# data[].attributes.attachment_link.readable_text
By Kelly Bonyata, BS, IBCLC

How much milk do babies need?

Many mothers wonder how much expressed breastmilk they need to have available if they are away from baby.

In exclusively breastfed babies, milk intake increases quickly during the first few weeks of life, then stays about the same between one and six months (though it likely increases short term during growth spurts). Current breastfeeding research does not indicate that breastmilk intake changes with baby's age or weight between one and six months. After six months, breastmilk intake will continue at this same level until - sometime after six months, depending in baby's intake from other foods - baby's milk intake begins to decrease gradually ( see below).

Now infants can get
all their vitamin D
from their mothers' milk;
no drops needed with
our sponsor's
TheraNatal Lactation Complete
by THERALOGIX. Use PRC code "KELLY" for a special discount!

The research tells us that exclusively breastfed babies take in an average of 25 oz (750 mL) per day between the ages of 1 month and 6 months. Different babies take in different amounts of milk; a typical range of milk intakes is 19-30 oz per day (570-900 mL per day).

We can use this information to estimate the average amount of milk baby will need at a feeding:

Estimate the number of times that baby nurses per day (24 hours).

Then divide 25 oz by the number of nursings.

This gives you a "ballpark" figure for the amount of expressed milk your exclusively breastfed baby will need at one feeding.

Example: If baby usually nurses around 8 times per day, you can guess that baby might need around 3 ounces per feeding when mom is away. (25/8=3.1).

What if baby is eating solid foods?

Sometime between six months and a year (as solids are introduced and slowly increased) baby's milk intake may begin to decrease, but breastmilk should provide the majority of baby's nutrition through the first year. Because of the great variability in the amount of solids that babies take during the second six months, the amount of milk will vary, too. One study found average breastmilk intake to be 30 oz per day (875 ml/day; 93% of total intake) at 7 months and 19 oz (550 ml/day; 50% of total energy intake) at 11-16 months.

Several studies have measured breastmilk intake for babies between 12 and 24 months and found typical amounts to be 14-19 oz per day (400-550 mL per day). Studies looking at breastmilk intake between 24 and 36 months have found typical amounts to be 10-12 oz per day (300-360 mL per day).

Is baby drinking too much or too little expressed milk?

Keep in mind that the amount of milk that baby takes at a particular feeding will vary, just as the amount of food and drink that an adult takes throughout the day will vary. Baby will probably not drink the same amount of milk at each feeding. Watch baby's cues instead of simply encouraging baby to finish the bottle.

If your baby is taking substantially more than the average amounts, consider the possibility that baby is being given too much milk while you are away. Things that can contribute to overfeeding include:

Fast flow bottles. Always use the lowest flow bottle nipple that baby will tolerate. Even with a slower flowing nipple, it is important to pace the bottle feed to allow baby to better control his intake.

Using bottle feeding as the primary way to comfort baby. Some well-meaning caregivers feed baby the bottle every time he makes a sound. Use the calculator above to estimate the amount of milk that baby needs, and start with that amount. If baby still seems to be hungry, have your caregiver first check to see whether baby will settle with walking, rocking, holding, etc. before offering another ounce or two.

Baby's need to suck. Babies have a very strong need to suck, and the need may be greater while mom is away (sucking is comforting to baby). A baby can control the flow of milk at the breast and will get minimal milk when he mainly needs to suck. When drinking from a bottle, baby gets a larger constant flow of milk as long as he is sucking. If baby is taking large amounts of expressed milk while you are away, you might consider encouraging baby to suck fingers or thumb, or consider using a pacifier for the times when mom is not available, to give baby something besides the bottle to satisfy his sucking needs.

If, after trying these suggestions, you're still having a hard time pumping enough milk, see I'm not pumping enough milk. What can I do?

If baby is taking significantly less expressed milk than the average, it could be that baby is reverse-cycling, where baby takes just enough milk to "take the edge off" his hunger, then waits for mom to return to get the bulk of his calories. Baby will typically nurse more often and/or longer than usual once mom returns. Some mothers encourage reverse cycling so they won't need to pump as much milk. Reverse cycling is common for breastfed babies, especially those just starting out with the bottle.

If your baby is reverse cycling, here are a few tips:

Be patient. Try not to stress about it. Consider it a compliment - baby prefers you!

Use small amounts of expressed milk per bottle so there is less waste.

