.

Breast milk adapts as your baby grows to meet your baby's changing needs.

Health benefits of breastfeeding for you

Breastfeeding and making breast milk also has health benefits for you. The more you breastfeed, the greater the benefits.

Breastfeeding lowers your risk of:

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.

Get Better Health: Start for Life

Sign up for Start for Life weekly emails for expert advice, videos and tips on pregnancy, birth and beyond.

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Breastfeeding has lots of health benefits for your new baby, including fewer infections and a lower risk of obesity, as well as protecting you from some cancers and other health problems, too.

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Choosing which method is best for you

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

Expressing exclusively

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

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

Find more information about expressing.

Mixing breastfeeding and expressing

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

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

Mixing breastfeeding and formula feeding

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

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

Mixing expressing and formula feeding

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

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

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

Mixing breastfeeding, expressing and formula feeding

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

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

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

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

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Skip to main content

Mixed feeding is when you combine breastfeeding with bottle feeding (either using expressed breast milk or infant formula).

If possible, it's best to make sure that you and your baby get the hang of breastfeeding before you start mixed feeding. Breastfeeding is a skill that you and your baby need to work at - it can take several weeks to feel happy and confident with it.

Sign up now for our pregnancy, baby and toddler guide

Get personalised emails for trusted NHS advice, videos and tips on your pregnancy week by week, birth and parenthood.
Get weekly emails

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Mixed feeding comes in different forms and can be tricky to get the hang of at first - read our advice on getting started with mixed feeding

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Skip to main content Mixed feeding is when you combine breastfeeding with bottle feeding (either using expressed breast milk or infant formula). If possible, it's best to make sure that you and your baby get the hang of breastfeeding before you start mixed feeding.

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Learning you are pregnant with twins, triplets or more changes your expectations and plans. But you can still plan to breastfeed. Breastmilk is a complete and perfect food for your baby. It is especially important for multiples, who are often small at birth. Breastfeeding also helps you create a spe…

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Sucking is a basic instinct that babies are born with. Babies suck for both food and comfort. Breastmilk also provides protection against disease so nature has made sure that babies love to be at the breast. They are comforted by the warmth, smell, delicious milk and reassuring sound of your heartbeat.

Breastfeeding offers a lot of security too, whether your baby is feeling lonely, frightened, sad, cross, or ill at ease with a new situation.

In the early days, it's easy to feel overwhelmed by your baby's need to nurse. But meeting his needs makes him feel safe and ensures you have plenty of milk. As he grows, your baby's nursing pattern will change and life with your new baby should settle down.

Whenever a substitute for sucking at the breast is used there is a risk of affecting the breastfeeding relationship, especially for a baby who has not yet mastered nursing at the breast.

Milk production

Dummy use may reduce your milk production and result in poor weight gain. In the early weeks it's really important to nurse often and ensure all sucking is at the breast to establish and maintain good milk production.

Breastfeeding problems

Using a dummy can make it harder for your baby to breastfeed comfortably and effectively (1). The shape and firmer feel of a dummy differs from your pliable breast. Some babies may prefer the stronger sucking trigger of a dummy, leading to 'confusion' about how to nurse at the softer breast. The result may be sore nipples for you and not enough milk for your baby. He may become frustrated and start to fuss, cry or refuse to breastfeed altogether.

Early weaning

Regular dummy use is associated with premature weaning (1,2). A dummy is often assumed to be an essential parenting tool. A baby is comforted by sucking, so what could be more convenient than a small portable device to pop in his mouth? But will offering a dummy cause problems with breastfeeding or can you combine the two?

Babies like to suck for pure pleasure even when milk flow slows. You have only to look at your older baby to see this-he frequently looks up into your eyes then breaks off sucking to give you a great big smile. You in turn smile and talk to your baby. These are the first steps in your baby's development of language and relationships.

Why give a dummy?

It's important to remember that a dummy is a substitute for the breast-an object to silence, or pacify a baby's crying until the real thing is available. For this reason it doesn't really make sense for people to suggest a baby is using his mother as a 'human dummy' when he wants to nurse for comfort.
There may be occasions when it's convenient to use a dummy-to calm your baby briefly when you can't nurse him immediately, for example if you're driving. Sometimes a baby with colic will find it soothing to suck on a dummy between feeds.

If you decide to give your baby a dummy, it's better to wait until breastfeeding is well-established and he is gaining weight well. You will also need to follow manufacturer's guidelines on cleaning and replacement.

In some hospitals premature babies may be given a dummy during tube feeding to stimulate their sucking reflex, help digestion and help them associate the action of sucking with receiving food. It's best if this is just a temporary substitute and efforts are made to establish breastfeeding as soon as possible.

Infections

Your baby has an increased risk of ear infections if he regularly has a dummy (3). Thrush can be a problem too, as it thrives on moist surfaces at room temperature.

Dental problems

Breastfeeding provides exercise for optimum development of a baby's mouth, tongue and jaws and many orthodontists say they see fewer dental problems in breastfed babies. Regular dummy use can affect the growth of teeth and the shape of babies' mouths, increasing the risk of sleep apnoea* and the need for braces later on (4,5). It can also increase the levels of decay-causing bacteria in babies' mouths (4).

Problems for mothers

You can be at risk of engorgement and mastitis when you introduce a dummy-a particular problem if you have an oversupply of milk. Your periods and fertility may also return earlier as your hormone levels are affected when your baby nurses less.

Don't forget

Many babies have no interest in using a dummy. You are the best pacifier in the world from your baby's point of view. And what could be more natural than to bring peace to your baby with the warmth of your presence through breastfeeding, rather than with a plastic device.

If breastfeeding is affected

Stop using the dummy so that your baby can concentrate on learning to feed well at the breast.

Offer a breastfeed while he is still calm and pay extra attention to how he is positioned and attached at the breast.

Encourage your baby to breastfeed at least 8-12 times in 24 hours, offering both sides and allowing him to nurse for comfort.

To encourage his interest in breastfeeding hand express so milk is flowing before offering the breast.

Ask your LLL Leader about the technique of breast compression which has been found to encourage babies to continue breastfeeding actively for longer.

Spend extra time cuddling, carrying and holding your baby, including skin-to-skin contact to help him relax and encourage his interest in breastfeeding.

Weaning from a dummy

Regardless of whether it affects breastfeeding, you and your baby can become over-attached to a dummy. It is easy to find yourself using it more and more and your toddler's language and social development may be delayed. It is recommended that parents stop using a dummy once a baby is 6 months old.

You may need to wean yourself from the convenience of popping in the dummy when your baby fusses and give extra attention, cuddling or nursing instead.

To reduce or cut out dummy use, try:

Offering to nurse instead.

Restricting your baby's dummy use to certain times such as only in the car.

Carrying him, taking him for a walk in the buggy, giving him a bath, playing games, singing or sharing other interesting activities.

If your baby has become accustomed to falling asleep with a dummy, the simplest option is to breastfeed him instead. From 6 months:

Try gently removing the dummy once he is asleep or very sleepy so that he gradually learns to fall asleep without it.

Keep trying as new sleep associations take a while to establish. You could introduce other sleep cues such as wrapping in a blanket, rubbing his back, rocking and/or a key word, for example 'shh'.

Extra time focussing on your baby's needs whilst working to reduce dummy use will help the change go more smoothly. If you have any questions or need support as you wean your baby from using a dummy you can contact an LLL Leader by calling our Helpline. You can find your local group here.

Breastfeeding, Dummies and SIDS

Some research has shown that using a dummy to settle a baby to sleep can reduce the risk of sudden infant death syndrome (SIDS) (6,7). The cause and effect is unknown, and may be related to other protective factors. It is possible that a baby falling asleep with a dummy mimics babies falling asleep at the breast (8,9) Babies generally keep a dummy in the mouth for less than 15 minutes at sleep times (10)-similar to the time it takes a baby to breastfeed to sleep.

Current recommendations for dummy use at sleep times (6,11) are that a dummy should:

Not be used to replace breastfeeding.

Not be replaced after a baby falls asleep.

Not be given to a baby who doesn't want it.

It would seem from these recommendations, that a baby who breastfeeds to sleep is unlikely to want or need a dummy.

*Sleep apnoea: irregular breathing during sleep.

Further Reading
Beginning Breastfeeding
My Baby Needs More Milk
Nipple Confusion?
Safe Sleep & The Breastfed Baby
Sleepy Baby - Why & What To Do

Books
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
References

1. Righard, L and Alade, M. Breastfeeding and the use of pacifiers. Birth 1997; 24(2): 116-20.

2. Victoria, C et al. Pacifier use and short breastfeeding duration. Cause, Consequence or Coincidence. Pediatrics 1997; 99(3): 445-453.

3. Warren, JJ et al. Pacifier use and the occurrence of otitis media in the first year of life. Pediatric Dentistry 2001; 23(2): 103-07.

4. Palmer, B. Breastfeeding: Reducing the Risk for Obstructive Sleep Apnea. Breastfeeding Abstracts. 1999 Feb 18(3): 19-20.

5. Viggiano, D, et al. Breastfeeding, bottlefeeding, and non-nutritive sucking: Effects on occlusion in deciduous dentition. Arch Dis Child 2005; 89: 1121-23.

6. Hauck, FR et al. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics. 2005 Nov; 116(5): e716-23.

7. Li, DK et al. Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based casecontrol study. BMJ 2006 Jan 7; 332(7532): 18-22.

8. Blair, PS and Fleming, PJ. Dummies and SIDS: Causality has not been established. BMJ 2006; 332: 178.

9. Fleming, PJ et al. Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study .CESDI SUDI research team. Arch Dis Child 1999; 81: 112-6.

10. Weiss, P and Kerbl, R. The relatively short duration that a child retains a pacifier in the mouth during sleep: implications for sudden infant death syndrome. Eur J Pediatr. 2001; 160: 60-70.

11. Moon, RY et al. Sudden infant death syndrome. Lancet. 2007 Nov 3; 370(9598): 1578-87.

12. NICE Clinical Guideline CG 37: Postnatal care: Postnatal care up to 8 weeks after birth National Collaborating

13. Centre for Primary Care and Royal College of General Practitioners, 2006. http://www.nice.org.uk/guidance/cg37/chapter/1-recommendations#infant-feeding http://www.nice.org.uk/CG037

This information is available to buy in printed form from the LLLGB Shop

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Dummies and Breastfeeding - La Leche League GB

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Sucking is a basic instinct that babies are born with. Babies suck for both food and comfort. Breastmilk also provides protection against disease so nature has made sure that babies love to be at the breast. They are comforted by the warmth, smell, delicious milk and reassuring sound of your heartbeat.

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Signs of effective feeding in the early days - La Leche League GB

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Most babies are keen to feed in the first 90 minutes after they are born especially if they are in skin-to-skin contact with their mum. If your baby is too sleepy to take this first feed or needs medical attention, it’s a good idea to ask your healthcare team to show you how to hand […]

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Getting your baby positioned and attached comfortably at the breast is an art-mothers often say it takes a little while for breastfeeding to feel entirely comfortable and natural, even if they've breastfed before. In the past girls grew up learning about breastfeeding by watching mothers in their families and communities. These days many of us become mothers having never seen a baby breastfeed.
But breastfeeding has worked for mothers and babies for thousands of years and it can work for you too.
Many babies can find their way to the breast by themselves, especially if they haven't been too affected by birth interventions. Other mums and babies need a little longer to work it out with maybe some help from a skilled breastfeeding supporter such as an LLL Leader.

When all is going well, specific holds and positions don't really matter because you and your baby will work out what suits you best. However if you are finding it awkward, uncomfortable or downright painful then the following information is designed to help you think about where you can make adjustments and get breastfeeding working comfortably for you.

Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively. This is important for maintaining milk production. Well-drained breasts make milk quickly. If there is any concern about how much milk you are making, working on improving positioning and attachment is an important first step.

There's no 'right' or 'wrong'. If you are comfortable, your baby is producing plenty of dirty nappies and is gaining weight after the first few days, then breastfeeding is going well for you. There are no rules-but there are a few principles that can help you work out what to do if things aren't going well: see Latching on - getting a good attachment.

Positioning describes how you sit or lie and how you support your baby as he takes the breast. How you hold your baby can make a big difference to how well he can breastfeed. Even small adjustments can be significant. Attachment describes the way he latches onto the breast.

Tips for getting started
The laid-back approach
Latching on - getting a good attachment
Different breastfeeding positions
As time goes by

Tips for getting started

If it hurts then make changes

If it doesn't feel right to you, then it isn't fine, whatever anyone says. Pain is your body's way of letting you know something is wrong. Start by trying to improve positioning and attachment. A few quick adjustments to how you are sitting or lying or how your baby comes towards the breast may be all that are needed.

Sometimes it can take a little longer. You may need to work with one or more skilled breastfeeding supporters over a period of time to get to the point where everything falls into place and breastfeeding starts feeling natural.

Each mother and baby pair is different and what works well for one mother and baby may not work for you. This is one reason why you may hear different suggestions from different helpers. You are the best judge of what is helpful so don't be afraid to use what feels right for you and discard the rest.

Your baby needs to be calm

You can offer the breast at any time when you are both calm. You may even find it easier if your baby isn't obviously hungry. Feed your baby before he needs to cry. Early cues for wanting to eat include suckingtheir hand, smacking their lips, turning their head towards you, or fussing. They won't latch well if they are distressed. If your baby is upset take time to soothe them. Hold them upright against you, stroke them and talk to them. A little expressed colostrum or breastmilk given on a spoon can help to calm them if they are desperately hungry.

Your baby needs full body contact

When your baby is held in full body contact against you, they will feel stable and be better able to coordinate their movements. Laid back positions ensure full body contact. If you're sitting up, you'll need to hug your baby in as tightly as if you were standing up holding them against you. Babies who don't feel stable tend to wave their arms around, which can make latching more difficult. Pillows can get in the way and aren't always necessary. So wait until after your baby's latched on, and then tuck them in only if you need them for support.

Some babies need time

Some babies find it difficult to latch on, or simply nurse ineffectively at the breast. Often a difficult birth or interventions during labour or birth are the cause. Giving a baby time to recover, and using laid-back breastfeeding positions with skin-to-skin contact can maximise your baby's natural instinct to breastfeed. If your baby isn't latching or feeding well seek help from an LLL Leader and read our page My Baby Won't Breastfeed. With time and patience, most babies will breastfeed. In the meantime express your milk for your baby to maintain milk production and give you both the time to work it out.

Laid-back breastfeeding

Many people assume you have to sit up to breastfeed. Not so. In fact evidence suggests humans evolved to breastfeed in laid-back positions with our babies upright against our chests. You may have experienced this type of position when you had your first feed, soon after your baby's birth. There is more and more evidence that laid-back breastfeeding positions (also called Biological Nurturing) help babies breastfeed more effectively and are more comfortable for mothers, especially in the early days and weeks.

Laid back breastfeeding is really useful for those first few days and weeks when you want to rest and recover and your baby needs to be in close contact with you to get breastfeeding established. It can be done skin-to-skin or with you both lightly dressed. You don't have to be in bed; the sofa or a reclining chair is a comfortable alternative.

You can also use laid-back breastfeeding principles when sitting in an upright chair by shifting your weight back onto your tail bone and reclining your body back a little, to open up a space for your baby. This allows more of their weight to be supported by your body and less by your arms. It isn't safe to sleep with your baby on a chair or sofa.

Sleepy babies

If your baby is sleepy, perhaps because of birth interventions, then using laid-back positions with skin-to-skin contact can encourage your baby's interest in feeding. In laid-back positions babies often attach and feed when in light sleep so it helps to spend substantial periods of time with your sleepy baby against you. When you notice the little movements that indicate your baby is moving into a light period of sleep you can encourage them to latch.

How laid back breastfeeding works

You lay back in a comfortable, supported semi-reclining position (not flat) that opens up your body, creating space for your baby.

Your baby lies against you, their whole front against your body, vertically or at any comfortable angle.

Your baby feels stable and secure and their instinctive feeding reflexes are triggered, prompting them to bob their head and seek out the breast.

Gravity helps them latch deeply and stay latched, rather than hindering the process.

Your hands are free to support and caress your baby and help them attach.

Your body releases the hormones that stimulate milk production and make you experience loving feelings towards your baby.

There are no rules-you and your baby are free to work it out between yourselves.

Latching on - getting a good attachment

Your baby needs to tip their head back and reach forward with their lower jaw. As your baby tips their head back their jaw drops and their mouth opens wide, so they can anchor their chin and lower lip firmly against your breast. If they have to tuck their chin in to reach the nipple they won't be able to open their mouth so wide. Tipping their head back also makes a deep latch possible, swallowing easier, and frees up their nose for comfortable breathing. In laid-back positions lay your baby with their head between your breasts. If you are sitting up, keep your supporting hand away from the back of their head. Babies tend to creep forward, so try shifting them so that their eyes and nose are opposite the nipple to encourage them to reach forward and anchor their chin first. In sitting or side lying positions a little push between the shoulder blades with your supporting hand or arm as they latch brings their chest in closer and helps their head tip back.

Their lower jaw needs a clear space to anchor. Think about how you might take a mouthful from a big sandwich by placing your lower jaw first then opening your mouth to accommodate the top of the sandwich-the principle is the same. Your baby's lower jaw needs to be deeply placed on your breast well away from the nipple. Keep the fingers of your supporting hand away from the place where their chin and lower jaw need to be so their lower lip and chin can sink into your breast. Your baby's chin needs to stay firmly in contact with your breast.

Your baby needs a big mouthful. When a baby chews on a nipple, this compresses the milk ducts, prevents milk flowing and hurts. When a baby has a good big mouthful of breast beyond the nipple, breastfeeding is comfortable and milk can flow. Some women like (or need) to hold their breast when nursing. They flatten their breast as they would a big sandwich they were offering to the baby, matching it to the oval of his mouth. This can help their baby grasp more breast tissue. It doesn't matter if fingers are closer to the upper jaw but try to keep the "lower jaw fingers" out of your baby's way. Biological Nurturing™ positions make use of gravity to help a baby get a bigger mouthful.

The exaggerated latch. To get an even deeper latch you could try this optional extra. Place your thumb or finger near the base of the nipple where the middle of your baby's upper lip will be, lined up with their nose. If you press, your nipple will tilt away from your baby, presenting them with your breast rather than your nipple. Avoid pressing your nipple into their mouth. As they open wide, snuggle them in close and use your thumb or finger to tuck the breast into their mouth. Your nipple will be taken in last and unroll in their mouth. You can then slip your finger out.

Our own video below demonstrates flipple technique (aka exaggerated latch), it can be very helpful for getting an effective pain free latch:

Let your breast rest at its natural level. It can be tempting to lift your breast and move it towards your baby's mouth. If you do this, your baby probably won't get a full mouthful, and after a while your hand will get tired and the breast will drop and slip out of their mouth. Breastfeeding pillows can get in the way too because they lift a baby up too high and prevent you tucking them in against your tummy. See where your breasts naturally rest and hold your baby accordingly. If you need them, tuck pillows in after they are well attached.

Bring baby to breast, not breast to baby. Since breasts are attached to you and you baby is moveable it makes much more sense to bring your baby to the breast, not the other way round! And it works better too. With their body tucked firmly against you (or laid on top of your body), your baby will feel more stable and have better head control, and you'll feel a lot more comfortable too.

It's easier to latch onto a softer breast. It's much easier to get a deep mouthful if the breast is soft so breastfeed frequently to avoid engorgement. When your baby bobs their head and licks the nipple, it naturally makes it easier to latch on. If your breast is full and hard, you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Apply gentle steady pressure with your fingertips on the areola around your nipple for about a minute. You can also press with the sides of your thumbs or fingers. Denting the breast at the edge of the areola with a finger and placing your baby's chin in the dent may also help. Gently hand express a little milk too if needed.

Your baby needs to choose his own timing. Your baby will probably do best if they pick the moment to latch on. You can help by supporting them in a position that lets them do this when they are ready. To encourage your baby to gape hold them close against you, close enough to the breast so they know the nipple is there, but where they can't quite reach it. Be prepared for your baby to lick and nuzzle for several minutes before they are ready to open wide.

The natural or laid-back breastfeeding positions shown in the following videos can be a great help in encouraging your baby to latch on well, as well as being comfortable for you. You can recline comfortably with your baby on top of you with their whole front against you and their body completely supported by yours.

Best Beginnings' video demonstrates clearly how to make sure your baby is attaching well to the breast, you can view it here.

This video demonstrates how to enable your baby to latch deeply on to your breast so that breastfeeding is comfortable for you and means your baby get enough milk:

This video shows how to attach your baby well, and shows a variety of comfortable breastfeeding positions:
http://m.raisingchildren.net.au/articles/breastfeeding_attachment_video.html

Using different breastfeeding positions

The cradle hold

Although the cradle hold is one of the most common nursing positions it can be a challenge for new mothers to learn. You need to hold your baby's body firmly against you to give them stability because their weight is supported mainly by your arms. Shifting so you are sitting on your tailbone, rather than upright can help stability and reduce the strain on your arms (see picture right). It can be difficult to control a baby's head and to keep them high enough and close enough to your breast. A small baby may tend to curl up in a ball in this position if not pulled in closely enough against your body. It may not be the best choice at first if you're experiencing any problems with latch-on, milk transfer or if you have sore nipples. Once you're more confident with breastfeeding, you may find you use a version of the cradle hold much of the time, especially when out and about.

Your baby's whole front is against your tummy, their hip resting on or near your thigh, tucked around you like a comma. Their chest will be snuggled into the breast and your nipple near their nose.

Their head is resting on your forearm and/ or wrist (not the crook of the elbow).

As your baby opens their mouth to take the breast, pull their body in firmly against you.

Once your baby is attached, settle back a little for your own comfort and so that more of their weight is taken by your body.

Laid back breastfeeding

Remember that Biological Nurturing™ positions aren't just for the first week or two. They can be really useful later on when you want to relax, and especially if you are breastfeeding more than one baby or if your baby is fussy or unwell.

The cross-cradle hold

The cross-cradle position can be useful in the early days because it gives you more control in guiding your baby to the breast. It can be uncomfortable to maintain without good support under your arms, especially with larger babies, so once your baby is attached, switch arms as shown in the picture below. After the first few weeks and as your baby grows longer and heavier, you may prefer to use other comfortable holds. Avoid touching the top or back of your baby's head because it often causes a baby to pull back from the breast. Forcing a baby onto the breast by firmly holding the back of the head usually has the opposite effect and can put a baby off breastfeeding.

Cross cradle

Tuck their whole front against your tummy, their hip near or resting on your thigh.

Your hand supports their neck (not the back of the head) with your palm between their shoulder blades.

Your other hand is free to shape or stabilise your breast if needed.

Make sure your baby isn't too far round the front-line them up so their eyes and nose are near the nipple.

As your baby opens their mouth, give a little push with the palm of your hand to bring their chest in close against you.

This will help their head tip back and let them plant their chin deeply against your breast.

Once your baby is attached you can bring your other arm round to support your baby's body and settle back a little for your own comfort and so that more of his weight is taken by your body. Hold your baby with the arm opposite to the breast he's going to latch onto.

The underarm (clutch or rugby) hold

The underarm hold is useful if you have had a caesarean birth. It helps keep the weight of your baby off your incision. It is also a good position for mothers with flat or inverted nipples and for babies with latch-on or sucking problems because it offers you a good view of baby and breast and control of your baby's head. You can also feed two babies at once in this position. For larger, longer babies you may need extra cushions behind your back to bring you further forward and allow space for your baby's length.

Your baby's front is close against your side, with your hand under their shoulders and neck.

Your elbow keeps them tucked closely against your body.

Your baby approaches your breast from below. This can work well if you have large breasts. If you have smaller breasts you may need to bring your baby into a semi-sitting position.

Make sure your baby isn't too far round the front. You may need a cushion between your back and the chair back to allow room for your baby's length and prevent them pushing themselves forward with his feet.

Side lying

This side-lying position is helpful if you are recovering from a caesarean birth or an episiotomy and invaluable for nursing in bed during the night.
It can take a while to get the knack but it's well worth persisting because it can make night feeds so much easier.
Some mothers decide to sleep with their baby alongside them. Others choose to move their baby back onto a separate sleep surface.
Safe Sleep and the Breastfed Baby will help you decide on the safest sleep arrangements for your family, based on your own individual circumstances.

* Lie on your side, with your knees bent up and a pillow under your head.
* Place your baby on their side facing you so that their body and your body form a V-shape, meeting at your hips, with your nipple level with their nose or eyes.
* You can put your arm under your baby's head as shown, or up by the pillow with your baby lying on the bed.
* As your baby latches, give a little push between their shoulder blades to bring their chest in closer and help their head to tip back and their mouth to
open wide.
* You may find it helpful to tuck a small pillow or rolled blanket behind the small of your back and/or between your knees.

Standing up

At some feeds babies just do better if you stand up. You can sway or bounce gently to help calm your baby, and the lack of a lap can be helpful. As always keep your baby nice and stable and let them lead the way. Try angling their legs down instead of holding them horizontal, and see what happens. Or try starting with them against your shoulder, supporting them as he moves down to the breast. Even when using other positions, sometimes just standing up and sitting down again straight away helps everything settle into a comfortable position.

As time goes by

Whether you choose to breastfeed sitting up, reclining or lying on your side, you will need to adjust how you support your baby as he grows in length and weight. Use the principles shown here as you experiment with different positions. Sometimes there are physical or medical causes for pain or discomfort such as tongue tie or a thrush infection. If you are still finding it difficult to get comfortable, do persist with seeking further and continued support. There is almost always a breastfeeding solution to breastfeeding problems. You can contact an LLL Leader by calling our Helpline. You can also find support and encouragement from breastfeeding mothers in your local LLL group.

Written by Sue Upstone, Karen Butler and mothers of LLLGB

Further Reading

The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.

Mastitis
Beginning Breastfeeding
Breastfeeding Your Baby - easy read
Caesarean Birth & Breastfeeding
Comfortable Breastfeeding - easy read
Skin-to-Skin
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
Inverted Nipples
My Baby Needs More Milk
My Baby Won't Breastfeed
Nipple Confusion?
Nipple Pain
Nipple Shields
Nursing Supplementers
Safe Sleep & the Breastfed Baby
Sleepy Baby - Why & What To Do
Tongue Tie
Too Much Milk & Oversupply

LLLI Resources
Position to breastfeed

Other resources
How to do Biological Nurturing: www.biologicalnurturing.com/video/bn3clip.html
Best Beginnings videos to watch online: www.bestbeginnings.org.uk/watch-fbtb

References
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.
Biological Nurturing: Laid-back breastfeeding for mothers (DVD). Colson, S. et al. 2012.
An Introduction to Biological Nurturing; New angles on breastfeeding, Colson S. Amarillo, TX: Hale Publishing, 2010.
Supporting Sucking Skills, Watson Genna, C. Burlington, MA: Jones & Bartlett, 2012.

This information is available to buy in printed form form the LLLGB Shop.
It is also available in kindle edition.

Information, references and links on this page are taken from La Leche League resources, unless stated otherwise. Please note that LLLGB does not endorse information from outside sources, extra information is provided for you to consider. Information supplied is not intended as advice, and you are in the best position to make a decision as to how the information offered will affect you and your baby.

Copyright LLLGB 2016

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Positioning & Attachment - La Leche League GB

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Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively.

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As new parents, we suddenly find ourselves examining our babies' poo more closely than we could ever have imagined. We pay attention to the colour, quantity, texture and smell, and notice the slightest changes. We then go to the internet looking for answers and fear the worst. There are many versions of normal, and we will share some of these below.

When your baby is born, your colostrum (first milk) has laxative and diuretic compounds in it to make your baby wee and poo. In the first few days your midwife and health visitor will ask how many wet and dirty nappies your baby has had, so you may find it helpful to take note of how many nappies you change.

Your baby may not poo much at first but this will increase as your milk comes in. For an idea of how many poos to expect, see https://www.laleche.org.uk/is-my-baby-getting-enough-milk/#dirtynappies

It can be tricky to tell if disposable nappies are wet - after five full days, when copious milk comes in, they should be heavy.
Many disposable nappies have a faint line down the middle of the nappy which changes colour when wet.
You can feel what a properly wet nappy should feel like by putting three tablespoons (45ml) of water onto a clean, dry one. Urine should be pale and mild smelling.
This post on signs of effective feeding has more information.

Pictures 1-9 below show the contents of one baby's nappy in the first few days of his life, to give you an idea of what to expect from a healthy, full-term baby. If you have any concerns about your baby's poo, or if you see blood in the nappy (beyond the first few days, when baby girls can have a mini period caused by birth hormones), don't hesitate to contact your midwife, health visitor or GP.

Picture 1
Baby's first bowel movement, called meconium, is tar-like, sticky and hard to remove.

Picture 2
Baby's second bowel movement.

Picture 3
Poo from the first day of baby's life. Reddish pink urate crystals are visible in this nappy; see picture 10 for more about urates.

Picture 4
Bowel movement on day two. Your baby's poo will gradually change colour, from black to green to brown. It becomes a lot easier to wipe off as your baby begins to drink more milk.

Picture 5
Day three bowel movement. Looking a lot paler, heading towards a yellowish colour, and much less sticky.

Picture 6
Day four bowel movement.

Picture 7
Day five bowel movement.

Picture 8
Day six bowel movement.

Picture 9
Day ten bowel movement. By this age most fully breastfed babies' poo will be this pale yellow colour. It is common for babies to have what are described as "explosive" poos, which may take you by surprise if your baby poos while you are changing her nappy!
The following pictures show some ways in which your baby's poo may look different from the typical pattern shown above.
Picture 10
In the first few days, you may see reddish pink crystals called urates in your baby's nappy. They are often described as looking like brick dust. As your baby begins to take more milk, the urates should stop appearing in her nappy.

Picture 11
Sometimes your baby's poo may be light green rather than yellow, and have small lumps in it like cottage cheese. This is common and not significant by itself, unless your baby has other symptoms that you are worried about.

Picture 12
This poo came from a three-week-old baby who was given Gaviscon because of reflux. When the medication was stopped, the baby went back to having runny yellow stools.

Picture 13
After the 12-week injections this baby had green poo, which went back to being yellow after a few days.

Picture 14
This dark green poo came from a baby who was later diagnosed with cow's milk protein intolerance.

Picture 15
This poo, containing mucus, came from a baby diagnosed with allergies. Mucus in the poo is also common when a baby has a heavy cold, but this should be temporary and should stop when the baby is well again. If your baby's nappy has persistent or unexplained mucus in it, seek medical advice.

Picture 16
As your baby starts to eat solid foods, you will see the results in his nappy. It is common for your baby's very first foods to come out looking almost exactly as they did when they went in, as his digestive system is not used to dealing with these other foods yet. This is much easier to spot if your baby is eating finger foods rather than mashed food; the mashed foods are passing through semi-digested in the same way, but are less obvious in the nappy.

With time, your baby's poo will gradually change from yellow liquid to soft brown lumps, and you won't generally see pieces of food. However, some foods are hard to digest and tend to pass through the body unchanged (even for older children or adults). This picture shows an 11-month-old's nappy with partially digested grapes visible in it. Strongly coloured foods (like blackberries or beetroot) can also affect the appearance of your baby's wee and poo.

Written by Amanda Dunbar and Emma Taylor for LLLGB, 2017

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As new parents, we suddenly find ourselves examining our babies' poo more closely than we could ever have imagined. We pay attention to the colour, quantity, texture and smell, and notice the slightest changes. We then go to the internet looking for answers and fear the worst.

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Are you experiencing pain while breastfeeding, possibly combined with slow weight gain for your baby? While the vast majority of such breastfeeding problems can be resolved by adjusting positioning and attachment, and with good breastfeeding management, occasionally tongue tie might be the cause of the problem.

Tongue tie (ankyloglossia) is caused by a tight or short lingual frenulum (the membrane that anchors the tongue to the floor of the mouth). The frenulum normally thins and recedes before birth. Where this doesn't happen, the frenulum may restrict tongue mobility. Tongue tie often runs in families and is thought to be more common in boys than girls. There is an association between high or unusual palates and tongue tie, because restricted tongue movement can affect the shape of the palate.

Breastfeeding challenges can also occur for other reasons. Identifying the cause is important when deciding on appropriate solutions, so seek help from someone skilled.

Identifying tongue tie

When your baby tries to lift their tongue or move it forwards it may appear misshapen, short or heart-shaped, with the frenulum clearly pulling its centre down and restricting its movement. Or you may be able to see or feel firm tissue where their tongue meets the floor of his mouth. Degrees of tongue tie vary and it can be difficult to diagnose accurately. A short, tight, posterior tongue tie is rarer, but may be particularly hard to spot.

How breastfeeding may be affected

Tongue tie affects tongue movement to varying degrees. The shorter and tighter it is, the more likely it is to affect breastfeeding. Some babies with a tongue tie breastfeed well from the start, others do so when positioning and attachment are improved. But any tongue tie that restricts normal tongue movement can lead to breastfeeding difficulties. A baby needs to be able to move their tongue freely and extend it over the lower gum with their mouth open wide to be able to breastfeed well. The symptoms below are all associated with poor attachment that may be caused by tongue tie.

A baby may:
* Be unable to latch on to the breast at all.
* Be unable to latch on deeply, causing nipple pain and damage.
* Have difficulties staying on the breast, making a clicking sound as he loses suction.
* Splutter and choke when coping with fast flowing milk.
* Breastfeed constantly to get enough milk.
* Have poor weight gain or need supplementation to maintain adequate weight gain.
* Develop jaundice that needs treating.
* Be fussy at the breast when the milk flow slows.
* Develop colic.

A mother may experience:
* Pain during feeds, with damaged nipples. Her nipple may be compressed or distorted into a wedge shape like that of a new lipstick immediately after feeding, often with a stripe at its tip.
* Engorgement, blocked ducts and mastitis because of ineffective milk removal.
* Low milk production because of ineffective milk removal.
* Oversupply-if her baby compensates for not being able to breastfeed well by nursing very frequently.
* Tiredness, frustration and discouragement.
* A premature end to breastfeeding.

Breastfeeding is important for every baby

Though sometimes needed as a temporary supplement if your milk production is very low, introducing infant formula is not the answer. It has short-term and long-term health risks for both your baby and you. A baby with tongue tie can also have difficulties with bottlefeeding. Milk may leak from his mouth during feeds and he may suffer from colic.

Treatment

Where a tongue tie is causing breastfeeding problems, treatment options are available and effective- especially if the treatment is prompt. Although attention to positioning and attachment can help maintain breastfeeding and improve comfort to a certain extent, there is evidence that treating tongue tie by frenotomy (see below) is effective in resolving breastfeeding difficulties. Weight gain can improve dramatically. As well as the continued breastfeeding benefits, continuing to breastfeed after frenotomy maximises a baby's chance of normal mouth (palate), speech and dental development. This includes tongue mobility for licking and moving particles of food around the mouth, helping prevent tooth decay.

Keeping breastfeeding going

Mastering the art of breastfeeding can sometimes be a challenge and it takes determination to keep going if you are in pain. The information here can help you keep breastfeeding, both before and after treatment.

Soften your breast

A baby with tongue tie may find it easier to latch on if your breast is soft so breastfeed frequently to avoid engorgement. When your baby bobs their head and licks the nipple, they naturally makes it easier to latch on. Or you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola. You can also press with the sides of your fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby's lips will be. Gently hand express a little milk if needed.

Biological nurturing™
A baby often instinctively attaches more deeply and comfortably if they can snuggle up close to their mother's chest for periods of time. Try letting your baby lie on your body as you recline so both their chest and tummy are against you. This kind of 'laid-back' breastfeeding contact is known as Biological Nurturing™ and can be done skin-to-skin or with you and your baby lightly clothed-whatever is more comfortable and convenient for you both. Because gravity helps a baby keep their tongue forwards, this can make a real difference to how well your baby feeds and how much milk you make. See picture above and Online Information section for details of an online video.

A deeper latch
Help your baby get as deep a latch as possible at the breast. This will maximise the amount of milk they get and minimise nipple pain.

If your baby retracts (pulls back) their tongue when they open their mouth, try sliding their chin a little further from the nipple so he can feel the 'fatter' part of the breast with his tongue. Denting the breast at the edge of the areola with a finger and placing your baby's chin in the dent may also help.

You could also try placing your thumb or finger near the base of the nipple where your baby's upper lip will be. If you press, your nipple will tilt away from your baby, presenting them with your breast rather than your nipple. As they open wide, snuggle them in close and use your thumb or finger to tuck the breast into their mouth. Your nipple will be taken in last and unroll in their mouth. If needed, you can then slip your finger out. An LLL Leader can give you further suggestions to help you improve your baby's positioning and attachment

Encourage tongue mobility

To encourage your baby to move their tongue forward, you can also try:
* Reclining with your baby on top of you. Try leaning forward and back yourself to understand how gravity affects tongue position.
* Encouraging them to lick milk from their lips or from your nipple before and after feeds.
* Sticking your tongue out at your baby to encourage them to copy you.

Maintain milk production

If your baby is sleepy or has jaundice, or if you have engorgement or inverted nipples, then a tongue tie can make things worse. If they are not able to take enough milk directly at the breast then you will need to express it and give it to your baby until they are able to breastfeed effectively. Express by hand and/or with a pump at least 8 times a day if your baby is not draining the breast well. This will maintain your milk production and ensure they get enough milk.

Small amounts of expressed milk can be offered by spoon, cup or syringe while you both learn how to breastfeed. Bottles or dummies can confuse your baby's sucking technique so consult an LLL Leader about breastfeeding friendly ways to bottlefeed or about using a nursing supplementer. This device delivers extra milk through a tube along your breast as your baby nurses, avoiding the need for bottles.

An unusual palate

Restricted tongue movement caused by tongue tie may affect the shape of a baby's palate, leading to a high palate or a bubble palate with a high spot. These may be a factor in broken suction, a clicking sound and pain during breastfeeding. A baby with an unusual palate may also resist a deeper latch due to gagging.
The following may help.
* Start with a clean finger with closely trimmed nail.
* Touch your baby's lips and wait until they open their mouth.
* Gently slide in your finger, pad side up along his hard palate, stopping just before the gag reflex is triggered.

Make this a pleasant game and, over a few days, gradually move your finger back to overcome sensitivity. After a tongue tie is divided, a baby's increased tongue movement helps the palate shape become more normal

Treating Tongue Tie

What can be done?
Frenotomy-dividing the tongue tie-can dramatically improve breastfeeding comfort and efficiency for both mother and baby. Dividing a tongue tie is a quick and simple procedure. No anaesthetic is needed for a baby under six months of age.

There are health professionals around the UK who have been specifically trained to divide tongue ties. For treatment on the NHS, you will need a referral from your midwife, health visitor or GP. Knowledge about tongue ties and how they affect breastfeeding varies, so it is worth persisting and seeking a second opinion. In areas where only GPs can refer, your midwife or health visitor may be able to give a recommendation to your GP or suggest seeing a particular GP. Private treatment may also be an option. See Further Reading for information on finding a practitioner trained to divide tongue ties

Is waiting an option?
Sometimes a very thin tongue tie breaks spontaneously or can be stretched by gentle massage of the frenulum. The earlier a tongue tie is divided, the easier it is to resolve any breastfeeding difficulties. Dividing a tongue tie in a baby over six months old is also a more complicated procedure and usually requires a general anaesthetic.

Frenotomy-what will happen?
After the health professional's initial assessment, your baby will be swaddled and held (often by an assistant) so they stay still during the procedure, which only takes a minute or two. The health professional lifts the tongue and divides the frenulum by cutting it with a pair of round-ended sterile scissors or by cauterising it.

Does it hurt?
No anaesthetic is needed for a very young baby as having a tongue tie divided only hurts a little, if at all. Some babies protest more at being swaddled than about the treatment. Others sleep right through the procedure! You will be asked to breastfeed your baby as soon as the procedure is over, to offer comfort, clean the wound and get their tongue moving as soon as possible. The inside of a baby's mouth heals very quickly. The only treatment usually needed is to breastfeed to keep the wound clean and keep his tongue mobile. There may be a white patch under your baby's tongue, but this heals within 24 to 48 hours.

If things don't resolve
Usually a mother notices an instant improvement in her comfort during breastfeeds. Sometimes it takes a week or two for a baby to adjust to their tongue's greater mobility. An older baby may find it harder to adjust to increased tongue mobility and tongue exercises may be recommended. Occasionally a baby's frenulum needs dividing a second time, usually because the division was not quite extensive enough the first time. If you suspect that the initial procedure has not resolved your baby's breastfeeding problems arrange another consultation. Do persist with finding solutions. If several factors are involved it can take time and expertise to resolve the problem. An LLL Leader can suggest further paths to explore and provide ongoing support.

Painful nipples

Using different feeding positions can help if breastfeeding is painful. Or use the position you find most comfortable until your nipples heal. Check your baby's attachment later in the feed-if they slip down your nipple, this may cause you pain. Reclining breastfeeding positions or extra support under your arms may help.

Ask your LLL Leader about breast compression, which can help your baby get more milk quicker. An increase in milk flow may also help them breastfeed more effectively.

Hand express to stimulate milk flow before feeding. Or start on the least painful side, switching sides once your milk lets down. Pain can reduce milk flow, leading to engorgement and mastitis. Ask your doctor, midwife or health visitor about using a suitable painkiller. Applying warmth and using gentle massage and relaxation exercises just before feeds can help milk to flow.

Moist wound healing

When the underlying problem is corrected, moist wound healing can help your nipples heal without scab formation. After each feed gently pat your nipples dry to remove surface wetness. Apply a tiny smear of ultra pure modified lanolin to each nipple, dabbing it on rather than rubbing. Hydrogel pads without a cloth backing can also be used.

Blood from cracked nipples
Blood from cracked nipples is not harmful to your baby. You can continue to breastfeed whilst working to improve positioning and attachment.

If healing is slow
Once your baby starts latching on well you should feel more comfortable and notice signs of healing within a few days. If not, visit your GP-sometimes a bacterial or fungal infection can prevent healing. Continued pain may be a sign that treatment (or further treatment) of your baby's tongue tie is needed.

Seek support

This is a time when the support of other mothers in your local LLL group can be invaluable. You can find your nearest Leader or by calling our Helpline.

Further Reading

Find a tongue tie practitioner- Association of Tongue Tie Practitioners, has details of both NHS and Private Practitioners
Biological Nurturing™
Lactation Consultants of Great Britain

The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010: p63-81, 428-430.
Comfortable Breastfeeding
Engorged Breasts - Avoiding & Treating
Expressing Your Milk
Hand Expression of Breastmilk
My Baby Needs More Milk
Nipple Know-How
Nipple pain
Nursing Supplementers
Sleep Baby - Why and What To Do
Storing Your Milk
LLLI Resources
Tongue Tie & the Breastfed Baby
References

Hazelbaker, AK. Tongue-Tie: Morphogenesis, Impact, Assessment and Treatment. Columbus, OH: Aidan and Eva Press, 2010.

Mohrbacher, N. Breastfeeding Answers Made Simple. Amarillo Tx: Hale Publishing, 2010.

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

Geddes, DT. et al. Frenulotomy for breastfeeding infants with ankyloglossia: Effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 2008; 12(1):e188-94.

Hogan, M. Westcott, C. and Griffiths, M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005; 41:246-50.

Hong, P. et al. Defining ankyloglossia: A case series of anterior and posterior tongue ties. Int J Ped Otorhinolaryngology 2010; 74:1003-6.

Knox, I. Tongue tie and frenotomy in the breastfeeding newborn. Neoreviews 11 (9) Sept 2010.

Miranda, BH. and Milroy, CJ. A quick snip-a study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding. JPRAS 2010; 63:e683-5.