If you're worrying that baby can't go that long without more milk, keep in mind that some babies sleep through the night for 8 hours or so without mom needing to worry that baby is not eating during that time period. Keep an eye on wet diapers and weight gain to assure yourself that baby is getting enough milk.

Ensure that baby has ample chance to nurse when you're together.

Other ways of estimating milk intake

There are various ways of estimating the amount of milk intake related to the weight of the baby and the age of the baby, based upon formula intake - research has shown that after the early weeks these methods overestimate the amount of milk that baby actually needs. These are the estimates that we used for breastfed babies for years, with the caveat that most breastfed babies don't take as much expressed milk as estimated by these methods. Current research tells us that breastmilk intake is quite constant after the first month and does not appreciably increase with age or weight, so the current findings are validating what moms and lactation counselors have observed all along.

More:

References

Onyango, Adelheid W., Receveur, Olivier and Esrey, Steven A. The contribution of breast milk to toddler diets in western Kenya. Bull World Health Organ, 2002, vol.80 no.4. ISSN 0042-9686.

Salazar G, Vio F, Garcia C, Aguirre E, Coward WA. Energy requirements in Chilean infants. Arch Dis Child Fetal Neonatal Ed. 2000 Sep;83(2):F120-3.

Kent JC, Mitoulas L, Cox DB, Owens RA, Hartmann PE. Breast volume and milk production during extended lactation in women. Exp Physiol. 1999 Mar;84(2):435-47.

Persson V, Greiner T, Islam S, and Gebre-Medhin M. The Helen Keller international food-frequency method underestimates vitamin A intake where sustained breastfeeding is common. Food and Nutrition Bulletin, vol.19 no.4. Tokyo, Japan: United Nations University Press, 1998.

Cox DB, Owens RA, Hartmann PE. Blood and milk prolactin and the rate of milk synthesis in women. Exp Physiol. 1996 Nov;81(6):1007-20.

Dewey KG, Heinig MJ, Nommsen LA, Lonnerdal B. Maternal versus infant factors related to breast milk intake and residual milk volume: the DARLING study. Pediatrics. 1991 Jun;87(6):829-37.

Neville MC, et al. Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation. Am J Clin Nutr. 1988 Dec;48(6):1375-86.

Dewey KG, Finley DA, Lonnerdal B. Breast milk volume and composition during late lactation (7-20 months). J Pediatr Gastroenterol Nutr. 1984 Nov;3(5):713-20.

Butte NF, Garza C, Smith EO, Nichols BL. Human milk intake and growth in exclusively breast-fed infants. J Pediatr. 1984 Feb;104(2):187-95.

Dewey KG, Lonnerdal B. Milk and nutrient intake of breast-fed infants from 1 to 6 months: relation to growth and fatness. J Pediatr Gastroenterol Nutr. 1983;2(3):497-506.

Brown K, Black R, Robertson A, Akhtar N, Ahmed G, Becker S. Clinical and field studies of human lactation: methodological considerations. Am J Clin Nutr 1982;35:745-56.

Jelliffe D, Jelliffe E. The volume and composition of human milk in poorly nourished communities: a review. Am J Clin Nutr 1978;31:492-515.

Summary of Research Data

Baby's Age

Average Milk Intake per 24 hours

Reference

Specific Gravity of Mature Human Milk = 1.031, so Density of Mature Human Milk ~ 1.031 g/ml;1 oz = 29.6 ml;Numbers in gray were derived using the above conversion factors.

# data[].attributes.attachment_link.title
How much expressed milk will my baby need? * KellyMom.com

# data[].attributes.attachment_link.description
Many mothers wonder how much expressed breastmilk they need to have available if they are away from baby. In exclusively breastfed babies, milk intake increases quickly during the first few weeks of life, then stays about the same between one and six months (though it likely increases short term during growth spurts).

# data[].attributes.body
Everything you are likely to need to know in one video.

# data[].attributes.attachment_link.title
Collecting your milk before the birth of your baby

# data[].attributes.body
Short and easy to follow

# data[].attributes.attachment_link.readable_text
This video guides mothers through how to hand express, and talks about the times when hand expression might be useful.