NICE Guideline s

Watson Genna, C. And Coryllos, EV. Breastfeeding and tongue-tie. J Hum Lact 2009; 25(1):111-2.

You can buy this information in printed form from the LLLGB Shop.

Copyright LLLGB 2016

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Treating and coping with breastfeeding a baby with tongue tie

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UK Drugs in Lactation Advisory Service (UKDILAS)

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UKDILAS is committed to providing evidence based information on the use of drugs during the breastfeeding period to all UK healthcare professionals. The service is provided…

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The thought of breastfeeding your baby when out and about might be daunting at first, but that's true of lots of things about being a new parent. A little planning and preparation can help you to feel more confident. Remember that most people never even notice a mum is breastfeeding, and everyone prefers a happy, quiet baby feeding than a hungry, crying one. Although we all understand that babies cry sometimes too.

If you are bottle feeding your baby, then the most important thing to think about is how you will make up milk safely outside the home. Advice on safe bottle feeding can be found in the 'Guide to bottle feeding' by Start4life.

If you are breastfeeding:

Your baby has the right to eat when you are outside the home by law. Everywhere you and your baby can be, you can feed. Almost everyone who breastfeeds their baby never receives anything but warm smiles and the occasional free drink. Media reports that mums are sometimes made to feel uncomfortable make the news precisely because they are rare. We know from surveys that our society supports mums feeding outside the home. Every day, there are babies and mums nursing in cafes, shops, parks, on buses and trains happily and peacefully.

When and where to feed is a decision for you and your baby. You don't have to ask for permission. You don't even have to look around. And with practice, feeding outside the home gets easier every time. You might be in an environment where you'd like to find a quieter space. Many facilities can offer you that, but it's fine to feed as part of your normal day wherever you need to be. When you breastfeed out and about, you're helping to make it 'the norm' in society.

If you feel unsure, you can start by practising at home. Have a go in front of a mirror or ask someone to take a video. How much can someone opposite see? You might be surprised how you look like someone just holding a baby. Most people, even quite close by, wouldn't know you were feeding a baby. In time, most mums become confident about feeding in public and don't even have to pause to think about what they're doing, as you'll see in these lovely photos of mums feeding all over the UK from our #FeedOn Campaign.

The first time you feed outside the home, it can be helpful to have your partner or a friend with you. They might help you get organised or get you something to eat and drink, but often it's just nice to know someone else is there. You might want to practise feeding away from home by visiting a breastfeeding group, and exploring different positions that you can use in different chairs. You might like to go to a familiar place like a local café. The positions you use may not be exactly the same as at home, but that's OK. You might support your arm and your baby's head with a rolled-up jacket or a blanket. Or you might lean back so your baby's weight is supported by your body. It doesn't have to be exactly the same as if you were on the sofa at home. It can be a good idea to practise using a position where you have a hand free so you can eat and drink too.

Layering your clothing might be helpful. Two light, loose tops with trousers or skirt is often easier for feeding than a one-piece top or dress. Some clothes are specially designed for breastfeeding with zips, slits or pieces that lift up. Not everyone finds them helpful, so experiment at home. You could pop your baby under a loose-fitting top, but you might also have a front-opening top or jacket around the side of your body.

* You do not need to 'cover up' unless you want to. Some mums carry a scarf so that if they feel a little unsure of themselves when feeding, the scarf can be draped over their shoulder and across their baby. This will look more like normal clothing than using a muslin cloth (which may not be very big) or a baby blanket that can make baby uncomfortably warm. Some mums also feed their baby when they are in a sling. Clips or clothes pegs can be useful to secure clothing out of the way so it doesn't fall into baby's face and to keep scarves on shoulders.

Breastfeeding helps your baby to feel safe and secure and when they are feeling tired and overwhelmed, it is valued even more. Getting the hang of nursing in public can be really useful for a mum, since if your baby is happily feeding away, you can focus on your own tea, cake and conversation. When you feed your baby outside the home, you are helping the next person to do the same thing. Let's make this country a great place for mums and babies to feel welcome, however they feed their little ones.

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Breastfeeding outside the home nibbles at the mind of many new mums. Mothers are not allowed to be discriminated against on the grounds of breastfeeding.

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Expecting a baby? - Find out how your milk making Superpower works! Check out our fab new video explaining all about how lactation works.

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Download the Breastfeeding Suffolk App.

The 'Breastfeeding Suffolk' app is built for new mothers who are breastfeeding their newborn. The app features helpful tools that allow mothers to track feed times, record child development milestones and read daily information cards related to their breastfeeding cycle.

The app also contains important contact details for local organisations and links to other helpful information, to ensure new mothers are up to date and informed throughout the full breastfeeding period.

Features:

Left and Right Breastfeeding Tracker

Baby Milestone Log

Built-in Calendar for Information Logging

Important Contact Info

Daily Information Linked to the Babies Age and the Feeding Cycle

Available for download on the Apple App Store and Google Play Store

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Breastfeeding Suffolk - The Breastfeeding Process

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Previous Slide❮ Next Slide❯ The 'Breastfeeding Suffolk' app is built for new mothers who are breastfeeding their newborn. The app features helpful tools that allow mothers to track feed times, record child development milestones and read daily information cards related to their breastfeeding cycle.

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NHS Suffolk and North East Essex - After Birth Booklet

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1 After your baby's birth Information booklet for mums & families This information pack is designed for women who are going home from hospital, following the birth of their baby in Suffolk and North East Essex. We recommend you read this booklet before you leave hospital.

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Colostrum Harvesting and Gestational Diabetes

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Colostrum Harvesting and Gestational Diabetes

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Colostrum harvesting is collecting colostrum from the breast. Colostrum is the first secretion from the mammary glands, rich in antibodies. It is a sticky liquid from the nipples which is made before the milk has 'come in' (before breast milk is produced). It is produced from around the 20th week of pregnancy, up until the first few days after the baby has been born.

Colostrum is easily digested and is packed with proteins, vitamins, minerals and salt which helps prevent dehydration and help boost the baby's immune system. Colostrum helps the passing of meconium (the baby's first bowel movement) which also assists in preventing jaundice.

Antenatal colostrum harvesting is when the mother collects or expresses the colostrum from the breast during pregnancy before the baby is born and freezes it for use after birth.

The frozen colostrum is taken to the hospital and stored until it is required, where it can be defrosted and fed to the baby.

The link between diabetes and colostrum harvesting

Many babies born to diabetic mothers can have low blood sugar levels after birth putting them at risk of neonatal hypoglycaemia and jaundice.

Neonatal hypoglycaemia (low blood sugar levels) is the biggest post-birth complication we see in our support group, even when the mother's blood sugar levels have been well controlled.

To raise blood sugar levels the baby needs to feed as much as possible. Even though many mothers manage to successfully breastfeed, some babies still require further top-up feeds and some have difficulties feeding and therefore require bottle or cup feeds. In more concerning situations, babies born to gestational diabetes mothers may need an NG tube or a glucose/dextrose infusion.

The best thing to raise blood sugar levels in the baby is colostrum. If you choose not to breastfeed or cannot for any reason, the formula can be used to raise blood sugar levels instead.

Increased risk of neonatal hypoglycaemia

Babies born to diabetic mothers have very likely been subject to high blood glucose levels whilst growing in the uterus at some point. In response to processing these high blood glucose levels from the mother during the pregnancy, the baby overproduces its own insulin to compensate.

Once born, the baby may still overproduce insulin amounts in their body, struggling to regulate their own insulin production and causing low blood glucose levels.

The baby may struggle to raise their blood sugar levels without additional help and so this is where additional colostrum top-up feeds can really help.

Things that can be done to help control babies born to diabetic mothers' blood glucose levels after birth

1. It is really important to try to gain control and keep blood glucose levels stable throughout pregnancy, especially towards the end and during labour. Avoiding any high readings becomes extremely important right at the end, so don't be tempted to give in to temptations in those last few days, thinking "oh it won't make much difference now I'm so close to the end!". Despite what you may be told, avoid energy drinks or high sugar foods which may be suggested such as flapjack during labour. Keeping your blood sugar levels stabilised gives the baby the best chance to normalise their own insulin production and blood glucose levels before they are born

2. Harvesting colostrum so that you have some readily available should baby require top-up feeds

3. Have skin to skin and try to initiate breastfeeding as soon as possible, ideally straight away

4. Feed baby as regularly as possible, ideally every 3 hours. If you have a sleepy baby then you may need to strip the baby down, change their nappy etc. to help rouse them and encourage them to feed. If you have any difficulties breastfeeding then don't be afraid to ask for help and support from the midwives and nurses. Some hospitals have breastfeeding consultants, support workers and specialist breastfeeding midwives.

Experienced breastfeeding mothers benefit too

Many ladies who are experienced breastfeeding mothers do not understand the need for expressing colostrum before birth. Firstly, each and every baby can be very different, along with different complications such as issues with latching and/or tongue tie, preventing them from breastfeeding. GD babies can be very sleepy and may also struggle to latch, wake for feeds or feed effectively. Some babies may feed well from the breast but still require additional feeds on top of regular breastfeeds to keep blood sugar levels stable.

Colostrum v's formula

Formula will raise blood sugar levels, however, research suggests that breastfeeding colostrum has a better effect on raising blood sugar levels than formula:

RESULTS: Infants who were breastfed in the delivery room had a significantly lower rate of borderline hypoglycaemia than those who were not breastfed in the early postpartum period (10% versus 28%; Fisher's exact test., P = 0.05,). Likewise, infants breastfed in the delivery room had significantly higher mean blood glucose level compared to infants who were not breastfed in the delivery room (3.17 versus 2.86 mmol L(-1), P = 0.03). Additionally, breastfed infants had a significantly higher mean blood glucose level compared to those who were formula fed for their first feed (3.20 versus 2.68 mmol L(-1), P = 0.002).

CONCLUSIONS: Early breastfeeding may facilitate glycaemic stability in infants born to women with gestational diabetes.

Can't I just breastfeed or express when the baby is born?

Yes, of course, you can breastfeed when the baby is born and we actively encourage this. However each baby is different, some babies may have difficulty feeding for many reasons and some may need additional top-up feeds on top of breastfeeding. Expressing can be difficult and having a supply harvested ready for use can be helpful and reassuring should your baby need it.

Lactation aiding foods/drinks and sweet things to increase sugar amounts in colostrum are not necessary

Colostrum itself is extremely potent and sweet (we call it 'liquid gold'). Your normal GD-friendly diet is best and you don't want to cause any unnecessary high blood sugar levels for yourself and your growing baby. Stay well hydrated by drinking plenty of fluids.

Please note that whilst lactation cookies, teas, oats, fenugreek etc. may be advocated to assist milk production, there is no evidence to support these things increasing colostrum production during pregnancy.

You will still have gestational diabetes at this time and so it is important to not risk eating or drinking things that could cause high blood sugar levels, in fact, this could have a detrimental effect on your baby's blood sugar levels after birth and so should be avoided.

When to start colostrum harvesting

After 36 weeks is the usual time for mothers with gestational diabetes, based on induction or planned delivery of around 38 weeks+. But giving yourself 2 weeks before the baby is due or planned is a good idea. It is advisable to speak with your diabetic team regarding when would be the best time for you.

It is not advised to express in order to collect colostrum before this time as expressing may induce contractions early.

However, if you are leaking colostrum then do not waste it! All colostrum is full of goodness and so this can be sucked from the nipple with a sterile syringe and frozen. If you start to get strong Braxton Hicks or contractions then stop expressing. If you are leaking lots through the day, then you may want to purchase some milk collection shells so that every little drop of colostrum can be saved, rather than letting it soak into breast pads and be wasted.

There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breastmilk from 36 weeks' gestation Prof Della A Forster et al. 2017

Will my diabetic team or midwife discuss colostrum harvesting with me?

Some diabetic teams will advocate colostrum harvesting, giving out supplies or packs for colostrum harvesting, along with guidance and support on how to express. Other teams may look at you like you've grown another head when you mention it! Just like with everything else related to gestational diabetes, advice, support and information can vary dramatically from one hospital to another.

In a survey Gestational Diabetes UK ran in 2016, from 1,308 answers 77% (1,005 ladies) were not happy with the information and support giving around colostrum harvesting at their hospital

If you wish to harvest colostrum ready for birth, then speak with your diabetes team and breastfeeding specialists and if they are unaware, then explain the benefits and reasons why. As long as they have space in a freezer for your colostrum to be stored during your labour, then there should be no reason why you can't harvest.

Some may suggest that they would prefer to use formula instead of colostrum if the baby requires top-up feeds. This is your decision and if you wish to use colostrum instead, as long as it has been stored correctly, there is no reason for the formula to be used instead.

Harvesting colostrum

Some Mums may find they leak colostrum, others will need to express to extract colostrum from the breast.
Please do not panic or worry that you are not leaking colostrum or do not notice any difference in your breasts. This does not mean you will not be able to harvest colostrum.
Equipment needed

Sterile syringes should be used to collect the colostrum and is what are recommended for use in the UK.

1ml sterile syringes are best for collecting colostrum which can be bought in pharmacies or online. We find 1ml the best as each syringe can be defrosted and used without any wastage.

Capped syringes (syringes with caps or lids) are not necessary but may be preferred to eliminate contamination risks. However, these can be hard to get hold of and quite expensive.

Ask for some syringes

In the first instance ask your diabetic team or midwife if you could have some syringes. Sterile syringes without caps will serve the same purpose as long as the filled syringe is placed inside the wrapper or a clean plastic bag (like a sandwich/freezer bag) and chilled or frozen straight away. Or you could ask your hospital for some syringe caps.

Your diabetic team/midwife may be able to supply syringes for free so it is worth asking! Some teams even offer colostrum harvesting packs such as these

ask your diabetic team if they provide colostrum harvesting packs or syringes for free

If your hospital cannot provide you with syringes for colostrum harvesting and you need to purchase some syringes, then head over to Drops of Gold where you can purchase everything from just syringes to whole colostrum harvesting kits!

How to harvest colostrum - antenatal expressing of colostrum

Step 1. Always wash your hands before you start expressing.

Expressing after a shower or bath can be extremely beneficial to colostrum harvesting. Some ladies also find a warm compress such as a hot flannel or holding a hot water bottle to the breasts aids colostrum harvesting.

Make sure you have your colostrum harvesting equipment ready to hand such as your sterile syringes, sterile spoon or pot.

Step 2. Sit in a comfortable position. You need time, space and to be able to relax. Some mothers find it helps to sit in the baby's nursery or to look at scan pictures of their baby.

Step 3. Gently massage your breast, massaging from the back of your breast towards the nipple. Use kneading, circular and stroking movements to massage. You should be gentle when massaging, you can use one or both hands and it should not cause any discomfort. Some mothers find it works well to massage whilst in the shower or bath.

Step 4. Find the correct place to press using your thumb and index finger.

This is usually a few centimetres back from the base of the nipple, or move up slightly until you find where the breast feels firmer and a change in the texture of the breast tissue is felt.

Cup the breast using the 'C shape' position with the thumb and finger.

Step 5. Using the pads of your fingers rather than the fingertips, press back into the breast, squeezing gently for a few seconds and then releasing.

Your fingers should not touch the nipple, they should work on the outside of the areola but should not tug, squeeze, pinch or drag your nipple.

Squeeze and release, squeeze and release. Continue to repeat this motion to mimic the action of a baby sucking.

(This picture shows beads of colostrum forming on the nipple, but it may take many, many attempts before any colostrum is seen - do not let this put you off! This is completely normal)

Step 6. If any beads of colostrum form they can be collected in 3 different ways depending on how much colostrum is produced.

6a) Beads of colostrum on the nipple: The easiest way to collect colostrum which is forming beads on the nipple is to suck it directly from the nipple into a sterile syringe. This can be fairly tricky and you may need a little help in sucking up the colostrum.

Have a sterile syringe ready to use. DO NOT pull the plunger out. To use the syringe it must have the plunger pushed fully into the syringe.

Place the tip of the syringe over the bead of colostrum and with your other hand, gently pull up the plunger slightly (but only enough to suck up the bead of colostrum).

If the colostrum is pulled too far down the syringe, flick the syringe to remove any air bubbles and very gently push up the plunger. This will push the colostrum back nearer the top BUT do this carefully! Many ladies have done this, pressed too hard and lost all the colostrum out the end of the syringe.

Continue expressing and keep adding to the syringe each time a bead forms.

6b) Slightly more flow can be expressed onto a sterile spoon

If you are getting more flow than just beads forming, you may want to try expressing directly onto a sterile spoon which involves catching the droplets with the spoon.

Once you have some on the spoon, you can then use your syringe to suck up the colostrum.

Use the same technique mentioned above to suck up the colostrum and move the colostrum up the syringe to the top.

6c) Heavier flow can be expressed into a sterile pot

If you're lucky enough to get larger volumes of colostrum then you may find it easier to express straight into a sterile container. This involves holding your breast over the container and allowing the colostrum to flow or drop into it.

Once you have finished expressing, the colostrum can then be sucked straight into a sterile syringe.

Step 7. After expressing in this position for a while, move your hand around to hold the breast in the 'C position' from another angle and repeat the squeeze and release motions again.

Step 8. Repeat the whole process on the other breast.

Step 9. When you have finished expressing, replace the syringes into their wrappers or place a cap on them.

Step 10. Label your syringes with your name, hospital number and most importantly the date.

Many ladies have forgotten to do this in the past which has resulted in wasted colostrum.

You can continue adding to the same syringe for 48 hours (as long as it is kept refrigerated) but the date you first expressed is the date that should be written on the syringe.

Step 11. Refrigerate or freeze your colostrum. Use a Tupperware box or a suitable freezer bag to store your colostrum.

Don't let your hard work and efforts go to waste! Make sure your colostrum is stored correctly until you need it.

For further details on storing colostrum, please read below.

*Please note: The mother in the video above is expressing breast milk and so please do not expect this amount of milk to flow. Colostrum can be very thick and sticky and may form in very small droplets, rather than 'squirting' out when expressing. This is completely normal! We recommend collecting colostrum in small syringes (1-2ml) so that small top-up feeds can be defrosted as and when needed to avoid any wastage of defrosted colostrum

Further guidance on hand expressing

Hand expressing is advised for antenatal colostrum harvesting. Hand expressing is when you use your hand to massage and squeeze the breast to extract colostrum as the guide above explains.

Further guidance on hand expression can be found through the many links below.

Please remember, you will not be expressing milk as breast milk will not 'come in' until after the baby is born. Also don't expect great amounts of colostrum unless you're really lucky! You may only manage a bead or two, but don't give in...the more you express, the more you collect!.. Every drop of liquid gold counts!

Colostrum will not 'run out' or be used up by the time your baby is born, you will continue to produce colostrum until your milk comes in, so please do not worry that your supply will disappear by expressing.

Here is a video to demonstrate how to hand express, but please note that the recommendations around freezing are different in the UK. Sterile syringes are the preferred way to store harvested colostrum - this can easily be given straight into the baby's mouth when required. These should then be clearly marked with your name and date

Here is another video showing expressing, this shows a lady actually expressing from the breast, but please bear in mind that colostrum is much thicker and stickier than breast milk and so it doesn't tend to flow from the breast like this and another video here from UNICEF.

Can I use a breast pump?

If you are getting a heavier flow of colostrum then breast pumps can cause a lot of wastage as colostrum is so sticky and can get stuck in the breast pump tubes.

If you are really struggling to get any droplets to form then you may find using a breast pump is enough to encourage your colostrum to bead or form droplets. Personally, I could only harvest colostrum by using an electric breast pump. It was just enough to get beads of colostrum to form for me to suck up.

Breast pumps should be used with caution antenatally due to the expression being stronger than with hand expressing. If you decide to use a breast pump then use it sensibly and stop expressing if you notice any tightenings or contractions.

Storing colostrum

You should only store colostrum in a sterilised container, ideally a sterile syringe. Ensure the syringes you use are sterile before using. Coldwater sterilisation is the best method for non-sterile syringes.

Label every syringe with your name and the date it was collected, hospital stickers from your handheld notes are great for this if you have spares!

How long to store colostrum for

in the fridge for up to 48 hours at 4ºc or lower (store in the main part of the fridge, not the door). You can add to the same syringe for a couple of days before freezing but you should date it as the first date collected

for two weeks in the ice or freezer compartment of a fridge

for up to six months in a freezer

Colours and consistency of colostrum

Colostrum can vary dramatically in colour, from dark orange/brown, and yellow/cream to pale/clear.

Please do not panic if yours does not look the same colour as the examples are shown here, or if yours changes colour and consistency over a few expressing sessions, this is normal.

Consistency can be very thick and sticky, or more watery and thinner.

All colostrum is packed with the goodness your baby needs, so please do not worry. If you express and get pink colostrum then this may mean that some blood may be present. Small amounts of blood are not harmful to the baby and so they should not be discarded. If you have any concerns then please speak to a medical professional.

Frequency of colostrum harvesting and the amount required

Collect as much as you would like and are able to. Bear in mind that a newborn baby's tummy is the size of cherry on Day 1, the size of a walnut by Day 3 and the size of an apricot by 1 Week. You don't need huge amounts, but any harvested colostrum will not go to waste.

Some mothers have used expressed colostrum when returning home from hospital and some even use it for the first stages of weaning at 6 months or for teething lollies! Colostrum has many uses including using it to ease sore nipples from feeding or in skin or eye infections of baby. It really is liquid gold!

You can express colostrum as often as you feel comfortable doing so. Most mothers prefer to express daily after a warm shower or bath.

ARGH...I've been trying for ages and I'm not getting any colostrum!

Don't panic!

It is not easy expressing and harvesting colostrum and many (in fact the majority) really struggle to do it.

It may take many days of trying and a lot of frustration before you even see a bead of colostrum!

If you're happy to continue then keep trying every day. If it's stressing and upsetting you then stop putting pressure on yourself. Only you can choose if you wish to continue or not. It is is not necessary to harvest colostrum and so please do not feel that you HAVE to do this.

Many mothers that have tried expressing colostrum have found that they have had better breast feeding experiences compared to previous births where they've struggled to breastfeed. This is obviously not a given, but even if you struggle to actually collect colostrum, know that the process is helping prepare your body for feeding your baby. If you collect some colostrum then it's a bonus!

Not being able to harvest colostrum has NO indication of lack of milk production or how well breast feeding will go

The amount of colostrum harvested, or lack of, prior to birth does not mean that you will not be able to breastfeed or express once your baby has been born. I repeat, it has NO impact or indication of a lack of milk production. Please do not feel that if you can't express colostrum that you will not be able to breast feed or produce milk.

Tips:

1. Try expressing after a warm bath or shower

2. Hold warm flannels or even a hot water bottle wrapped in a cover or towel on your breasts before expressing to increase circulation. You can also purchase breast warming pads which may be helpful

3. RELAX, Relax, relax - stressing will not help, if you can do it great, if you can't it is not the end of the world and it has no relation to whether you will be able to breastfeed or not OR how much milk you will have

4. Massage your breasts before expressing

5. Don't touch the nipple during expressing or try to express too close to the nipple - many ladies say that they have sore nipples following trying to express. It shouldn't hurt. Pulling fingers back to the outside of the areola then forwards really milks the ducts

6. Drink plenty of fluids

7. Looking at scan pictures, sitting in your nursery or baby's room, rocking something like a toy like you would your baby, thinking of your baby and listening to a newborn baby cry have all been great tips to help!

8. Ask for help! Speak with midwives, your health visitor, local breastfeeding peer supporters and lactation consultants in your area for tips and advice on expressing. There are lots of people out there who can help you, but you may have to go online and search for local specialists. Try The Breastfeeding network or La Leche League

Is it safe to harvest colostrum when taking Metformin?

Yes - Metformin is often used in women who have PCOS. PCOS causes insulin resistance and so many mother's with GD may have PCOS. Both PCOS and insulin resistance can be linked to low milk supply. For further information regarding metformin and PCOS please read more here

More helpful links:

Research
Importance of early first feed for babies of diabetic mums

Background

Infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia, admission to a neonatal intensive care unit (NICU), and not being exclusively breastfed. Many clinicians encourage women with diabetes in pregnancy to express and store breastmilk in late pregnancy, yet no evidence exists for this practice. We aimed to determine the safety and efficacy of antenatal expressing in women with diabetes in pregnancy.

Methods

We did a multicentre, two-group, unblinded, randomised controlled trial in six hospitals in Victoria, Australia. We recruited women with pre-existing or gestational diabetes in a singleton pregnancy from 34 to 37 weeks' gestation and randomly assigned them (1:1) to either expressing breastmilk twice per day from 36 weeks' gestation (antenatal expressing) or standard care (usual midwifery and obstetric care, supplemented by support from a diabetes educator). Randomisation was done with a computerised random number generator in blocks of size two and four, and was stratified by site, parity, and diabetes type. Investigators were masked to block size but masking of caregivers was not possible. The primary outcome was the proportion of infants admitted to the NICU. We did the analyses by intention to treat; the data were obtained and analysed masked to group allocation. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000217909.

Findings

Between June 6, 2011, and Oct 29, 2015, we recruited and randomly assigned 635 women: 319 to antenatal expressing and 316 to standard care. Three were not included in the primary analysis (one withdrawal from the standard care group, and one post-randomisation exclusion and one withdrawal from the antenatal expressing group). The proportion of infants admitted to the NICU did not differ between groups (46 [15%] of 317 assigned to antenatal expressing vs 44 [14%] of 315 assigned to standard care; adjusted relative risk 1·06, 95% CI 0·66 to 1·46). In the antenatal expressing group, the most common serious adverse event for infants was admission to the NICU for respiratory support (for three [<1%] of 317. In the standard care group, the most common serious adverse event for infants was moderate to severe encephalopathy with or without seizures (for three [<1%] of 315).

Interpretation

There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breastmilk from 36 weeks' gestation.

Funding

Australian National Health and Medical Research Council

Prof Della A Forster, PhD

Lisa H Amir, PhD

Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes

It has been recognised that babies of diabetic mothers are at greater risk of hypoglycaemia and as such, an early feed is recommended. This study was carried out to ascertain both the impact of an early feed and to establish what type of feeding provided the best option to reduce the risk of hypoglycaemia. The researchers found that infants who were breastfed in the delivery room had a significantly lower rate of borderline hypoglycaemia than those who were not breastfed in the early postpartum period and the researchers concluded that an early breastfeed may facilitate stable blood glucose levels in the infants of mothers with gestational diabetes.

Neonatal hypoglycaemia in infants of diabetic mothers Management of Infants of Diabetic Mothers The Confidential Enquiry into Maternal and Child Health (CEMACH). Diabetes in pregnancy: caring for the baby after birth. Findings of a National enquiry: England, Wales and Northern Ireland. CEMACH London; 2007

Results: Eighteen (47%) infants developed hypoglycaemia (blood glucose level less than 2 mmol/L) during the first 2 h of life. There was no difference in the cord blood glucose levels between infants with or without hypoglycaemia (3.7 ± 1.1 vs 4.5 ± 1.1 mmol/L, respectively). Infants of mothers with diabetes diagnosed prior to 28 weeks gestation were at a higher risk of developing hypoglycaemia (8 of 10 vs 10 of 28, OR 7.2, 95%CI 1.3-40.7). Hypoglycaemic infants were of significantly higher birthweight, and were more likely to be born to Caucasian mothers and by Caesarean section. Raised maternal fructosamine blood level, the need for insulin treatment or the infant's haematocrit were not different between infants with or without hypoglycaemia.

Conclusions: In well-controlled diabetic mothers, the incidence of early hypoglycaemia in infants is still high, particularly in those mothers who had a longer duration of diabetes. Cord blood glucose level did not identify the infants with hypoglycaemia.

Hypoglycemia rates in the first days of life among term infants born to diabetic mothers Colostrum Versus Formula Supplementation for Glucose Stabilization in Newborns of Diabetic Mothers Nutritional Factors That Affect the Postnatal Metabolic Adaptation of Full-Term Small- and Large-for-Gestational-Age Infants Hypoglycemia and the breastfed neonate Metformin before and during pregnancy and lactation in polycystic ovary syndrome
Hypoglycaemia of the Newborn, copy of the literature, from WHO (World Health Organization), with 10 pages of references

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Colostrum harvesting * Gestational Diabetes UK

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Colostrum harvesting is expressing and collecting colostrum whilst pregnant. Colostrum is hugely beneficial to babies born to diabetics. Learn more here...

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Antenatal Expression of Colostrum - La Leche League GB

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Mothers start to produce colostrum (early milk) while pregnant. Being able to express colostrum is a useful skill to have. Saving your expressed colostrum may also be beneficial if your baby is likely to need special care after birth. Why express while pregnant? Being familiar with your breasts and…

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Is My Baby Getting Enough Milk? - La Leche League GB

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How can you tell if your baby is getting enough milk?

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Unicef UK Baby Friendly Initiative | Hand expression

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Unicef UK Baby Friendly Initiative | Importance of relationship building

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Drugs In Breastmilk - Is It Safe? - The Breastfeeding Network

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

Please use the below links for more information

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

What is the Drugs in Breastmilk Information Service?

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

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

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

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

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

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

Evaluation of the Drugs in Breastmilk Information Service

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

Become a Friend of Drugs in Breastmilk

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

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Drugs In Breastmilk - Is It Safe? - The Breastfeeding Network

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

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How to Give Baby CPR - First Aid Training - St John Ambulance - YouTube

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How to Give Baby CPR - First Aid Training - St John Ambulance

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Lead - Zoe Meakin

Infant Feeding Support Workers - Liz Partridge, Lorraine Barrett, Fiona Stewart & Beth Carpenter

For extra feeding support up to 28 days please follow the link

Colchester Additional Infant Feeding and Tongue Tie Support

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Colchester Additional Infant Feeding and Tongue Tie Support

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Colchester Additional Infant Feeding and Tongue Tie Support

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Find out about baby friendly venues in Suffolk

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Safer-sleep-for-babies-a-guide-for-parents-web.pdf (lullabytrust.org.uk)

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Safer sleep overview - The Lullaby Trust

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

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Science | Welcome to Human Milk CIC (human-milk.com)

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

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

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

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

"Your milk contains ingredients that kill cancerous cells"

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

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

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

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

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The science of human milk and breastfeeding

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The benefits of breastfeeding - Baby Friendly Initiative (unicef.org.uk)

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Feeding and Nurturing your Baby (padlet.com)

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https://fb.watch/d1NYEX9w4T/

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Breastfeeding and a Mother’s Diet: Myths and Facts - La Leche League GB

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Breastfeeding and a Mother’s Diet: Myths and Facts - La Leche League GB

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Women hear a lot of conflicting information about what they can or cannot eat while breastfeeding and these recommendations may vary according to culture and tradition, along with individual personal preference and finances. In some cultures a food may be considered beneficial to a breastfeeding mot…

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UK Babies Infant Feeding Support Groups (Ipswich)

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UK Babies Infant Feeding Support Groups (Ipswich)

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UK Babies Lets Talk Babies (Gainsborough)

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UK Babies Lets Talk Babies (Gainsborough)

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Suffolk LaLeche League uk | Facebook

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Welcome to the La Leche League Suffolk Facebook Group. La Leche League's mission is to help mothers worldwide to breastfeed through mother-to-mother support, encouragement, information and education,...

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Breastfeeding Positions | Feeding Your Baby | Start for Life (www.nhs.uk)

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Skip to main content

Breastfeeding takes practice. It takes time to work out which positions feel best - try them all out to see which feels best.

Breastfeeding positions

Before you breastfeed your baby, have a drink beside you - something thirst quenching like a big glass of water. There are a few different breastfeeding positions you can try, these are 3 of the most popular:

Cradle hold

This is the probably the most popular breastfeeding position. However, if you've had a caesarean, this may be uncomfortable as your baby lies across your tummy near the scar (try lying on your side or the rugby hold instead). For the cradle hold, sit in a comfy chair with arm rests, or a bed with cushions or pillows around you.

1. Lie your baby across your lap, facing you.

2. Place your baby's head on your forearm - nose towards your nipple. Your hand should support the length of their body.

3. Place your baby's lower arm under yours.

4. Check to make sure your baby's ear, shoulder and hip are in a straight line.

Here is a top tip...

If you're sitting on a chair, rest your feet on a stool or small table - this will stop you from leaning forward which can make your back ache.

Lying on your side

This is a good position if you've had a caesarean or difficult delivery, or if you're breastfeeding in the middle of the night.

1. Start by getting comfy lying on your side. Your baby lies facing you, so you are tummy to tummy. Check to make sure your baby's ear, shoulder and hip are in a straight line - not twisted.

2. Put some cushions or pillows behind you for support. A rolled up baby blanket placed behind your baby will help support them - remember to remove it after you have finished feeding. If you've got a pillow under your head, make sure it's not too close to your baby's head or face.

3. Tuck the arm you're lying on under your head or pillow (ensuring your baby's position isn't altered by the pillow) and use your free arm to support and guide your baby's head to your breast.

Laid-back nursing

Laid-back breastfeeding, also known as "biological nursing", is when you lie back in a comfortable semi-reclined position on a comfy sofa or bed. If you have had a caesarean section (c-section), your baby can lie across you and away from your incision.

1. Lean back (but not flat) on a sofa or bed.

2. Prop yourself up with cushions or pillows so your back, shoulders and neck feel supported.

3. When you are comfortable, place your baby on your front. Their tummy should be resting on your tummy - but if this is uncomfortable, lie them to one side.

4. Make sure you are upright enough to look into your baby's eyes

5. While supporting your baby, gently guide your baby to your nipple. For more information, have a look at this video on laid back nursing..

Rugby hold (or the 'clutch')

The rugby hold is a good position for twins as you can feed them at the same time, as well as caesarean babies as there's no pressure on the tummy and scar area.

1. Sit in a chair with a cushion or pillow along your side.

2. Position your baby at your side (the side you want to feed from), under your arm, with their hips close to your hips.

3. Your baby's nose should be level with your nipple.

4. Support your baby's neck with the palm of your hand.

5. Gently guide them to your nipple.

Breastfeeding Friend from Start for life

The Breastfeeding Friend, a digital tool from Start for Life, has lots of useful information and expert advice to share with you - and because it's a digital tool, you can access it 24 / 7.

For confidential breastfeeding information and support, call the National Breastfeeding Helpline on 0300 100 0212. Lines are open 9:30am to 9:30pm every day.

Sign up now for our pregnancy, baby and toddler guide

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Find out about the different ways you can breastfeed with our step-by-step guide on breastfeeding positions

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Skip to main content Breastfeeding takes practice. It takes time to work out which positions feel best - try them all out to see which feels best. Before you breastfeed your baby, have a drink beside you - something thirst quenching like a big glass of water.

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Breastfeeding: positioning and attachment - NHS (www.nhs.uk)

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Breastfeeding tips, including how to get your baby attached (latched on) properly at the breast, and getting comfortable when you're breastfeeding.

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Positioning & Attachment - The Breastfeeding Network

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Getting Started
Breastfeeding should be COMFORTABLE
How you sit (or lie down) and how close you hold your baby as you feed can make a difference to how well things go. Sometimes a little difference in how your baby is feeding can make a big difference to how comfortable it is for you and how easily your baby gets your milk.
Breastfeeding should NOT HURT
Changing how you hold your baby and how they start to feed can sometimes make a difference to how they settle after feeds.

How you hold your baby is frequently called positioning.

How your baby takes the breast is sometimes called attaching, latching or fixing.
Positioning can help make ATTACHMENT more effective and comfortable, here's how:
Your baby needs to be able to take a large mouthful of breast and feed effectively without causing you any discomfort.

Especially in the early days, you may find it more comfortable to feed lying in a semi reclined position, with your body and head completely supported. In this position your baby feeds while lying on your stomach, with their body and legs downwards. This way your baby can move towards your nipple and breast itself, with some gentle guidance if needed. You may prefer to breastfeed sitting up with your baby lying across your body or in a rugby hold.

Sit comfortably with your back well supported

Sit comfortably with your feet flat on the floor or raised on a stool or a pile of magazines or similar so that your lap is flat.

Keep your baby's body in a straight line with their whole body facing the food (nipple and breast).

Support their neck, shoulders and back so that your baby can tilt their head back easily.

Move your baby from your cleavage towards the nipple.

Make sure your baby's lower lip and chin is in contact with your breast first.

The following issues are possible signs that your attachment could benefit from being altered. They are not always caused by attachment, but it is worth trying to adjust the way you are holding your baby and bringing them to the breast before considering any other explanations:

Baby starts to feed then pulls away

Nipples cracked or sore

Baby is unsettled or 'colicky'

Breasts leak

Baby fights or refuses the breast

Baby wakes up frequently in the night

Baby has sore bottom or watery stools or green poo

Slow weight gain

Blocked ducts or mastitis

Baby's nose is blocked by mother's breast

Very frequent and/or lengthy feeds

There are some illustrations and more information in Off to the Best Start.

If you want to talk through positioning and attaching in more detail, you could contact the National Breastfeeding Helpline to speak to a registered Breastfeeding Supporter. The National Breastfeeding Helpline is available from 9:30 am to 9:30 pm, 365 days a year, on 0300 100 0212, or via social media and webchat.

Here are some links to external breastfeeding websites with line drawings and images that give tips on how to get your baby to the breast correctly:

Speak to a registered Breastfeeding Supporter

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How to breastfeed - The Breastfeeding Network

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Getting Started Breastfeeding should be COMFORTABLE How you sit (or lie down) and how close you hold your baby as you feed can make a difference to how well things go. Sometimes a little difference in how your baby is feeding can make a big difference to how comfortable it is for you and how [...]

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Breastfeeding With Large Breasts - Breastfeeding Support

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Breastfeeding can run smoothly with all sizes of breast. However, large breasts may make it more challenging to position baby comfortably, or to find nursing bras, pump flanges or nipple shields in larger sizes. This article shares tips for breastfeeding with large breasts and looks at common concerns larger breasted women can have when breastfeeding.

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Thrush (of the breast/nipple) and Breastfeeding - The Breastfeeding Network

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Thrush (of the breast/nipple) and Breastfeeding - The Breastfeeding Network

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

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Breastfeeding and thrush - NHS (www.nhs.uk)

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

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Sore Nipples | Breastfeeding Challenges | Start for Life (www.nhs.uk)

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What causes sore nipples?

The most common cause of nipple pain is when your baby does not latch on properly.

It's very important that you correct this as soon as possible - ask your midwife, health visitor or breastfeeding specialist for help, they can show you how your baby needs to be positioned when feeding. Have a look at our step-by-step guide to latching on.

Whatever you do - do not stop breastfeeding! Breast milk is created on a supply and demand system, so the less you feed, the less you produce.

If you are finding it really painful to breastfeed try expressing your breast milk to keep up the supply.

Other possible causes for sore nipples

Tongue-tie

When the strip of tissue under your baby's tongue (attaching the tongue to the floor of the mouth) is shorter than normal - this can prevent them from latching on properly.

Read more about tongue-tie.

Thrush

Thrush (or "candida") is an infection that can occur when your nipples become cracked or damaged. Symptoms are usually severe pain in your nipples after breastfeeding (it's described as burning or shooting pains) lasting up to an hour.

Your doctor can prescribe treatment for you and your baby.

Read more about thrush.

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Sore nipples - Breastfeeding challenges - Start for Life

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Sore nipples can be caused if your baby is not positioned correctly while breastfeeding. Find out about other causes and how to treat it.

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Blocked Milk Duct - Breastfeeding Support

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

What is a blocked milk duct?

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

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

Causes of a blocked milk duct

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

Preventing a blocked milk duct

Ideas to prevent blocked milk ducts include:

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

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

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

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

Signs of a blocked milk duct

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

How to clear a blocked milk duct

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

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

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

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

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

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

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

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

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

Strategies over which some practitioners disagree include:

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

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

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

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

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

Massage techniques

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

Lymphatic breast drainage therapy

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

Therapeutic breast massage

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

Wide toothed comb

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

Cicular movements

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

Six step recanalization manual therapy (SSRMT)

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

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

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

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

4. Push and press the areola from different directions

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

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

Further ideas for persistent blocked milk ducts

Ultrasound and other therapies

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

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

Probiotics and vitamin C

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

Recurring blocked milk ducts

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

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

Oversupply of breast milk

Restricting breastfeeds to a schedule instead of on demand

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

Using a breastfeeding pillow if it is interfering with good positioning

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

A previous episode of mastitis that hasn't cleared properly

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

Stress , exhaustion or fatigue (Lawrence, 2016)

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

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

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

If your blocked milk duct is still there...

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

Summary

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

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

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Reflux | Breastfeeding Challenges | Start for Life (www.nhs.uk)

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Skip to main content

Breastfeeding challenges

There may be times when breastfeeding is challenging. Never ignore any issues you may have - talk to your health visitor, midwife, GP or breastfeeding specialist as soon as possible, they will be able to help you sort it out quickly.

Here are some common breastfeeding issues, and tips on what to do.

Baby reflux

If your baby brings up milk, or is sick during or after feeding, this is known as reflux. Reflux, also called posseting or spitting up, is quite common and your baby should grow out of it, usually by the time they are 12 months old.

What causes baby reflux?

The muscle at the bottom of the food pipe acts as a kind of door into the stomach - so when food or milk travels down, the muscle opens allowing the food into the stomach.

However, while this muscle is still developing in the first year, it can open when it shouldn't (usually when your baby's tummy is full) allowing some food and stomach acid to travel back up again. Acid in the stomach is normal and a necessary part of the digestion process - it helps break down food.

In most babies, reflux is nothing to worry about as long as they are healthy and gaining weight as expected.

Baby reflux symptoms

Constant or sudden crying when feeding.

Bringing up milk during or after feeds (regularly).

Frequent ear infections.

Lots of hiccups or coughing.

Refusing, gagging, or choking during feeds.

Poor weight gain.

Waking up at night a lot.

Did you know?

Reflux is very common in the first 3 months, and usually stops by the time your baby is 12 months.

GORD

When reflux becomes painful and it happens frequently, this is known as 'gastro-oesophageal reflux disease' (GORD). GORD is more serious than mild, everyday reflux. The strong stomach acid can irritate and make the food pipe sore and inflamed, which is painful for your baby and may result in them needing medication.

The main signs and symptoms of GORD in your baby are:

spitting up frequently

abdominal pain

feeding difficulties

seeming unsettled and grizzly after a feed

These symptoms can lead to your baby not gaining weight, or even losing weight.

Silent reflux

Silent reflux can be confusing as there are no obvious signs or clues (such as spitting up). It's when the food travels back up the food pipe - but it's swallowed rather than spat out so is harder to identify. But your baby may display similar symptoms to those of regular reflux.

Breastfeeding Friend from Start for Life

The Breastfeeding Friend, a digital tool from Start for Life, has lots of useful information and expert advice to share with you - and because it's a digital tool, you can access it 24 / 7.

Breastfeeding tips for babies with reflux

Feeding little and often (smaller feeds stop their tummy getting too full).

Burping them requently during feeds - have a look at our guide to burping your baby for techniques.

Try a different feeding position - check out our our guide to breastfeeding positions.

Keep your baby upright, for at least an hour after feeding, this should help keep the milk down.

If you are mixed feeding (combining breastmilk and formula feeds), have a look at our advice on bottle feeding and reflux.

When to see the GP

If your baby has difficulty feeding or refuses to feed, regularly brings milk back up and seems uncomfortable after a feed, talk to your pharmacist, GP, or health visitor. They'll be able to give you practical advice on how to ease the symptoms and manage it - they may also need to rule out other causes (such as cow's milk allergy).

It might be helpful to keep a record of when your baby feeds, with details of how often and how much your baby brings the food back up, and how often your baby cries or seems distressed. This will help your health visitor or GP decide if your baby needs treatment.