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

Problems viewing this video? Try viewing here or Please contact us

# data[].attributes.attachment_link.title
Hand expression video - Baby Friendly Initiative

# data[].attributes.attachment_link.description
See the Breastfeeding Network website for FAQs and a leaflet all about expressing and storing breastmilk. Problems viewing this video? Try viewing here or Please contact us

# data[].attributes.headline
Article about antenatal expression of colostrum

# data[].attributes.subject
Article about antenatal expression of colostrum

# data[].attributes.attachment_link.title
Antenatal Expression of Colostrum - La Leche League GB

# data[].attributes.attachment_link.description
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…

# data[].attributes.body
this is a technique to ensure your baby only takes as much milk as he needs

# data[].attributes.attachment_link.title
Baby Led Bottle Feeding - Wendy Lever IBCLC

# data[].attributes.headline
Explanation of responsive bottle feeding

# data[].attributes.subject
Explanation of responsive bottle feeding

# data[].attributes.body
This article has a good in-depth exploration of the rational and the details of responsive bottle feeding

# data[].attributes.body
This is a situation where talking to someone can help, so do contact me or another bfc so we can help you talk through strategies. In the meantime. . . .

# data[].attributes.attachment_link.readable_text
Our video is presented by Melissa Little, Paediatric Dietitian
The Department of Health, UNICEF UK Baby Friendly, paediatricians and midwives all agree it's best to exclusively feed breastmilk for the first 6 months.

However, there are all sorts of reasons you may decide to switch your baby from breastfeeding to bottle feeding. You might be going back to work for example. Ideally, you will carry on feeding your baby expressed breastmilk even when you switch to a bottle by expressing your milk. You can also still offer your baby breastfeeds when you get home from e.g., work and your milk supply will adjust to feed when you are able to.

You may decide to give your baby some expressed breastmilk and some formula which is sometimes referred to as 'mixed' feeding. Remember any breastmilk you give to your baby is beneficial and will provide lots of immune boosting and developmental constituents.

As with most things to do with babies, it's different for all of them! Some babies seem not to even notice switching over. Others will put up a determined fight. If your baby won't take a bottle, go back to square one and start again, following these top tips.
Here is a video showing how to bottle feed sensitively and responsively:
The absolutely top tip is to do it slowly. Don't expect your baby to give up the warmth and cuddliness of breastfeeding overnight. Start well in advance of when you need to make the switch, say around a month before you need to go back to work.

Let him get used to the teat as a dummy before you even start with the bottle.

Begin by using expressed milk. If you decide to use formula Don't switch both to a bottle AND formula milk in one go. It's too much for your baby and chances are he'll flat-out refuse.

Start using expressed milk you have just expressed so it's still naturally warm and fresh. If you warm it from the fridge it won't taste quite the same, switch over gradually so your baby doesn't notice the change.

Put some of the warm expressed milk on the bottle teat so it smells like you.

The first time you try with the bottle, choose a time when your baby is hungry but not desperately so. You don't want him stressed out, or the bottle could be the last straw.

You can try doing a little bit of bottle, with expressed milk, just for a few seconds or minutes, in the middle of a breastfeed, and then go back to the breast. You then build up the time on the bottle slowly. This is a very unthreatening method, your baby knows the breast will come back, so there's nothing to worry about, and then you change over slowly.

Which teat to use, is really a matter of trial and error, but generally speaking, a slow flow teat is good to start with, since your baby might get overwhelmed by the volume let through by a fast flow teat. Remember your baby has to suck pretty hard on your breast to get the milk, so they're used to slow flow. Also sucking on a nipple and sucking on a bottle teat are not the same as the teat is much harder in their mouth.

It's important not to be too forceful if your baby is at all reluctant. You can tickle around your baby's upper lip and encourage them to open their mouths and then gently place the bottle inside. If they resist strongly or become upset, it's better to stop and try again later. Your baby may also pick up if you are feeling stressed and worried so give yourself plenty of time and stay calm.

If it's a total disaster and your baby won't take a bottle, you can switch straight from the breast to a sippy cup at around 6-9 months. Start with one with a soft flexible spout, not a hard plastic one.

Some people find that asking someone else to do the bottle feed can help, so there's no smell of you nearby and therefore the chance of a breastfeed. This has pros and cons, the pro is your baby might agree to feed, the con is he won't be bonding with you through that feed. So ask the person feeding them to remember to give them lots of cuddles, eye contact, and to recognise their feeding cues, i.e. especially when they've had enough. People mustn't insist your baby finishes the bottle if he doesn't want to. So you need to find someone sensitive and patient. They may need to give your baby a break and a burp halfway through as well, then see if he wants more.

The more you can be involved in the bottle feed, the better. Then your baby will still be getting all the cuddles they want. Howeverm you may find that your baby roots for the breast in skin to skin contact

If you introduce your breastfed baby to a bottle, use expressed milk, and do it very slowly.