For confidential breastfeeding information and support, call the National Breastfeeding Helpline on 0300 100 0212. Lines are open 9:30am to 9:30pm every day.

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Reflux is when your baby brings milk back up during, or just after a feed. Read about reflux symptoms and how to help your baby

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Skip to main content There may be times when breastfeeding is challenging. Never ignore any issues you may have - talk to your health visitor, midwife, GP or breastfeeding specialist as soon as possible, they will be able to help you sort it out quickly.

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Too Much Milk and Oversupply - La Leche League GB

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While it's good to have plenty of milk, some mothers produce more milk than their babies need. This is usually called oversupply.

Some babies cope very well with a generous milk supply; however, others will be unhappy and uncomfortable even though they are gaining weight and appearing to thrive. Oversupply can also make feeding uncomfortable and increase the risk of mastitis.

Symptoms of oversupply
How does oversupply happen?
How is your milk supply established?
A note about foremilk and hindmilk
What can I do about the symptoms of oversupply?
Reducing your milk supply
If you still have problems
Breast compression
Adjusting to the new normal

Symptoms of oversupply

The main symptoms of oversupply for a baby are:

Very fast weight gain, moving upwards through centile lines

Explosive green frothy poos

Struggling to control milk flow

Pain and excessive wind or 'gas'

You may also notice the following:

Choking, coughing, and pulling on and off the breast

Clamping down and biting to slow the flow of milk

Frequent spitting up

Always appearing hungry and unsatisfied despite large weight gain

Unwillingness to nurse to sleep

Breast refusal

Faltering weight gain due to breast refusal

Lots of wet and dirty nappies

General 'colicky' behaviour

A mother with oversupply may have the following symptoms:

Some of these symptoms may have other causes; allergies and reflux, for example, can have similar symptoms to oversupply. They may also fall within the normal range. Therefore, it is important to rule out other possibilities before taking steps to reduce your milk supply, as this can have longer term consequences.

How does oversupply happen?

Some mothers naturally produce large quantities of milk, and we tend to produce more milk with each baby. Occasionally, there are medical reasons for having much more milk than your baby needs. Oversupply can also occur as a result of breastfeeding management, for example, when a baby's feeds are scheduled, or if a mother is told to feed from each breast for a certain amount of time. It can happen if a pump is used too often, or used in a way that overstimulates the breast.

Milk production is best regulated by your baby's appetite. When you breastfeed responsively, rather than by following a schedule, your milk production adapts to their needs. Occasionally, a poor latch can contribute to oversupply as a baby might feed very frequently to get the volume they need. However, this tends to reduce milk supply over time.

How is your milk supply established?

After your baby is born, milk production is regulated on a supply and demand basis. Put simply, the more milk you remove, the more milk you are likely to make. How quickly or slowly milk is made depends on the fullness of the breast - an 'empty' breast makes milk more quickly, a full breast makes milk more slowly.

It takes a few weeks for your supply to settle down to what your baby actually needs. It is not unusual in the early weeks to feel as if you have too much milk, and to have times when the breasts feel full or even engorged. This is not the same as oversupply.

Feeding frequently and removing milk from the breasts is essential to resolving engorgement - it won't make the engorgement worse or result in too much milk.

Babies usually nurse more during developmental leaps and growth spurts, and many mothers find there are changes to their baby's nursing pattern during holidays and family get-togethers, or during periods of stress. Milk supply is very adaptable - if you follow your baby and your body, your supply will most likely regulate itself.

Read more about how milk production works.

A note about foremilk and hindmilk

One of the symptoms of oversupply in a baby is green frothy poos, gas, and pain. This is sometimes called lactose overload or a foremilk-hindmilk imbalance.

You may be given confusing information about foremilk and hindmilk, and how long a feed 'should' last. Or think that there are two different kinds of milk - lower-fat and fat-rich - and that one is better than the other.

Typically, the fat content does increase during a feed, as the fat globules tend to be drawn down towards the end of a feed. However, it is not the length of a feed that is important, but the length of time between feeds. Fat content is determined mostly by the fullness of the breast. If there is a long gap between feeds and the breast is full, the baby may get a large quantity of lower-fat milk before much of the fat starts getting pulled down. The same may be true if a mother naturally produces very large quantities of milk. In the absence of fat-rich milk, the lower-fat milk moves through the gut faster than it can be digested, causing green poos, gas, and pain.

All breastmilk is good! What matters most to weight gain is overall milk volume.

What can I do about the symptoms of oversupply?

To start with, you might like to:

adjust your position and your baby's attachment to help them manage a fast letdown

feed responsively (as often as your baby wants) and/or offer more frequent feeds

use breast massage

avoid overpumping

Managing a Fast letdown
A fast letdown can be one symptom of oversupply. It is possible to have a fast letdown with an 'average' milk production. When your baby nurses, a hormonal reflex causes milk to release, (what is known as 'letdown'). When this happens, it is not unusual for milk to spray out quickly. Some babies like this fast flow, but others are upset by it and struggle to coordinate sucking, swallowing, and breathing. You may find it helpful to:

Ensure that your baby is deeply attached at the breast. This will make it easier for them to manage a fast flow.

Try different positions. Some parents use gravity to help them by feeding in a 'laid-back' (reclined) position. Others find it helps to feed in a more upright position such as a 'koala hold', or to feed while using a sling or baby carrier. Side-lying may also be helpful as excess milk can easily leak out.

Allow your baby to come off the breast when they need to catch their breath, and use a muslin to catch the spray.

Some mothers hand express a little to slow the flow before bringing the baby to the breast (however, if this is done frequently, it may make oversupply worse).

If your breast is very full and engorged, you might try 'reverse pressure softening' to move fluids away from the nipple area as this can help your baby to latch more deeply.

Feed frequently so that the milk spray doesn't have quite so much volume and force behind it.

Try breastfeeding before your baby is really hungry, or while they are slightly sleepy.

Responsive feeding
How do you know how often or how long to feed your baby for? Let your baby tell you! We all have different milk storage capacities and this may determine how frequently your baby feeds, and whether they feed from one side or two. Allow your baby to feed from the first breast for as long as they want to before offering the second breast - they may or may not take it.

Sometimes babies will only take one breast, and sometimes two (or three or four!). Most babies will take both breasts, at least some of the time. Babies are very good at letting us know how often they want to feed, and if in doubt, it is always fine to offer.
Breast massage
You could do what is sometimes called the 'breast milkshake'. This involves massaging each breast very gently for half a minute or so before feeding, then using a combination of massage and breast compression (see below) during a feed to help dislodge some of the fat. Any massage should use a light fingertip pressure such as you would use to apply body lotion.
Expressing
Overuse of pumps - or using a pump in a way that unintentionally stimulates milk production (such as a silicone pump to collect dripping milk) - can make oversupply worse. If you've been expressing regularly, reduce this gradually to avoid further problems.

Reducing your milk supply

If your baby is gaining more weight than average and you and your baby are happy, then you don't need to change anything. It is not possible to overfeed a breastfed baby.

If you or your baby are struggling with some of the above symptoms, you have ruled out other causes and changes to breastfeeding management do not help, then you may want to consider taking steps to gradually slow milk production.

Consult an LLL Leader before using these approaches. This is especially important if your baby is under one month old, or you are experiencing other problems such as sore nipples or mastitis.

Monitor your baby's weight gain to ensure it doesn't drop below expected levels, and keep a close eye on nappy output.

One side per feed
Limit your baby to one breast per feed. If your baby wants to have a short rest during a feed, then offer the same breast again. When a mother has a generous milk storage capacity, their baby may only need to feed on one side. This approach may help milk production to reduce in line with their baby's demand.

Block feeding
Block feeding involves feeding on the same side for a set period of time (block), e.g. for two or three hours. If your baby wants to feed again within that time block, offer the same side. As a starting point, you might like to:

Limit your baby to one breast for about two hours, allowing them to nurse as often and for as long as they like, but only on that one side.

Continue in this way, switching breasts every two hours. If your baby is asleep, switch breasts when they wake.

It is important not to have a rigid approach to block feeding: read your breasts and your baby, not just the clock. By doing this, you will find the time block that works best for both of you. If the unused breast feels uncomfortably full before the next feed then 'express to comfort' only.

It is possible to experience oversupply in just one breast, in which case you could nurse for longer periods on the unaffected side.

Full drainage and block feeding method
For more severe oversupply - for example, if you are suffering from recurrent blocked ducts or mastitis and your breasts never feel soft and comfortable even after a breastfeed - you will need to keep your breasts well drained while you take steps to reduce milk production.

You could try the following, in consultation with an infant feeding specialist, in addition to block feeding:

Express from both sides thoroughly to 'empty' your breasts as fully as possible.

After expressing, immediately offer both 'empty' breasts to your baby.

Next, limit your baby to one breast changing sides every two or three hours (see block feeding above).

Some mothers will need to use this approach only once. However, if your breasts feel uncomfortably full, you may need to repeat it, increasing the interval between each pump for your breasts to readjust.

Medications and herbs to reduce milk production
There are herbs and medications that can help dry up your milk production. Talk with your health care provider or a lactation consultant.

If you still have problems

After 4-7 days, your breasts may be more comfortable. If you and your baby still have trouble coping with the supply of milk, you can gradually increase the time block you keep your baby to one breast. Some women with extreme oversupply have gone as long as six or more hours before switching breasts to adjust milk production. A hormonal imbalance may cause overproduction of milk, but this is rare. A visit to your doctor may be helpful if the suggestions offered here aren't enough.

Block feeding should be a temporary measure. In practice, it is suggested that it is done for no more than one week, and only when babies are gaining double (or more) the average weight for their age. Once supply has settled, you can return to a more normal feeding pattern, following and trusting your baby and your body.

Breast compression

Babies used to a generous milk flow can become fussy at the breast when milk flow slows. They may have to work harder at the breast and deepen their latch to remove milk effectively. Breast compression will increase milk flow and encourage your baby to keep feeding actively:

1. Support your breast with one hand - thumb on one side, fingers on the other.

2. Wait while your baby breastfeeds actively (slow, rhythmic sucking, lots of swallowing). When their swallowing slows, compress your breast gently to increase milk flow and encourage swallowing. Hold it squeezed while they continue nursing actively, then release your hand.

3. Rotate your hand around your breast and repeat step 2 on different areas of the breast as needed. Be gentle - this shouldn't hurt.

Adjusting to the new normal

Always monitor your baby's weight gain, wet and dirty nappies, and overall well-being while following these strategies. Monitor their weight over a period of several weeks to see a trend. If your baby had been gaining weight very quickly, you may see 'catch-down' growth. Your baby will gain weight steadily, but may gradually drop against the percentile lines as your milk production adjusts. Their weight should then settle into following a new percentile line on the chart.

As your supply reduces, your breasts will feel softer and more comfortable, and leaking will be reduced. Soft comfortable breasts between feeds during the early weeks are normal and a sign that your milk production is in tune with your baby's needs.

Written by Charlotte Allam

Last updated May 2023

Kimberly Seals Allers' photos on this site are used under a creative commons license of Black Breastfeeding 360° http://mochamanual.com/bb/

Further Reading
Mastitis
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
Is My Baby Getting Enough Milk
Comfortable Breastfeeding
Rhythms & Routines
The Unhappy Breastfed Baby
Reflux
Allergies and Intolerances
Fat Content of Breastmilk - FAQs
Positioning and Attachment

Other websites
UK-WHO Growth Charts: www.rcpch.ac.uk/growthcharts
Block Feeding Dos and Don'ts: http://www.nancymohrbacher.com/articles/2013/10/9/block-feeding-dos-donts.html?rq=oversupply

Books
The Womanly Art Of Breastfeeding. LLLI, London: Pinter & Martin, 2010

Copyright LLLGB 2023

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While it's good to have plenty of milk, some mothers produce more milk than their babies need. This is usually called oversupply. Some babies cope very well with a generous milk supply; however, others will be unhappy and uncomfortable even though they are gaining weight and appearing to thrive.

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Constipation | Breastfeeding Challenges | Start for Life (www.nhs.uk)

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Skip to main content

There may be times when breastfeeding is challenging. Never ignore any issues you may have - talk to your health visitor, midwife, GP or breastfeeding specialist as soon as possible, they will be able to help you sort it out quickly.

Here are some common breastfeeding issues, and tips on what to do.

Constipation

Constipation makes it more difficult for your baby to have a poo. It's often caused by their diet and is easy to treat from home.

Symptoms of constipation

The symptoms of constipation in your baby can include:

pooing fewer than 3 times in a week

finding it difficult to poo, and poos that are larger than usual

dry, hard, lumpy or pellet-like poos

unusually smelly wind and poo

your baby may be less hungry than usual

their tummy might feel firm

Other signs of constipation can include your baby lacking energy and being a bit grizzly.

How often should my breastfed baby poo?

There's no 'normal' when it comes to how often babies poo - breastfed babies will sometimes go several days, or even a week without having a poo (this is more common in babies aged 6 weeks or older). You'll quickly get used to your baby's bowel movements, so you'll be able to tell what's normal for them.

Breastfeeding Friend from Start4life

The Breastfeeding Friend, a digital tool from Start4Life, has lots of useful information and expert advice to share with you - and because it's a digital tool, you can access it 24 / 7.

What causes constipation?

Change in diet

It's quite common for your baby to become constipated when they start taking first infant formula (which is harder to digest than breast milk), or eating processed foods. That's just because their body is learning how to cope with digesting new things.

Dehydration

Constipation can be caused by a lack of fluids. There are various reasons why your baby may not be getting enough fluids - they may be teething and finding it uncomfortable, it could be down to illness (a cold, a throat or ear infection, etc), or if they are older, not drinking enough fluids with their food. Lack of fluids can make your baby's poo harder and more difficult to push out.

Lack of fibre

In older babies, it can also be caused by not getting enough fibre, (such as fruit, vegetables and cereals) in their diet. For advice on which foods to include in your baby's diet, have a look at our guide to What to feed your baby.

Treating constipation

Here are some tips on helping relieve constipation at home:

lie your baby down and gently move their legs like they're riding a bicycle - this can help get things moving. If your baby is happy lying down, give them a gentle tummy massage

if your baby is bottle-fed, try giving them extra water between some feeds

if your baby is on solids, make sure they're getting enough fibre. Apples, pears and prunes are particularly good for constipation. Find out more about foods with plenty of fibre.

It may take a few days to get things moving again, but if things do not improve, speak to your health visitor or doctor. Your doctor may prescribe a laxative, or want to double check that it's not being caused by any underlying medical conditions.

For confidential breastfeeding information and support, call the National Breastfeeding Helpline on 0300 100 0212. Lines are open 9:30am to 9:30pm every day.

Sign up now for our pregnancy, baby and toddler guide

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Do you think your baby could be constipated? Find out what causes constipation and how to treat it

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Skip to main content There may be times when breastfeeding is challenging. Never ignore any issues you may have - talk to your health visitor, midwife, GP or breastfeeding specialist as soon as possible, they will be able to help you sort it out quickly.

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

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

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

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

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

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

Some infants who are allergic to cow's milk protein may also react to soya.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019

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

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

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Sleepy Baby – Why And What To Do - La Leche League GB

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What is normal?
Normal newborn feeding cues
Why is my baby sleepy?
Good attachment
Wake your sleepy baby to nurse
Other ideas
Biological nurturing™
Breast compression
Express milk for your baby
Avoid bottles and dummies
When to offer expressed milk
Don't give up too soon

What is normal?

Your newborn baby needs to breastfeed effectively at least 8-12 times in 24 hours to gain weight and stimulate your milk production. Most babies nurse every 2-3 hours from the start of one feed to the next, with one longer sleep of 4-5 hours. 'Cluster nursing' is also common, where a baby breastfeeds on and off for several hours, especially in the evening. As well as breastfeeding and sleeping, your baby will probably also have periods of quiet alertness. Your newborn needs to nurse actively from one or both breasts at each feed. Offer the second breast after he seems to have finished at the first, although he may not want both sides at every feed. Look at our page Beginning Breastfeeding for more information.

Normal newborn feeding cues

Offer feeds generously. Don't make your baby wait until he is desperate-by that point he is unlikely to feed well. In order of urgency, signs your baby is ready to feed include:

Mouth movements, including smacking or licking his lips.

Sucking on lips, tongue, hands, fingers, toes, toys, or clothing.

Rooting, head bobbing or nuzzling against whoever is holding him.

Fidgeting or squirming a lot.

Fussing.

Crying-a late sign of hunger.

Why is my baby sleepy?

In the first few days, some babies are sleepy or uninterested in feeding. This can be especially true for small babies, after a difficult labour or birth, or if you received drugs for pain relief during labour. Jaundice or an infection may make a baby sleepy. Frequent breastfeeding helps prevent normal newborn jaundice becoming a problem. Your baby may sleep to conserve energy if he is not getting enough food. He may also sleep longer than is good for him if he is apart from you.

Good attachment

Getting a deep, comfortable latch is crucial. If your baby is not latched on well at the breast, he will have to work harder to get your milk. He may tire easily and fall asleep. Sometimes just a small adjustment to the way your baby comes to the breast can make a huge difference. An LLL Leader can provide individual suggestions tailored to your circumstances. If your breasts are engorged, gently hand express a little milk and/or ease swelling back with your fingertips to make it easier for your baby to latch on deeply and prevent you getting sore. Find an LLL group near you.
Seek skilled help early on if you are finding breastfeeding difficult or uncomfortable.
Wake your sleepy baby to nurse

If your baby is too sleepy or groggy to rouse himself every few hours, you will need to wake him to feed to ensure he gets enough milk. This will be easier if your baby is in a light sleep cycle: watch for rapid eye movements under his closed eyelids, arm and leg movements, sucking activity and changes in his facial expression. See whether his arm shows some resistance to movement rather than being floppy and relaxed.

Aim for him to feed at least 10 times in 24 hours.

Encourage active nursing on the first breast, watching and listening for signs of swallowing.

Use breast compression (see overleaf) to keep your baby nursing actively.

Offer the other side in the same way. You can switch back and forth several times if it helps your baby stay awake and feed.

Encourage cluster nursing whenever your baby is more alert.

Laid back breastfeeding positions and skin-to-skin contact are also very effective in helping a baby to rouse and feed. Your baby will need to feed in the night too. Keep him close by-day and night-so he doesn't sleep too long and you don't miss his feeding cues.

Other ideas

Dimming the lights and keeping your surroundings quiet and peaceful.

Keeping the room temperature at around 18°C or undressing him a little if the room is warm. Being too hot can make a baby sleepy.

Unwrapping any blankets.

Biological nurturing™

A baby often instinctively seeks the breast and attaches deeply and comfortably if he can snuggle up close to his mother's chest for periods of time, even when sleepy or during light sleep. Try letting your baby lie on your body as you recline so both his chest and tummy are against you. This kind of 'laid-back' breastfeeding contact is known as Biological Nurturing™ and can be done skin-to-skin or with you and your baby lightly clothed-whatever is more comfortable and convenient for you both. Watch for signs your baby is stirring and gently encourage feeding. Spending time relaxing like this can make a real difference to how well your baby feeds and how much milk you make. Our page on Comfortable Breastfeeding has more ideas.

Breast compression

If your baby starts to doze at the breast, this technique will help him breastfeed actively and take more milk.

Support your breast with one hand-thumb on one side, fingers on the other.

Wait while your baby breastfeeds actively, his jaw moving all the way to his ear. When he stops swallowing, compress your breast firmly. Hold it squeezed until he stops nursing actively, then release your hand.

Rotate your hand around your breast and repeat step 2 on different areas of the breast as needed. Go gently-this should not hurt.

Switch nursing: t ry switching breasts at least two or three times during each feed-when he comes off the first breast on his own or when breast compression no longer keeps him breastfeeding actively.

If your baby isn't responding

Express milk for your baby

Until he gets the hang of feeding you may need to do some work for your baby. If he is not latching at all, or is not feeding well and gaining weight, then expressing your milk will help establish milk production. The earlier you start, the sooner you'll produce plenty of milk. On day one, expect to express small amounts of milk at a time: about 5 ml every couple of hours, to mimic your baby's feeding pattern, increasing to about 30-60 ml each time by day seven after birth. Hand expression is often easiest at first but you can combine hand expression with pumping when your milk comes in.

Avoid bottles and dummies

You can give small amounts of expressed milk using a spoon, flexible feeding cup or syringe. Bottles or dummies can confuse your baby's sucking technique, see our page on Nipple Confusion. Consult an LLL Leader about breastfeeding friendly ways to bottlefeed or about using a nursing supplementer. This device delivers extra milk through a tube along your breast as your baby nurses, avoiding the need for bottles. Visit our page When Mum Can't Be There for more information on breastfeeding friendly ways to bottlefeed.

When to offer expressed milk

Babies may sleep to conserve energy if they are not getting enough food. Giving your baby your expressed milk after breastfeeding can help him overcome sleepiness and feed more effectively next time. But if you can't get him to feed well at all, a little expressed milk before nursing may give him the energy he needs to breastfeed more effectively this time.

Don't give up too soon

If your baby doesn't respond quickly to your efforts to get him to breastfeed more often and more effectively, don't give up.
Check with your doctor to eliminate any medical reasons and contact your local LLL Leader to find one-to-one breastfeeding help. You can find support and encouragement from breastfeeding mothers in your local LLL Group too.

Written by mothers of LLLGB. Photos courtesy of Ellen Mateer and Suzanne Tobin.

Further Reading
Comfortable Breastfeeding
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
My Baby Needs More Milk
Jaundice in Healthy Newborns

Other websites
Biological Nurturing™: www.biologicalnurturing.com/video/bn3clip.html
Benefits of skin-to-skin contact: www.kangaroomothercare.com

Books
The Womanly Art Of Breastfeeding. LLLI, London: Pinter & Martin, 2010

This information is available to buy in printed form from our shop.

Copyright LLLGB 2016

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Sleepy Baby - Why And What To Do - La Leche League GB

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What is normal? Normal newborn feeding cues Why is my baby sleepy? Good attachment Wake your sleepy baby to nurse Other ideas Biological nurturing™ Breast compression Express milk for your baby Avoid bottles and dummies When to offer expressed milk Don't give up too soon What is normal?

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Increasing Your Milk Supply - Video - Global Health Media Project

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Most mothers are able to provide their babies with all the milk they need. However, if a baby is not thriving as she should, this video shows a mother steps to improve her milk supply and the baby's feeding.

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Increasing Your Milk Supply - Video - Global Health Media Project

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Most mothers are able to provide their babies with all the milk they need. However, if a baby is not thriving as she should, this video shows a mother steps to improve her milk supply and the baby's feeding.

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Supplementing at the Breast - Breastfeeding Support

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Sometimes a baby may need supplemental breast milk, donor milk or formula in addition to direct breastfeeding. There are many possible reasons for low milk supply and if a baby isn't gaining weight or not gaining enough weight more milk may be needed either temporarily or longer term.

Traditionally supplemental milk has been fed by spoon, syringe, cup-feeding or bottle. But there is another option; supplementing at the breast using a fine feeding tube or supply line. This article looks at how at-breast supplementers work, when to use one, and the pros and cons of supplementing at the breast.

How supplementing at the breast works

Supplementing at the breast requires a container of milk connected to a length of flexible feeding tube. The tube and container may be referred to as an at-breast supplementer, nursing supplementer, lactation aid or a supply line. The free end of the feeding tube is held or taped to run alongside mother's nipple so that the baby takes the tube and nipple together in his mouth when he latches. Alternatively the tube can be inserted in the corner of baby's mouth part way through a breastfeed after the breast has been drained. While the baby feeds at the breast, he also receives supplemental milk via the small tube. As long as baby breastfeeds with a good attachment (latch) and suction, with his lips sealed around the breast, milk will flow up the tube with much the same principle as sucking up a straw.

It is a good idea to stay in contact with your IBCLC lactation consultant or health professionals while supplementing at the breast.

Types of supplemental feeding system

There are currently only a few commercial systems, each using different designs and each with their own advantages and disadvantages. It is also possible to make a homemade version, see Homemade Supplemental Nursing System or use a supply line as a finger-feeder. The commercial systems include:

The Medela Supplemental Nursing System (SNS) uses a hard sided container for the supplement which hangs from your neck. Two tubes deliver the supplement from the container one to each breast. The feeding tubes can be taped to the breast with surgical tape or a sticking plaster. Slits in the cap make it possible to pinch shut one or both tubes to prevent milk flowing.

The Lact-Aid uses a soft disposable bag to hold the supplement which also has a neck strap to hang around the neck like the SNS and a clamp to stop milk flow if needed. This system only has one feeding tube which can be moved between breasts. There are ongoing costs to buy new sterile bags to hold the supplement.

Haakaa's Supplemental Feeding Combo is a new supplementer on the market currently available in New Zealand. Squeezing the container of milk controls the flow of supplement.

Controlling the rate of flow of milk

It is important to get the flow of supplement at the right speed-too fast and your baby may get too much milk to cope with. If the flow is too slow, an underweight baby may not have the stamina to keep feeding long enough or at all. Ideally with the supplementer in place, your baby will be having one swallow of milk after every suck or after every two to three sucks for most of the feed. The rate of flow of milk from the supplementer varies with:

The diameter of the tube-the wider the tube, the faster the flow of milk. The Medela SNS provides several sizes of tube to help you find the right flow rate for your baby.

The position of the container in relation to the baby-the flow is slower if the bottle is positioned below the baby and faster if the container is positioned above baby's head.

Lactation consultants Diana West and Diane Wiessinger discuss how to adjust flow rate in the Medela SNS in the following excerpt:

A baby who is seriously underweight or who has a weak suck might be fed with the larger tube, while a baby who is gaining well might use the smaller tube. Most mothers start with the medium size tubing. If milk flow is not sufficient with any one tube size, even when the bottle is as high as it can go, another option is to tape both tubes of a given size together on one breast, or to tape one tube to the side of the bottle, facing upwards and unclamp it, allowing air to enter the reservoir more quickly. Milk exits only when air enters, so the faster air flows into the reservoir, the faster milk can be removed from it.

Cleaning a supplemental nursing system

The small feeding tubes are very difficult to clean and will need replacing regularly. Follow manufacturer's cleaning recommendations very carefully for commercial feeding systems and for information about cleaning homemade versions see Homemade Supplemental Nursing System on this website.

When to use an at-breast supplementer

Supplementing at the breast can be used short term or long term and helps avoid a baby losing interest in breastfeeding prematurely in favour of a bottle. Potential uses include:

Supplementing a baby if there is a reason for low milk supply including insufficient glandular tissue.

Keeping an adopted baby fed at the breast to give mother and baby the experience of breastfeeding.

Keeping a baby interested in latching when encouraging a baby back to the breast after a period of bottle feeding or while a mother is relactating.

The tube can be used as part of a finger feeding exercise for suck training.

Pros and cons of supplementing at the breast

Advantages

Baby can get the additional milk he needs at the breast without introducing other feeding methods or techniques.

Baby gets more practice at breastfeeding well. If baby doesn't feed correctly, milk won't come up the tube.

Mother is able to enjoy the full experience of breastfeeding.

Helps avoid bottle preference or nipple confusion. There is less chance that a baby will start to prefer a bottle instead of the breast or stop breastfeeding correctly due to nipple confusion with a bottle teat.

Increases the flow of milk. Supplementing at the breast eliminates a baby's frustration with slow flow when milk supply is very low.

The breasts are stimulated to make more breast milk by additional suckling.

Baby associates feeling full with the breast and this reinforces his desire to breastfeed.

Disadvantages

It can be difficult and fiddly to use until you get the hang of it, particularly when away from home. An IBCLC lactation consultant can help you get started.

It is difficult to clean the little tubes thoroughly.

The system can leak, particularly homemade versions.

Doesn't work for all babies. Some babies can't seem to suck milk up the tube or are not able to get very much. A very underweight baby may still fall asleep at the breast without having fed well. Older babies may be aware of the tube and keep pulling it out.

Only works with good positioning. It isn't a suitable method if a baby isn't latching or is latching so badly as to make his mother's nipples painfully sore.

May affect baby's attachment at breast (latch). Some babies are aware of the tube and it can disturb their latch, tweaking it into different positions may help. Some babies try to suck on the tube like a straw rather than breastfeed correctly.

The tube could cause gagging if it reaches too far into the baby's mouth. Taping the tube to the breast with medical tape so that it aligns with the end of the nipple or behind the nipple can avoid this (see "Taping the tube" below)

Reconstituted powdered formula may clog the tubing.

What supplements can be used with a supply line?

This will depend on your individual circumstances. Supplements could be a mother's own expressed breast milk, donor milk or formula supplements if needed. Some mothers prefer to use ready made formula as powdered formula may clog the small tubes if it is not well blended. If using powdered formula, use the World Health Organization (WHO) guidelines for safe preparation or the UK's National Health Service guidelines Making up Infant Formula, NHS, 2019. And when using expressed breast milk see our storage guidelines. If your baby is underweight, your health professional or IBCLC lactation consultant can guide you with suggested volumes of milk to use in the supplementer. Generally a baby will take as much as they need at any given feeding and this could vary widely depending how much breast milk he is also getting direct from the breast. Staying in contact with your health care team for regular weights will ensure baby is getting enough and growing appropriately.

Taping the tube

The manufacturer's instructions for one of the commercial systems discuss taping the tube beyond the end of the nipple. However, this might cause a baby to gag or use the tube as a straw instead of breastfeeding correctly. The tube need not extend beyond the mother's nipple to work. Surgical sticky tape can be used horizontally across the tube or vertically along its length to prevent the tube from slipping. Some mothers use sticking plasters to guide and hold the tubes by slipping the tube under the non sticky portion of the plaster at each feed.

Video of inserting a lactation aid with Dr. Jack Newman

This clip from Dr Jack Newman's website shows a homemade supplementer being inserted during a breastfeed. Note the baby in this clip looks like he is having to turn his head slightly to reach the breast as he is on his back. Rotating a baby's body towards his mother to ensure his head and neck are all in a straight line is usually preferable to make swallowing easier for baby. See Homemade Supplemental Nursing System for further information on how to make your own at-breast supplementer.

Video using a commercial supplementation system by Natasha Batsford

Get help with breastfeeding

There are lots of ideas to increase your baby's intake of breast milk even if you can't produce a full supply. See How to Make More Breast Milk and contact your IBCLC lactation consultant for more support. Your lactation consultant can help you find the best latch and position for you and your baby, check your baby's tongue function, and help with breastfeeding management.

Summary

An at-breast supplementer or supply line allows a baby to take top ups of supplemental milk directly at the breast while breastfeeding. Supplementing this way has various pros and cons but is another option to consider alongside bottles or cup feeding. A very underweight baby who has not been gaining weight can still tend to fall asleep at the breast without having swallowed plenty of milk, even with a supplemental tube in place. It is important to monitor weight gains and dirty nappies to establish whether your baby is getting enough milk. Stay in contact with your IBCLC lactation consultant or health professionals while supplementing at the breast using a lactation aid.

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This article looks at how at-breast supplementers work, when to use one, and the pros and cons of supplementing at the breast.

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Cup Feeding a Newborn - Breastfeeding Support

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Cup feeding is an alternative to bottle feeding if a baby can't latch to the breast and needs to be given some milk. It can also be used for supplementing a baby who is not getting enough milk or for a baby who is separated from his mother for a while. It is thought to be a useful short-term alternative to using a bottle teat as it avoids a baby getting confused by the different sucking action required on an artificial bottle nipple (nipple preference/confusion). However, there are disadvantages as well as advantages to cup feeding. This article looks at the pros and cons of cup feeding and how to cup feed a newborn baby.

Find an IBCLC

Search for a breastfeeding expert near you

Pros and cons of cup feeding

Advantages of cup feeding

Better oxygen saturation and heart rate. A premature baby can feed at his own pace which may improve his oxygen saturation and heart rate making him more physiologically stable

Cup feeding may help preserve breastfeeding by avoiding bottles. Studies show cup feeding premature babies instead of using bottles can increase the number of babies who breastfeed and increase the length of time they breastfeed

Cup feeding can prepare a baby for breastfeeding. Feeding technique (use of muscles) while cup feeding is thought to be closer to breastfeeding than using a bottle and may help prepare a baby for breastfeeding by encouraging the tongue to come forward for lapping/sipping

Open cups are easily available, inexpensive and very easy to clean in resource poor areas or emergencies compared with teats, bottles or feeding tubes

Suitable for very young babies. Cup feeding can begin from as early as 29 weeks gestational age.

Disadvantages of cup feeding

There is a risk of aspiration or choking if cup feeding is not done correctly

Feeds can take a long time

There can be a lot of spilled and wasted milk compared with bottle feeding or tube feeding

Long term cup feeding can dampen the sucking reflex or create a preference for the cup

Not suitable for sleepy babies as there is a risk of choking.

Can cup feeding help preserve breastfeeding?

One review found cup feeding had no significant benefit in maintaining breastfeeding after discharge from hospital and that the length of hospital stay was likely to be a lot longer with cup feeding in some settings. However more recent studies have found the opposite - more cup fed babies were exclusively breastfeeding at discharge, and beyond, with no apparent increase in hospital stay for term, late preterm and premature babies (Penny et al. 2018). The Academy of Breastfeeding Medicine states cup feeding may help preserve breastfeeding and the World Health Organisation recommends cups or spoons rather than bottles and teats for premature babies.

How to cup feed a baby

Cup feeding is best taught by a demonstration from your experienced health care professional if possible. They will advise you whether the technique is suitable for your baby. To cup feed a baby needs to be awake and alert, and in an upright position. Never cup feed a sleepy baby or a baby who is lying flat and never pour milk into a baby's mouth as these all increase the risk of your baby choking.

Cup feeding videos

Global Health Media has a lovely series of videos about breastfeeding, the first clip below (9 minutes long) discusses how to safely cup feed a small baby who isn't breastfeeding yet and includes spoon feeding, using a paladai (see below) and using a nifty cup:

Cup feeding description

The following description is summarised from the video above. Use a small cup with a smooth edge such as a medicine cup, sherry glass or shot glass-your maternity hospital may give you one. You can also buy little plastic cups specially for the purpose which can be shaped slightly during feeding. You may need a cloth under baby's chin in case any milk spills.

Half fill or two thirds fill a small cup with slightly warmed breast milk or infant formula

Ensure your baby is fully awake, alert and interested in feeding. Never cup feed a sleepy baby

If needed, wrap your baby to prevent him knocking the cup out of your hands

Sit your baby in a comfortable, upright position on your lap. Never cup feed a baby who is lying flat on their back

Rest the rim of the cup lightly on your baby's lower lip or their lower gum ridge

Tip the cup just enough so that milk reaches the rim of the cup, don't put the cup too far into baby's mouth

Your baby will quickly learn to sip or lap milk from the rim of the cup with his tongue

DO NOT pour the milk into his mouth, go slowly alwayskeeping the milk just at the rim of the cup

Leave the cup in position when baby pauses to rest between swallows and is not drinking, avoid putting pressure on the lower lip

Continue to tip the cup enough to keep the milk at the rim of cup resting lightly on baby's lower lip

Burp baby if needed during the feed.

Short film clips of cup feeding

In the following short clip from Global Health Media, a premature baby is cup feeding. Notice how the baby's tongue extends to lap the milk.

Jack Newman is a Canadian paediatrician and breastfeeding expert. Here is a clip of cup feeding from his International Breastfeeding Centre:

Using a paladai

Mothers in India have used a small spouted cup called a paladai for centuries. One study compared the use of a bottle, cup and a paladai in 100 newborn babies. Infants took the most milk in the least time and stayed calmest with the paladai . However a more recent pilot study comparing the paladai with bottle feeding in preterm infants found increased spillage, longer feed times and more stress cues .

Alternatives to cup feeding

Alternatives to cup feeding for the breastfed baby who needs supplementing include:

Supplementing at the breast. A breastfed baby who is latching well to the breast but who needs additional milk can be supplemented while they are breastfeeding by way of a small feeding tube alongside the nipple. The free end of the feeding tube is placed in a container of milk and provides milk when baby suckles with a good seal around breast and tube. For much more information about the pros and cons of this system see Supplementing at the Breast.

Finger feeding. Finger feeding is another method of providing supplemental milk to a breastfed baby by way of a feeding tube (above). In this case the feeding tube provides additional milk while the baby suckles on a clean finger. For more information on the pros and cons of finger feeding see What is Finger Feeding?

Bottle feeding. A traditional way to provide supplemental milk is by bottle and teat. Feeding from an artificial teat has a number of differences to breastfeeding which could cause nipple preference or confusion in some babies. However there are several ways to reduce the differences to help preserve breastfeeding, see Tips to Bottle Feed a Breastfed Baby and Best Bottle for a Breastfed Baby?

Summary

Used correctly, cup feeding can be a useful way to give a newborn baby supplementary milk for short term feeding. Other options for supplementary feeds include using a supplemental nursing system at the breast, or a bottle using our tips to minimise nipple confusion. Your breastfeeding specialist or health professional can help you decide which option is best for you and your baby.

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Cup feeding is an alternative to bottle feeding if a baby can't latch to the breast and needs to be

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Sterilising baby bottles - NHS (www.nhs.uk)

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It's important to sterilise all your baby's feeding equipment, including bottles and teats, until they're at least 12 months old.
This will protect your baby against infections, in particular diarrhoea and vomiting.

Before sterilising, you need to:

Clean bottles, teats and other feeding equipment in hot, soapy water as soon as possible after feeds.

Use a clean bottle brush to clean bottles (only use this brush for cleaning bottles), and a small teat brush to clean the inside of teats. You can also turn teats inside out then wash them in hot soapy water. Do not use salt to clean teats, as this can be dangerous for your baby.

Rinse all your equipment in clean, cold running water before sterilising.

You can put your baby's feeding equipment in the dishwasher to clean it if you prefer. Putting feeding equipment through the dishwasher will clean it but it does not sterilise it. Make sure bottles, lids and teats are facing downwards. You may prefer to wash teats separately by hand to make sure they are completely clean.

The advice about how to clean your baby's feeding equipment applies to all of the equipment, and whether you are using expressed breast milk or formula milk.

How to sterilise baby feeding equipment

There are several ways you can sterilise your baby's feeding equipment. These include:

cold water sterilising solution

steam sterilising

boiling

Cold water sterilising solution

Follow the manufacturer's instructions.

Leave feeding equipment in the sterilising solution for at least 30 minutes.

Change the sterilising solution every 24 hours.

Make sure there are no air bubbles trapped in the bottles or teats when putting them in the sterilising solution.

Your steriliser should have a floating cover or a plunger to keep all the equipment under the solution.

Steam sterilising (electric steriliser or microwave)

It's important to follow the manufacturer's instructions, as there are several different types of sterilisers.

Sterilising by boiling

Make sure the items you want to sterilise in this way are safe to boil.

Boil the feeding equipment in a large pan of water for at least 10 minutes, making sure it all stays under the surface.

Set a timer so you do not forget to turn the heat off.

Remember that teats tend to get damaged faster with this method. Regularly check that teats and bottles are not torn, cracked or damaged.

After you've finished sterilising

It's best to leave bottles and teats in the steriliser or pan until you need them.

If you do take them out, put the teats and lids on the bottles straight away.

Wash and dry your hands before handling sterilised equipment. Better still, use some sterile tongs.

Assemble the bottles on a clean, disinfected surface or the upturned lid of the steriliser.

Find out more about expressing breast milk and how to make up formula feeds.

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How to sterilise your baby's bottles and other feeding equipment safely and effectively, whether you're using boiling, steam or cold water sterilising equipment.

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Types of formula milk - NHS (www.nhs.uk)

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Formula milk, also known as baby formula or infant formula, is usually made from cows' milk that has been treated to make it more suitable for babies.
There's a wide range of brands and types of formula available in pharmacies and shops. Always check labels carefully to make sure you're buying a suitable milk for your baby.

Formula comes in 2 different forms: a dry powder you make up with water, or a ready-to-feed liquid formula. While ready-to-feed liquid formula can be convenient, it tends to be more expensive and, once opened, needs to be used more quickly.

Formula milk provides babies with the nutrients they need to grow and develop. However, it does not have the same health benefits as breast milk for you and your baby. For example, it cannot protect your baby from infections.

First infant formula (first milk)
Suitable from birth
First infant formula (first milk) should always be the first formula you give to your baby.

The cows' milk in formula contains 2 types of proteins - whey and casein. First infant formula is based on whey protein which is thought to be easier to digest than other types of formula.

Unless a midwife, health visitor or GP suggests otherwise, first infant formula is the only formula your baby needs. Your baby can stay on it when you start to introduce solid foods at around 6 months and drink it throughout their 1st year.

There's no evidence that switching to a different formula does any good or harm. However, if you think a particular brand of formula disagrees with your baby, talk to a midwife or health visitor. They can help you decide whether to try a different type.

When your baby is 1 year old, they can start to drink whole cows' milk or sheep's or goats' milk (as long as it's pasteurised).

Find out more about drinks to give your baby.

Goats' milk formula
Suitable from birth
Different kinds of goats' milk formula are available in pharmacies and shops. They are produced to the same nutritional standards as cow's milk-based formula.

Goats' milk formula is not less likely to cause allergies in babies than cows' milk formula.

Goats' milk formulas are not suitable for infants with cows' milk allergy (also known as cows' milk protein allergy), as the proteins they contain are very similar.

Hungrier baby formula (hungry milk)

Suitable from birth (but ask a midwife or health visitor for advice first).

This type of formula contains more casein than whey, and casein is harder for babies to digest.

Although it's often described as suitable for "hungrier babies", there's no evidence that babies settle better or sleep longer when fed this type of formula.

Anti-reflux (staydown) formula

Suitable from birth (but only under medical supervision).

This type of formula is thickened with the aim of preventing reflux in babies (when babies bring up milk during or after a feed).

Although it's available in pharmacies and supermarkets, it's recommended you only use it on the advice of a health professional.

The instructions for making up anti-reflux formulas may be different to standard formula. The usual guidelines for making up formula recommend using boiled water that has stood for no more than 30 minutes, so that the temperature is still above 70C.

Some manufacturers of anti-reflux formula recommend making it up at lower temperatures than are usually recommended. Otherwise it may get lumpy. Follow the instructions on the pack or speak to a health professional for advice.

It's important to take extra care when making up and storing these products as powdered formula is not sterile and making it up at lower temperatures will not kill any harmful bacteria it may contain.

Speak to a midwife, health visitor or GP if you have any concerns.

Comfort formula

Suitable from birth (but ask a midwife or health visitor for advice first).

This type of formula contains cows' milk proteins that have already been partly broken down (partially hydrolysed). This is supposed to make it easier to digest and help prevent digestive problems such as colic and constipation. However, there's no evidence for this.

Partially hydrolysed formulas are not suitable for babies who have cows' milk allergy.

Lactose-free formula

Suitable from birth (but only under medical supervision).

This formula is suitable for babies who are lactose intolerant. This means they cannot absorb lactose, which is a sugar that's naturally in milk and dairy products.

Lactose intolerance is rare in babies. Symptoms include diarrhoea, abdominal pain, wind and bloating.

Lactose-free formula is available in pharmacies and shops, but if you think your baby may be lactose intolerant, it's important to speak to a midwife, health visitor or GP.

Hypoallergenic formula

Suitable from birth (but only under medical supervision).

If your baby is diagnosed as being allergic to cows' milk, a GP will prescribe an appropriate infant formula with fully hydrolysed (broken down) proteins.

Formula with partially hydrolysed proteins (comfort formula) is available in pharmacies and shops, but it's not suitable for babies with cows' milk allergy.

Follow-on formula

Suitable from 6 months (but ask a health visitor for advice first).

Follow-on formula should never be fed to babies under 6 months old.