Don't be surprised if it takes a long time, babies are instinctively programmed to breastfeed and they need to learn new skills to bottle feed. The more time you allow for the change the more successful it will probably be.

Every baby is different and very few don't take a bottle in the end if their parents want them to. Take your time. Ask your friends and family what worked for them and don't be tempted to buy lots of different types of bottles in desperation. It's usually more about giving your baby time to get used to a change.

If it's a total disaster and your baby won't take a bottle, you can switch straight from the breast to a sippy cup at around 6-9 months. Start with one with a soft flexible spout, not a hard plastic one.

Some people find that asking someone else to do the bottle feed can help, so there's no smell of you nearby and therefore the chance of a breastfeed. This has pros and cons, the pro is your baby might agree to feed, the con is he won't be bonding with you through that feed. So ask the person feeding them to remember to give them lots of cuddles, eye contact, and to recognise their feeding cues, i.e. especially when they've had enough. People mustn't insist your baby finishes the bottle if he doesn't want to. So you need to find someone sensitive and patient. They may need to give your baby a break and a burp halfway through as well, then see if he wants more.

The more you can be involved in the bottle feed, the better. Then your baby will still be getting all the cuddles they want. However, you may find that your baby roots for the breast in skin to skin contact

If you introduce your breastfed baby to a bottle, use expressed milk, and do it very slowly.

Don't be surprised if it takes a long time, babies are instinctively programmed to breastfeed and they need to learn new skills to bottle feed. The more time you allow for the change the more successful it will probably be.

Every baby is different and very few don't take a bottle in the end if their parents want them to. Take your time. Ask your friends and family what worked for them and don't be tempted to buy lots of different types of bottles in desperation. It's usually more about giving your baby time to get used to a change.

# data[].attributes.attachment_link.title
What do I do if my breastfed baby won't take a bottle?

# data[].attributes.attachment_link.description
As with most things to do with babies, it's different for all of them! Some babies seem not to even notice switching over from breast to bottle. Others will put up a determined fight. If your baby won't take a bottle, try following these top tips.

# data[].attributes.body
And links to further information

# data[].attributes.attachment_link.readable_text
Following are some resources for alternative feeding methods, including bottle feeding, cup/dropper/spoon feeding, finger feeding, supplementing at the breast, and ideas for older babies.

Bottle | Cup, Dropper, Spoon | Finger Feeding | At Breast | Back to Breast | Older Babies

Now infants can get
all their vitamin D
from their mothers' milk;
no drops needed with
our sponsor's
TheraNatal Lactation Complete
by THERALOGIX. Use PRC code "KELLY" for a special discount!

Bottle feeding

Alternatives to bottles for younger babies (including preemies)

Cup, dropper, syringe, and links with various methods

Alternatives to bottle from AskDrSears.com

Refusing a Bottle: Dropper & Cup Feeding by Paula Yount

Finger and Cup Feeding by Jack Newman, MD, FRCPC

Cup Feeding from the Breastfeeding Committee for Saskatchewan

Cup Feeding Instructions and FAQs from foleycup.com

Comparison of the Safety of Cup and Bottle Feedings in Premature Infants Whose Mothers Intend to Breastfeed information on study by Kathleen A. Marinelli, MD, IBCLC; Georgine S. Burke, Ph.D; Virginia L. Dodd, MS, RNC. The full article can be found here.

Feeding by cup, paladai or spoon (see p. 206 of PDF file - note that this file is very large and will likely take a long time to load if you have a slow connection) from the WHO document Managing Newborn Problems: a guide for doctors, nurses and midwives.

Physiologic Stability of Newborns During Cup- and Bottle-feeding by Cynthia R. Howard, et al., from Pediatrics, Vol. 104 No. 5 Supplement, November 1999, pp. 1204-1207.

SoftFeeder (with link to Instructions) from Medela

Finger feeding

Options for supplementing baby at the breast

Weaning back to the breast from other feeding methods

Additional options for older babies (4+ months)

After 4-6 months, there is really no need to introduce a bottle - babies this age can generally handle a cup just fine (expect to help out in the beginning, though). If you need to, try different types of cups to see what works best for you and baby: regular cup (try different sizes), sippy cup, no-spill sippy cup, cup with straw (or a cup with a built-in straw), and sports bottle are all options that different babies use.