Research shows that switching to follow-on formula at 6 months has no benefits for your baby. Your baby can continue to have first infant formula as their main drink until they are 1 year old.

The labels on follow-on formula can look very similar to those on first infant formula. Read the label carefully to avoid making a mistake.

Good night milk

Suitable from 6 months (but ask a health visitor for advice first).

Some follow-on formula has cereal added to it and is sold as a special formula for babies to have at bedtime.

This type of formula is not needed, and there's no evidence that babies settle better or sleep longer after having it.

Good night formula should never be given to babies under 6 months old.

Soya formula

Suitable from 6 months (but only under medical supervision).

Soya formula is made from soya beans, not cows' milk. It's occasionally used as an alternative to cows' milk formula for babies who have cows' milk allergy.

There are some concerns about the fact that soya contains phytoestrogens. These are found naturally in some plants.

The chemical structure of phytoestrogens is similar to the female hormone oestrogen. Because of this, there are concerns that they could affect a baby's reproductive development, especially in babies who drink only soya-based infant formula.

Babies' low body weight means they take in much higher amounts of phytoestrogens than older children or adults who eat soya products as part of a varied and balanced diet.

Also, because soya formula contains glucose, so it is more likely to harm a baby's teeth.

Only use soya formula if it has been recommended or prescribed by a health visitor or GP.

Growing-up milk (toddler milk)

Suitable from 1 year (but ask a health visitor for advice first).

Growing-up and toddler milks are marketed as an alternative to whole cows' milk for toddlers and children over 1 year old. There's no evidence to suggest that these products provide extra nutritional benefits for young children.

Whole cows' milk is a suitable choice as a main drink for your child from age 1. Semi-skimmed cows' milk is a suitable main drink for children over 2 who are eating a balanced diet.

It's recommended that all children aged 6 months to 5 years have vitamin drops containing vitamins A, C and D every day.

See more about vitamins for children.

Types of milk to avoid

Not all milk is suitable for feeding babies. You should never give the following types of milk to a baby under 1 year:

condensed milk

evaporated milk

dried milk

goats' or sheep's milk (but it's fine to use them when cooking for your baby, as long as they are pasteurised)

other types of drinks known as "milks", such as soya, rice, oat or almond drinks

cows' milk as a drink (but it's fine to use it in cooking)

Further information

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Formula milk, also known as baby formula or infant formula, is usually made from cows' milk that has been treated to make it more suitable for babies. There's a wide range of brands and types of formula available in pharmacies and shops. Always check labels carefully to make sure you're buying a suitable milk for your baby.

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Formula milk: common questions - NHS (www.nhs.uk)

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How much formula does my baby need?

Newborn babies need quite small amounts of formula to start with. The amount will vary from baby to baby.

Although most babies settle into a feeding pattern eventually, they vary in how often they want to feed and how much they want to drink.

Feed your baby when they show signs that they want it. Babies tend to feed little and often, so they may not finish their bottle. Having a big feed does not mean your baby will go longer between feeds.

How do I know if my baby is getting enough formula?

Your baby's weight gain and the number of wet and dirty nappies will tell you whether your baby is getting enough formula.

Your baby should have around 6 wet nappies a day from a few days after the birth. Nappies should be wet with clear or pale yellow urine, or feel heavy.

For the first day or two after birth, your baby will pass a dark, sticky substance known as meconium. Within the first week your baby should start to pass pale yellow or yellowish brown poo. They should be having at least 1 poo a day.

Your baby will usually be weighed at birth and again in the first week. After that, healthy babies only need to be weighed at 8, 12 and 16 weeks, and again at 1 year.

This information should be entered on a chart in your personal child health record (PCHR) or "red book".

Read more about the personal child health record (red book) in Your baby's health and development reviews.

If you have any questions or concerns about your baby's weight gain, speak to a midwife or health visitor.

How will I know if my formula-fed baby is hungry?

After a while, you'll get to know the signs that show your baby is ready to feed.

For example, your baby may:

start to get restless

begin to turn their head and open their mouth (rooting)

find something to suck - usually their fist or fingers

Try to feed your baby before they cry, as this is a late sign of hunger.

What do I need if I'm formula feeding away from home?

If you need to feed your baby away from home, take with you:

a measured amount of formula powder in a small, clean and dry container

a vacuum flask of hot water that's just been boiled

an empty sterilised feeding bottle with cap and retaining ring in place

The vacuum flask does not need to be sterilised, but it should be clean, and only used for your baby. The boiling water should kill any bacteria present in the flask. If the flask is full and sealed, the water will stay above 70C for several hours.

Make up a fresh feed only when your baby needs it. The water must still be hot when you use it, to destroy any bacteria in the formula powder.

Remember to cool the bottle (with the lid on) under cold running water before you feed it to your baby.
Read more about how to make up baby formula
Alternatively, you could use a carton of ready-to-feed liquid formula when you're away from home.

What if I need to transport a made-up feed?

If it's not possible to follow the advice for formula feeding away from home, you should use a carton of ready-to-feed liquid formula.

But if you still need to transport a feed (for example, to a nursery), prepare the feed at home, cool under a running tap or in a bowl of cold water, and put it in the fridge to cool.

Make sure the feed is cold. Take it out of the fridge just before you leave and carry it in a cool bag with an ice pack, and use it within 4 hours. If you do not have an ice pack, or access to a fridge, the made-up infant formula must be used within 2 hours.

If the formula that you made up at home is stored:

in a fridge - use within 24 hours

in a cool bag with an ice pack - use within 4 hours

at room temperature - use within 2 hours

Can I use bottled water to make up infant formula?

Bottled water is not recommended for making up infant formula feeds for your baby. This is because it's not usually sterile and may contain too much salt (sodium) or sulphate.

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Information and advice on formula feeding, including how much formula to give your baby, how many wet nappies they should have and how to handle feeds away from home.

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Home | Breastfeeding Twins and Triplets

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Here at Breastfeeding Twins and Triplets UK we will answer all of these questions and more. We will try to put your mind at rest whilst being honest about journey on which you are about to embark. Breastfeeding more than one baby is challenging, but it is definitely possible and a lot of mums go on to have a really enjoyable experience.

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Successfully breastfeeding your premature baby - La Leche League GB

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You may be reading this because you have a preterm baby, or because you are expecting to deliver your baby before full term and you want to be prepared. Perhaps you're supporting someone who has recently had a preterm baby. Whatever your situation then we hope this information will help to get breastfeeding off to a successful start.

Before your baby arrives
Your premature newborn
Establishing breastfeeding
Looking after your own health and wellbeing
Taking your breastfed baby home

Before your baby arrives

If you know your baby will be arriving soon, you may wish to try antenatal expression of colostrum. This is where you hand express some of the thick, creamy first milk into a sterile container such as a syringe. This can be given to your baby immediately after birth reducing the possibility of them needing to have early formula feeds. Hypoglycaemia (low blood sugar) can cause serious long term health problems if left untreated, and preterm babies are at higher risk of low blood sugar than babies born at term. Having some colostrum ready means that this is available instead of formula (or donor milk if available).

If you are at risk of early labour and taking precautions to avoid it, then consult with your healthcare professionals about your individual case before starting antenatal expression as it may be considered to increase your risk of going into labour.
You can read more about antenatal expression here.

If there is time before your baby arrives, someone from the paediatric team on the neonatal unit where your baby will be cared for should come and talk to you about how you plan to feed your baby. You can supply them with any expressed colostrum you have in a labelled container, and discuss how you wish your baby to be fed while you are establishing your milk supply.

Some neonatal units will have access to donor breastmilk, and will be able to tell you if your baby will be eligible to receive this - as supply is limited, this is likely to be restricted to the babies who need it the most. They will discuss and get your consent if formula may need to be given while you are building your milk supply. This may also be the time to talk about how you want supplementary feeds to be given to your baby.

Smaller or weaker babies will be given a nasogastric tube, to allow milk (your own, donor or formula) to be fed down the tube. Bigger and stronger babies may be given bottles. You may wish to discuss paced bottle feeding (the art of giving bottle feeds in a way that supports breastfeeding) or cup feeding.

If you wish to express breastmilk for your baby, then your hospital should be able to provide you with a breastpump - asking for this before your baby is born means that you have it ready as early as possible. In the early days you need to be stimulating milk production in your breasts between eight and twelve times in twenty four hours, including at least once at night - this might be by your baby feeding effectively at the breast, or pumping sessions.

To read more about successfully expressing breastmilk, click here.

Your premature newborn

When you baby arrives there is likely to be a sudden rush of activity as your baby is checked and stabilised. They may be rushed off to the neonatal unit leaving you feeling stranded in the delivery unit. Be kind to yourself. You may feel that starting to express milk is a practical way that you can be involved in their care even when you are apart from each other. There is evidence to show that if you start expressing within the first hour after birth it can have a long term positive effect on your milk supply.

Establishing breastfeeding

You may be expressing on your ward (if you are still an inpatient) or on the neonatal unit. Many mothers find that being close to their babies while they are expressing can help to increase the amount that they are able to express. If you are separated, looking at photos of your baby can help or smelling something that has been close them.

If you are expressing on the unit, you may wish to be close to your baby as you do so. Some mothers use screens for privacy. You can ask for these to be provided. You don't have to use screens if you prefer not to - using scarves or nothing at all is a completely acceptable choice. Do what you feel comfortable with and helps your milk to flow easily. Listening to music may help you to relax and increase your milk production.

You are the person most known and familiar to your baby. Being with you is the safest and most secure they can possibly feel. If your baby is very fragile they may not be able to come out of their incubator at first. Ask the staff how you can be involved in their care and to show you how to hold and comfort them through the vents in the incubator. Once your baby is able to come out of the incubator, then kangaroo care can become an important part of your time together. This is where your baby is placed skin to skin on your chest for as long as possible and a blanket put over both of you. Your baby is able to enjoy the sensations of your closeness and the deep relaxation and comfort they feel helps them to regulate their breathing, temperature and other health indicators. It also helps your breast to become a familiar environment and allows them to practise feeding directly from the breast easily.

It used to be thought that babies under a certain gestation didn't have the ability to suck and swallow, or that directly breastfeeding was tiring to them. Happily, more recent studies have disproved these concerns. Once babies are well enough to breathe unaided (off ventilation and continuous positive airway pressure - CPAP), they can be brought to the breast. Smaller and younger babies will still need to have some of their milk given to them via tube feeds, but this allows you and your baby to learn to breastfeed together without a feeling of pressure.

Smaller babies have smaller mouths and lower muscle tone. This may mean you need extra support to get breastfeeding established. Seek skilled help early and often. Keep asking until you find someone who is able to support you effectively.

Premature babies often find it easier to feed in laid back breastfeeding positions. This is where you are supported in a reclined position with your baby tummy down on top of you. This helps gravity to 'stick' your baby to you and stops them slipping off. If you need to sit in a more upright position, then supporting the whole length of your baby's body close to yours with a hand behind their shoulders means they don't have to support their weight and stops them from curling in on themselves. Read more about laid back breastfeeding here.

You may find that your baby quickly falls asleep when breastfeeding. This isn't a sign that you are exhausting them, but that they are small and being soothed. You can help them to stay awake for longer by washing their face with cool water, gently blowing on them or tickling their feet. You may find that breast compressions - gently smoothing down your breast towards the nipple - helps your baby to stay alert and interested in feeding as this makes the milk flow more quickly and easily for them.

All new babies need to feed frequently - and premature babies are no different. The volume of milk that their stomachs can take at each feed is very small, and breastmilk is easily digested. It is normal for babies to feed between 8-12 times in a 24 hour period, including at least once at night.

Neonatal unit staff need to be able to ensure that all the babies in their care are receiving the right amount of milk for them to grow. Premature or sick babies may be less able to communicate their need for milk. These two things combined mean that units often use feeding schedules, with feeds timetabled every two, three, or even four hours.

When you agree how often your baby is to be offered supplemental feeds (any milk not directly from the breast) it may be helpful to remember that four hourly is less frequently than you would expect a healthy, full term newborn to feed. You may also choose to consider these as 'backup' feeds - any time spent feeding directly from the breast doesn't reset the clock, but is bonus extra calories. Keep writing down how often you are breastfeeding in your baby's notes, as this may help you and the staff to feel confident about the transition from scheduled, measured feeds, to baby led, responsive feeding.

One of the things the unit staff will look for in a baby coming close to going home is that your baby is able to rouse themselves to feed. If your baby is waking for feeds more often than their feeding 'schedule' (and you are spotting signs of effective feeding), this may be a sign that they are becoming better able to manage their own need for milk. You will probably need to keep offering more frequently than they ask for milk - this is true for many babies. Remember, you can't feed too often, and your baby can always say no if they don't want milk right now!

Breastmilk is an incredibly responsive food, made specially for each baby. The milk that you are making for your premature baby will be even more densely nutritious than the milk of a full term mother. Every drop of milk that you can supply for your baby is like medicine - strengthening and building their immune system and providing the calories they need to grow. Some mothers feel that providing milk for their babies is a unique way that they can care for their babies. It can be an important part of bonding with a new and fragile baby. While your baby will continue to benefit from your milk for as long as you provide it, you aren't tied to expressing for longer than you want to do so. If you decide it's time to stop, then gradually reducing your pumping sessions will slow and stop your milk production without causing problems for you.

Looking after your own heath and wellbeing

You will be recovering from pregnancy and birth, and may be experiencing additional health problems. It is important to remember to look after yourself - the more smoothly your recovery goes, the more strength and energy you will have to become more and more involved in your baby's care. If you have older children at home, you may be struggling to balance meeting their needs with being present with your newborn. Many mothers have to leave hospital long before their baby is ready to come home and have to travel back and forwards to be with their baby. This is a time to say yes to as many offers of help as you possibly can. If someone can provide a lift, deliver a meal, entertain an older child or do a load of washing - or just sit with you to talk things over in the hospital cafe - these may make life a little easier for you and help you to keep going at a difficult time.

You may be taking medications yourself and be concerned about them passing through your milk. Discuss your concerns with your and your baby's medical teams. They may be able to reassure you or find suitable alternatives. For specialist information about whether a drug is compatible with breastfeeding, you can contact your local LLL Leader who has access to resources and professional support.

It may feel impossibly painful to keep leaving your baby. Remember that by looking after yourself - eating, sleeping and taking the medication you need to get well - you are making sure that you carry on being able to be there to look after your baby.

Taking your breastfed baby home

Separately to any health issues your baby may be facing, your neonatal unit will want to know that you are able to make sure your baby is getting enough milk to continue growing. Being aware of your baby's early hunger cues is important so that you can feed responsively and before baby gets too upset. You may have a very sleepy baby who still needs your help to wake themselves up to feed beyond their due date. Setting an alarm for the middle of the night can help you to make sure they don't go for longer than a four hour stretch without feeding at night.

Read more about recognising early hunger cues and about waking a sleepy baby here.

Read more about how to tell if your baby is getting enough milk here.

Many breastfeeding mothers and babies enjoy safe cosleeping. Premature babies are at greater risk of Sudden Infant Death Syndrome or Sudden Unexplained Death in Infancy (SIDS/SUDI). While they will benefit from sleeping close to their mother, premature babies should sleep on a separate, firm surface such as a sidecar cot.

It can be scary to make the transition from caring for your baby in hospital with a team of staff around you, to being at home. Your healthcare professionals are likely to make extra visits to support you and to keep an eye on your baby's weight gain. You may find that being home together, able to stay together all the time, and in a comfortable environment, you rapidly get to know and understand your baby more easily and become more confident in your mothering skills.
Photo credits: Olivia Brown and other mothers
Other resources

You can read a mother's story about mothering her premature baby through special care

This video looks at breastfeeding in the first hour after birth

The drugs in breastmilk service, while not an LLL resource, gives quick access to information from a qualified pharmacist

The Small Wonders films follow families through their experiences of having a baby on a neonatal unit

Global Health Media have a series of videos about various aspects of life with a small baby

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Successfully breastfeeding your premature baby - La Leche League GB

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You may be reading this because you have a preterm baby, or because you are expecting to deliver your baby before full term and you want to be prepared. Perhaps you're supporting someone who has recently had a preterm baby. Whatever your situation then we hope this information will help to get breastfeeding off to [...]

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inourplace | Solihull Approach - Online courses for emotional health and wellbeing.

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inourplace | Solihull Approach | Online courses for parents

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inourplace | Solihull Approach : Online courses dedicated to improving emotional health and wellbeing in parents, children, teenagers, adults and grandparents.

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Breastfeeding your premature baby - NHS (www.nhs.uk)

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Your breast milk is important to your baby at any age. Giving your premature baby your breast milk benefits their health as well as yours.
Breast milk:

helps protect your baby from infections, particularly of their gut - premature babies are more likely to get infections

contains hormones, nutrients and growth factors that help your baby to grow and develop

is easier for your baby to digest than formula milk, because it's human milk specially designed by your body for your baby

See other benefits of breastfeeding.

If your baby is very small or sick, they may not be able to breastfeed from your breast at first. But you can start regularly collecting your breast milk (called expressing) as soon as possible after your baby is born.

This will help get your milk supply going and the milk you express can be frozen so you can give it to your baby later. Then you can start breastfeeding from the breast once you and your baby are ready.

Even if you were not planning to breastfeed, you could express your breast milk for a while to help boost your baby's immune system in the early weeks after birth.

Spending lots of time close together with your baby can help boost your breast milk supply and establish breastfeeding.

Skin-to-skin contact with your premature baby

If your baby is well enough, you'll usually be encouraged to spend time holding them against your skin as soon as possible. This is sometimes called kangaroo care.

Your baby will usually be dressed just in a nappy, hat and socks and then placed inside your top, under a blanket, or in a soft sling so they can be held securely against your skin. If it's cold outside, you can also put them in a sleeveless vest with an open neck.

This skin-to-skin contact helps you feel close to your baby. Your partner can enjoy this kind of contact as well.

For your premature baby, skin-to-skin contact:

reduces stress and pain

promotes healthy weight gain

helps to establish breastfeeding

helps them sleep better

helps to regulate and support their heart rate and breathing

For mums, skin-to-skin contact:

helps reduce your chance of developing postnatal depression

increases your confidence as a new parent

can help make breastfeeding easier and increase the amount of milk you make

For dads and partners, holding your baby skin to skin:

helps you bond with your baby - babies can hear both parents' voices in the womb and will be calmed by the sound of your voice as well as their mum's

helps you feel more confident as a parent

Expressing milk if your baby is premature

It's recommended you express often, ideally at least 8 times a day to begin with - including at least once at night - to keep your milk supply up.

In the early days, it's often easier to express your milk by hand. Your midwife or a breastfeeding supporter can show you how.

You'll probably only express a few drops to begin with but, if you hand express often, this will increase. Even if you are only expressing a small amount it will still help your baby.

In the early days you can collect your breast milk in a small, sterile cup and store it in a syringe.

Once you are producing more milk, you could try using a breast pump. If your baby is in a neonatal unit, the hospital will usually be able to lend you an electric breast pump for expressing your milk. If they cannot lend you one, you can hire one.

Read more about breastfeeding help and support to find out about hiring a pump, or phone the National Breastfeeding Helpline on 0300 100 0212.

The staff, your midwife or a breastfeeding supporter can give you advice about how to increase your milk supply. They can also show you how to encourage your milk to flow and how to use a breast pump.

Always ask for help early if you have any worries or questions.

Tube feeding your baby

Babies do not normally learn to co-ordinate the sucking, swallowing and breathing needed for feeding until about 34 to 36 weeks of pregnancy.

If your baby is born before this time, they may need to have breast milk through a feeding tube to begin with. This goes through their nose or mouth into their stomach. The staff in the neonatal unit can show you how to feed your baby this way.

Babies who are very premature or sick may need to be fed through an intravenous (IV) line to begin with. A fluid containing nutrients is fed straight into your baby's vein.
The Bliss website has more information and advice about tube feeding

Using donor breast milk

Some hospitals can provide donated breast milk for your baby to have until your own supply is established.
See the United Kingdom Association for Milk Banking (UKAMB) website for more information about donor breast milk
If donor breast milk is not available, your baby can have formula milk until you're producing enough breast milk.

It's recommended you do not buy donor milk over the internet. This is because the source cannot be confirmed and you cannot be sure whether the donor or the milk has been screened for infections.

Moving on to breastfeeding your premature baby

While holding your baby, you may notice them try to move towards your breast. Gradually, as they develop and get stronger, they will be able to breastfeed directly.

The first time you try it, the hospital staff may ask you to express first, then put your baby to your breast. This is so your baby is not overwhelmed when your milk lets down.

At first, your baby may only lick the breast, then next time take a few sucks until they gradually become happy and confident feeders.

You can combine tube feeding with breastfeeding until your baby is getting everything they need from the breast only.

Using a lactation aid (supplementer)

You could also consider using a lactation aid. This is a way of supplementing your baby's breastfeeds with either expressed breast milk or formula.

A tiny tube is taped next to your nipple so your baby can get milk through the tube as well as from your breast while attached to your breast. This helps to support your baby as they get used to attaching to the breast.

Got a breastfeeding question?

Sign into Facebook, or use an Amazon Alexa or Google Home and use the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

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Find out about breastfeeding your premature baby, including using expressed breast milk to start with before moving onto feeding them directly from the breast.

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Mothering through special care - La Leche League GB

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Rebecca's second son was born early, and spent several weeks in Special Care. Here she writes of that difficult early time, and of learning to balance her fragile newborn's needs with those of her older child.
Throughout my first pregnancy I felt like some sort of earth goddess woman - strong and beautiful, powerful and confident in my body. I felt powerfully attached to the tiny being inside me from a very early stage, and he was born at home, without complications.

When I became pregnant again, I looked forward to repeating the experience. I found it much harder this time, though. I was working almost full time, commuting longer distances, and mothering a two year old (who was adjusting to having daddy at home and mummy out at work). I was exhausted and full of fears - what if I wasn't up to having two children? How could I possibly ever love another child as much as I love my firstborn? If I love him so much, how can he wind me up so much? What if I can't cope at home again? What if our finances meant I had to go back to work early?

My body was struggling too. My knees and hips felt a million years old. Trudging up the hill to our house at the end of each work day I felt I was almost going so slowly that I was in reverse. I had terribly swollen feet and had to get special permission to wear sandals at work as they were the only shoes that would fit. At about 32 weeks pregnant I started to get a pain in my chest which I assumed must be heartburn (well, I knew it wasn't a heart attack and everyone knows pregnant women get heartburn, right?).

As soon as I arrived at the hospital it was clear I did have pre-eclampsia, and the midwives and doctors immediately started working to stabilise me as an anaesthetist gave me all the information I would need to consent to a caesarean section. The plan was to keep me pregnant long enough to give me two doses of steroids twelve hours apart to mature the baby's lungs, but to be ready to operate earlier if it became necessary.

After a night of very little sleep and lots of monitoring, I got the news that I was stable enough to attempt induction instead of going straight to a c-section. I wasn't as delighted as I expected to be.

Fortunately, nature kicked in and labour went quickly. My room had big windows and I was able to look out at a beautiful panorama of sky and hills. In between contractions and in a haze of hormones (natural and synthetic), exhaustion and gas and air, I attempted to explain to my husband that I was one with the hills, in giving birth I was part of them and every woman and animal mother that had ever roamed them. Sensibly, he did not press me for details.

Twenty four hours after arriving in hospital expecting it all to be a false alarm I had delivered a 4lb baby boy at 33+2 gestation. The first I saw of him was a tiny hand sticking in the air and at that moment the love for him hit me like a wave - he was mine and he was perfectly so. Within seconds he was away from me, on a Resuscitaire being assessed and stabilised. After a few minutes he was brought to me for a brief cuddle and then he was gone, off to the Special Care Baby Unit, and I was stranded on Labour and Delivery, still unwell and unable to walk or visit him until the next morning.

Thankfully, even though he was so little, Fergal seems to have escaped with no long term harm from his early start. He spent three weeks in SCBU. The earliest days were hardest. The staff felt strongly that babies needed to be in their incubator as much as possible to allow them to rest, but I felt that the best place for him was on my chest. He was too weak and sleepy to be able to gain much of his nutrition from direct breastfeeding and had expressed milk via a naso-gastric tube. Also the staff felt that I should not put him to the breast at every feed as the effort to nurse would tire him out. But I felt that the benefit of being at the breast would more than outweigh the calories he expended there.

I was still quite ill myself and had to trek back and forth between my ward and SCBU as well as keep up with expressing regularly. With lots of support from my LLL family I was able to gently increase the amount of time he spent in my arms and feel confident that I was doing the right thing keeping on encouraging him to nurse. He would feed a bit, sleep a bit, feed a bit more and then we would guess how much milk to top him up with via the tube.

After twelve days, I was discharged. Although it was terrible to walk away from my baby, get in a car and drive off leaving him miles away from me, in some strange ways I had more time with him. I would get up early, get to the hospital in the early morning before the traffic and spend the day there, no need to be anywhere else. I would get home for tea time, spend a little time with our older son and put him to bed.

I spent a lot of time with Fergal asleep on me - I'm not sure if staff just got used to my ways or they relaxed as he got a little older and bigger. I would watch closely for any hunger cues and encourage him to feed. At each nappy change I would make sure I washed his face. This was the best way to wake him up and increase the chance of him breastfeeding, even a little. At nearly three weeks old, the NG tube was removed and Fergal was receiving his overnight feeds by cup so as not to interfere with breastfeeding. He took well to this and continued to grow, possibly because of my decision to interpret any signs of wakefulness as being a hunger cue and see if he would feed.

Breastfeeding such a tiny baby was a strange experience. His mouth was so tiny and his suck was barely noticeable. He would drift in and out of sleep, but once he got going his little jaw would work away busily and a dark eye gaze intently at me. He clearly knew what he was doing and was ready to follow his instinct.

After a week of commuting, I arrived one morning to be told that Fergal had been very unsettled overnight and had spent a lot of time awake and crying. Could I stay that night and see how demand feeding went, and if all went well take him home tomorrow or the next day? I skipped out to buy a toothbrush and spare pants and a few hours later was in a side room, alone with my baby for the first time.

My older son was coping amazingly well with his first overnight separation from me. He found visiting the hospital stressful, though, as it was quite a distance from home and each time he came in he had to leave me there again. He came in every few days, and because he was still breastfeeding he was a great help to me in establishing a good milk supply. My husband was kept busy looking after him (with support from my parents who came to stay) and coming backwards and forwards to see me and the baby.

Although I had expected to be a confident second time mum, the three weeks in SCBU had institutionalised me a bit. There is a routine in SCBU: hand washing and alcohol gel, no walking around carrying your baby (you have to push the cot if you want to move them), set times to change nappies and exact volumes for feeds based on weight. After one night semi -supervised, we (my husband and I) were solely responsible for the wellbeing of a baby who still weighed less than five pounds.

Fergal is now seven months old. He still sleeps a lot, but enjoys a few hours awake at a time. He smiles and shakes his hands with excitement, loves to be talked to and will gurgle back at you happily. He can cope with lying down much better now. Although you'd better listen out for the gurgles changing from contentment to alarm or there will be second hand milk everywhere. He feeds intensely and efficiently, deep blue eyes gazing up at me. Prematurity comes with many fears but steadily we are working through the possible problems, and thankfully all tests have come back clear. Fingers crossed, I think we're in the clear. We are adapting to life as a family of four.

It has some challenging moments/ days/weeks as our three year old gets used to being a big brother, but we're surviving and loving our completed family, together at last.

Rebecca Coyle, LLL Calderdale
This story was originally published in issue 207 ofBreastfeeding Matters (May/ June 2015)
Copyright LLLGB

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Mothering through special care - La Leche League GB

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Rebecca's second son was born early, and spent several weeks in Special Care. Here she writes of that difficult early time, and of learning to balance her fragile newborn's needs with those of her older child. Throughout my first pregnancy I felt like some sort of earth goddess woman - strong and beautiful, powerful and [...]

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Breastfeeding | Bliss

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Breastfeeding has lots of benefits for you and your baby. As well as the health benefits of breast milk for your baby, breastfeeding is a good way to have skin-to-skin contact with your baby, which can help you and your baby to get to know each other.

Your baby may not be ready to breastfeed as soon as they are born. They may not be well enough or strong enough to breastfeed. Some babies who are born at term and sick may find it more difficult to breastfeed because of surgery or difficulties swallowing. Some babies with breathing or heart problems may also have difficulties coordinating breathing and feeding.

If your baby is very premature or sick, they may have to be fed using parenteral nutrition (PN) and/or tube feeding before they are well enough to breastfeed. We have more information about the signs a baby being tube fed may show if they are ready for breast or bottle feeding.

You can still provide breast milk for your baby if they are unable to breastfeed by using a technique called expressing. We have more information about expressing.

Sometimes premature babies need more nutrients than you can provide in your breast milk. If this is the case, your baby's doctor may prescribe a breast milk fortifier (which is usually a powder made from cow's milk) which can be added to breast milk. This can help with growth and bone development.

Some parents may feed their baby through a combination of breastfeeding and bottle feeding. This is often known as mixed or combination feeding. It is recommended that your baby, if possible, establishes breastfeeding before introducing another type of feeding. Combination feeding may be used if there are problems with breastfeeding, such as there not being enough breastmilk, or for other reasons. If you are thinking about mixed or combination feeding, talk to your neonatal team, feeding specialist, midwife, health visitor or GP.

Staff on the neonatal unit may recommend that your baby is fed your breast milk using cup feeding. They might suggest this if your baby is looking to feed but cannot latch onto the breast or is separated from the mother for any reason. If you are unsure, speak to the staff on the neonatal unit.

If you decide not to breastfeed your baby, it is very important that you are given information about the other options that are available. Your baby can still get many benefits of breastmilk if you express. Talk to your midwife, neonatal nurse or health visitor about how you are feeling and how they can support you.

The let-down reflex

Each time you breastfeed your baby, you may notice tingling or prickling in your breasts and nipples, or a feeling as if the milk is rushing in to fill them. This is called the let-down reflex (it is sometimes called the milk ejection reflex). During the let-down reflex, a hormone called oxytocin is released, which helps with milk flow. At first, this takes a few minutes to be released, but later it will happen within a few seconds.

The let-down reflex feels different to different women. Some women describe a slight pain and some have no sensations at all. Your body may respond to certain things you do, which can trigger your let-down reflex. For example, it is normal for the let-down reflex to happen in response to having a warm bath or shower, or to breast massage. It can also happen in response to being close to your baby, hearing your baby cry or having a picture or something close by that smells of them.

Staying as relaxed as possible and having skin-to-skin contact with your baby can all help to trigger the let-down reflex. Taking some deep breaths and concentrating on your breathing can also help.

How do I start to breastfeed my baby?

You may not know where to start with breastfeeding your baby, especially if your baby has previously been tube fed. A nurse, midwife or feeding specialist (such as an infant feeding coordinator) on the neonatal unit will be able to support you.

Both parents can be involved in breastfeeding, and other people close to you can also provide encouragement and support, such as grandparents. Having as much support as possible can help ensure that you continue to breastfeed when you go home from the neonatal unit. It might be helpful to talk about how you are going to approach breastfeeding with your partner, and how they can best support you. The NHS website has more information about how dads and partners can support breastfeeding, and signposts to more support that is available.

It is important to recognise the signs that your baby is hungry (feeding cues) before breastfeeding. Early feeding cues might include putting their fingers into their mouth, making sucking motions (rooting) and becoming restless.

What breastfeeding positions should I try?

When you are on the neonatal unit, a healthcare professional such as a neonatal nurse or midwife should support you to try to breastfeed your baby. They will help you to find feeding positions that are most comfortable for you. There are positions that may be more suitable for mothers who have had surgery, or whose baby was born premature or sick. Unit staff may recommend that you use pillows to support your arms or back.

If you have twins or multiples, you may also need more support with pillows when feeding, so that you are more comfortable and your babies are supported. Some mothers benefit from a hard pillow that ties at the back or a sling. It can be daunting at first to hold multiple babies at once, but staff in the neonatal unit will help with this. Twins Trust have some more information about breastfeeding multiples that you may find useful.

I am having difficulties getting my baby to breastfeed and latch on. Why is this?

As with all newborn babies, some find breastfeeding easier than others. This can depend on factors such as your baby's age, maturity and any medical conditions they have. It is normal for babies who are born premature or sick to take slightly longer to establish breastfeeding than babies born at term. Every baby is different, and it is important to ask for help and support, especially when you start.

There are some common problems that parents experience when starting breastfeeding. Some babies born premature can be too sleepy to feed effectively, and it can be difficult to get the right position for feeding when your baby is so small. We have a page that lists common problems you may have when breastfeeding or expressing milk for your baby and what can help.

For some mothers, it can take a while to gain confidence in breastfeeding. This is normal, even if you have breastfed before. Having a baby born premature or sick is a unique experience and it is okay to find things difficult at times. Having plenty of support around you can help you build up confidence. We have more information about support you can get with breastfeeding below.

Where can I get help and support with breastfeeding?

Many parents find breastfeeding a rewarding, empowering experience. But establishing breastfeeding can be challenging at times. It can be tiring, especially when you are travelling to and from the unit, and some mothers experience discomfort when they are starting to breastfeed. There are many places where you can get help and support.

Most parents find that having lots of support helps them to get started and to continue to breastfeed. Support can come from your partner, family and friends, and from medical professionals on the unit and at home.

Support on the unit could come from your unit's feeding specialist, a neonatal nurse, or your midwife. Some neonatal units also have a lactation consultant or feeding specialist, who are trained to help parents who are having problems with breastfeeding and expressing.

If you are at home, support with breastfeeding could come from your health visitor, a community neonatal nurse, if you have one, or your GP. You can talk to your health visitor for more information about any breastfeeding support groups in your area. It is always important to speak up and ask if you need more help and support, or if you have questions.

There are also helplines and organisations that can help:

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Breastfeeding has lots of benefits for you and your baby. As well as the health benefits of breast milk for your baby, breastfeeding is a good way to have skin-to-skin contact with your baby, which can help you and your baby to get to know each other.

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Expressing | Bliss

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Expressing milk can take time to learn. Find out how to express in neonatal care and how to look after yourself while expressing.

Expressing means collecting breast milk which you can store and feed to your baby later. You can express milk by hand or with a breast pump, which can be electric or manual.

Expressing can be helpful:

If your baby is not well enough or strong enough to feed from the breast straight away

So that both partners or others are able to share feeding

If you are too sick to feed your baby from the breast

If you cannot be near your baby and want to establish a good milk supply

If your baby has difficulty latching on to the breast, but you still want to give them your breast milk.

If your baby is not able to breastfeed straight away, the staff at the hospital will help you to express (collect) your breast milk as soon as possible after your baby is born. This means that your baby will still get the benefits of breast milk until they are ready to feed from the breast or bottle, as it can be given to them by a feeding tube.
It is important to express in the way that is most comfortable and convenient for you.
A small amount of milk is produced in the first few days after a baby is born. This milk is called colostrum, and is often thicker and more yellow in colour than breastmilk. Colostrum is really important for your baby. It helps to boost your baby's immune system, protect them from infections and helps them grow.

Some parents are worried that they are not producing enough milk in these first few days. This is normal - most parents start by expressing less than 1ml of milk at a time. This will increase gradually the more times you express. Around two to four days after giving birth, you will notice your milk becoming more white and your breasts might feel fuller. This is often referred to as your milk 'coming in'.

Later on, the amount of milk you express may change depending on the time of day and how you feel.

After expressing your milk, the milk can be kept in the fridge or be frozen and stored until your baby is ready to have feeds. We have some more information about how to store breast milk at the bottom of this page.

Your milk is best suited to your baby's needs, but sometimes premature or sick babies need more nutrients than are provided in breastmilk alone. If this is the case for your baby, your baby's doctor may prescribe a preterm fortifier (which is usually a powder made from cow's milk) to go in your milk. This will provide more nutrients that will help with your baby's growth and bone health.

Many parents tell us that expressing can feel like a big pressure. It is important not to be too hard on yourself if you are not able to express a lot of milk in the early stages. No matter how much or how little you can express, your baby will benefit.

Many parents find comfort in expressing as it is something positive and important they can do for their baby. Try not to compare the amount you are expressing with others, as they may have faced different challenges or situations to you.

Expressing breast milk can also take time to learn. The staff looking after your baby will give you support and practical help with this. Speak to your neonatal nurse, feeding specialist or midwife for more support.

In this section, we have more specific information about:

If you have any questions about expressing or are not sure what to do, you should always ask questions or seek more support. Most units will provide specific support with expressing, and your neonatal nurse will be happy to help with any questions that you have.

How often should I be expressing milk for my baby?

It is important to start expressing milk as soon as possible after your baby is born - ideally within two hours. It is recommended you express frequently to keep your milk supply up. To begin with, this is around eight to ten times in 24 hours, including at least once at night. This is because breast milk is produced on a demand and supply system, so you are likely to produce less milk overall if long periods of time are left between expressing.

In time you will find what works best for you. You may find that your milk flow responds to a fixed routine and will trigger a let-down reflex (see below), which will make it easier to express. This might include actions when you prepare to express, such as removing equipment from the steriliser, or putting the pump together.

The let-down reflex

When you express milk, you may notice tingling or prickling in your breasts and nipples, or a feeling as if the milk is rushing in to fill them. This is called the let-down reflex (it is sometimes called the milk ejection reflex). During the let-down reflex, a hormone called oxytocin is released, which helps with milk flow. This takes a few minutes to appear at first, but later it will happen in a few seconds.

The let-down reflex feels different to different women. Some mothers describe a slight pain and some mothers have no sensations at all. Your body may respond to certain things you do, which can trigger your let-down reflex. For example, it is normal for the let-down reflex to happen in response to having a warm bath or shower, or to breast massage (see below). It can also happen in response to being close to your baby, hearing your baby cry or having a picture or something close by that smells of them.

Staying as relaxed as possible and having skin-to-skin contact with your baby can all help to trigger the let-down reflex. Taking some deep breaths and concentrating on your breathing can help with this. It will also help to express at your baby's cotside if this is possible, so you can be close to your baby. Speak to the staff looking after your baby about this.

Gentle breast massage

Breast massage before expressing can help to trigger the let-down reflex and stimulate your milk flow. You can do this by gently stroking, rolling, kneading, and tapping your breasts with warm hands before hand expressing and/or using a breast pump. You should do this for at least two minutes. Breast massage during expressing can help to drain your breasts.

Looking after yourself when expressing

Expressing milk for your baby can be a great way for parents to feel more empowered and in control of their baby's care. Many mothers also tell us how difficult and exhausting it can be to express, especially at night. This can be a particularly difficult experience if their baby is not with them.

It can be a very stressful time, but it is important that you try to stay as relaxed as possible when expressing, as this helps with the let-down reflex and milk flow. Some research has shown that higher stress levels may contribute to the delay of milk production. Some parents find that having a photograph or something that smells of their baby nearby when expressing helps. It may also help to distract yourself by doing something like reading a book or watching TV when you express. Listening to soothing music, meditation or taking time to focus on your breathing may also help you to relax.

Partners can help with expressing. For example, they can offer encouragement, help you to relax, or get equipment ready.

It is not unusual to find feeding your baby a difficult experience. In our survey of over 100 parents, over 60% said that their mental health got slightly or significantly worse during the experience of feeding their premature or sick baby. It is okay to find the experience difficult, no matter your situation. Every parent will have a very different experience of neonatal care.

It is important to talk to someone if feeding your baby is having an impact on your mental health. This could come from your feeding specialist, neonatal nurse, midwife, doctor, partner, or friends and family. We have lots of information about the impact having a premature or sick baby can have on your mental health, and where you can get support.

How to store expressed milk safely

You can store milk if your baby is unable to drink it at the time it is expressed. It is very important that expressed milk is stored safely. This is something that partners can be involved with. On the neonatal unit, breast milk is stored in fridges and freezers that only store infant milk.

Many units supply sterile disposable bottles and labels for you to use. You should label each container with your baby's name, the date and time of collection.

If you will be using your breast milk within 48 hours of expressing, you should refrigerate it. If you are at home, breast milk that has recently been expressed will keep in a refrigerator for 48 hours (24 hours if it is defrosted). The breast milk should be stored at the back of the fridge and not in the fridge door. This is because the temperature in the door compartments goes up and down when the fridge is opened and closed.

If you will not be using your breast milk within 48 hours of expressing, it should be frozen. Milk can be frozen for up to 6 months in a home freezer. If you are freezing your milk, always leave at least one centimetre of free space at the top of the milk container. This is because milk will expand when frozen.

If you are on the neonatal unit, ask the unit staff about the best way to safely refrigerate and freeze milk. Different units may have different guidelines.

Once your milk is defrosted, it will need to be used within 24 hours. Try to use small containers to freeze your milk so that no milk is wasted. Defrosted milk may have a slightly soapy or sour smell, but this will not be harmful to your baby.

Fortified b reast milk that has been supplemented with addi tives should be used with the following one to two feeds. It is not suitable f or freezing and defrosting.

Talk to the hospital staff looking after your baby for more guidance on storing and defrosting breast milk.

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Expressing milk can take time to learn. Find out how to express in neonatal care and how to look after yourself while expressing. Expressing means collecting breast milk which you can store and feed to your baby later. You can express milk by hand or with a breast pump, which can be electric or manual.

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Foreign language resources - Baby Friendly Initiative (unicef.org.uk)

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Using straightforward language and simple illustrations to aid understanding, these infosheets on breastfeeding and bottle feeding are available in multiple languages and can be used to support parents with the basics of feeding and responding to their baby.

The infosheets are free to download and print, and are currently available in:
Please note: Following feedback, these translations were updated in 2019 to ensure the language used was as straightforward as possible.
The English versions of these resources are available below for reference:

Breastfeeding guidance: English (for reference)

Bottle feeding guidance: English (for reference)

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Foreign language resources - Baby Friendly Initiative

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These infosheets are available in multiple languages and can be used to support parents with feeding and responding to their baby.

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Support in languages other than English - La Leche League GB

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LLLGB resources

LLLGB breastfeeding information in Welsh is now available on our website.
Bwydo ar y fron
Hanfodion bwydo ar y fron
A yw fy mabi'n cael digon o laeth?

Our Leaders offer support to Mums in the following languages:
Afrikaans, Bemba, British sign language, Croatian, English, French, German, Gujarati, Hebrew, Hungarian, Italian, Polish, Portuguese, Spanish, Swahili, Welsh.

We are in contact with LLL Leaders around the world, and can access online support in many languages.
If you would like to access support in a language other than English, please contact our Administration Department and we will try to help you.

LLL Europe resources

You can also find articles, information and support on the LLL Europe website - it has contact details and links to LLL in 21 countries.

LLLI resources

LLLI's international online magazine Breastfeeding Today has translations of many articles in Spanish, German, French and Russian with articles in other languages coming soon.

For more information about LLLI click here.

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Support in languages other than English - La Leche League GB

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LLLGB resources LLLGB breastfeeding information in Welsh is now available on our website. Bwydo ar y fron Hanfodion bwydo ar y fron A yw fy mabi'n cael digon o laeth? Our Leaders offer support to Mums in the following languages: Afrikaans, Bemba, British sign language, Croatian, English, French, German, Gujarati, Hebrew, Hungarian, Italian, Polish, Portuguese, Spanish, Swahili, [...]

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BfN Supportline in Bengali/Sylheti: 0300 456 2421

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BfN Supportline in Bengali/Sylheti: 0300 456 2421

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Breastfeeding support available for Bengali and Sylheti speakers. If a volunteer is not available to take your call, a message can be left and someone will get back to you. Lines are open 9:30 am to 9:30 pm, 7 days a week.

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Bury St Edmunds Breastfeeding Support Group

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Bury St Edmunds Breastfeeding Support Group

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New ECC Infant Feeding Peer Support Group