Occasionally a baby will refuse to drink from any type of cup or bottle. In this case, try feeding baby breastmilk with a spoon, dropper or syringe. If baby has started solids, mix the solids with lots of breastmilk. You might also try a momsicle, ice cream, yogurt or a smoothie made with breastmilk.

# data[].attributes.attachment_link.title
Tools for Feeding: Bottles & More * KellyMom.com

# data[].attributes.attachment_link.description
There are a number of options for feeding baby when you are unable to directly breastfeed - a bottle is only one of them. Following are resources for alternative feeding methods, including bottle feeding, cup/dropper/spoon feeding, finger feeding, supplementing at the breast, and ideas for older babies.

# data[].attributes.body
Milk smells or tastes soapy? Or rancid? Read on. . . .

# data[].attributes.attachment_link.readable_text
Check out stylish,
functional breast pump bags
and accessories from
our sponsor Sarah Wells Bags.

Human milk that has truly soured has a very distinct sour taste and odor - much like soured cow's milk. If your milk doesn't smell distinctly sour or rancid, then it should be safe to feed to your baby.

First, troubleshoot your storage procedures

If you repeatedly notice that your stored milk doesn't smell or taste fresh, it might help to go through your storage procedures to see if there is something you could do to improve the smell/taste of your milk:

Storage containers: Standard glass or plastic bottles (or any type of leak-proof food storage containers) are acceptable for storing mother's milk, as are disposable bottle liners or "mother's milk" bags. The best materials are glass or food-grade polypropylene or polybutylene (hard) plastic. Polyethylene bags (bottle liners) do not preserve nutrients and immune properties as well as glass or hard plastic. (Jones & Tully 2005)

If you're using standard plastic bottle liners, instead try using bags specifically designed for storing human milk.

If you're storing in plastic, try glass instead.

Storage conditions:

Do you plan to freeze the milk? If you're not expecting to use refrigerated milk within 5-8 days of expression, then freeze as soon as possible after expression. Use as soon as possible after thawing (but always within 24 hours).

Make sure that all packages in your refrigerator or freezer are sealed well, so that your milk cannot absorb odors from other foods. A box of baking soda placed in the refrigerator or freezer may help to absorb odors.

Store your milk in the BACK of the refrigerator or freezer, not in the door. Don't store your milk against the wall of a self-defrosting freezer.

Is your freezer cold enough? If your freezer keeps ice cream hard, then the temperature is right.

Does your milk smell or taste soapy?

A few mothers find that their refrigerated or frozen milk begins to smell or taste soapy, even though all storage guidelines have been followed closely. Per Lawrence & Lawrence (p. 781), the speculation is that these mothers have an excess of the enzyme lipase in their milk, which begins to break down the milk fat soon after the milk is expressed. Most babies do not mind a mild change in taste, and the milk is not harmful, but the stronger the taste the more likely that baby will reject it.

Lipase is an enzyme that is normally present in human milk and has several known beneficial functions:

Lipases help keep milk fat well-mixed (emulsified) with the "whey" portion of the milk, and also keep the fat globules small so that they are easily digestible (Lawrence & Lawrence, p. 156).

Lipases also help to break down fats in the milk, so that fat soluble nutrients (vitamins A & D, for example) and free fatty acids (which help to protect baby from illness) are easily available to baby (Lawrence & Lawrence, p. 156).

The primary lipase in human milk, bile salt-stimulated lipase (BSSL), "has been found to be the major factor inactivating protozoans" (Lawrence & Lawrence, p. 203).

Per Lawrence & Lawrence (p. 158), the amount of BSSL in a particular mother's milk does not vary during a feed, and is not different at different times of day or different stages of lactation. There is evidence that there may be a decrease in lipase activity over time in mothers who are malnourished.

Many mothers who need to store their expressed milk but have problems with excess lipase sometimes wonder whether changing their diets may help. This post to the LLLI forums discusses some ideas from human milk researcher Leon Mitoulas about this question: Can diet changes help with the Lipase issue?

What can I do if my storage problem is due to excess lipase? Once the milk becomes sour or rancid smelling/tasting, there is no known way to salvage it. However, newly expressed milk can be stored by heating the milk to a scald to inactivate the lipase and stop the process of fat digestion. Scald the milk as soon after expression as possible.

To scald milk:

Heat milk to about 180 F (82 C), or until you see little bubbles around the edge of the pan (not to a full, rolling boil).

Quickly cool and store the milk.

Scalding the milk will destroy some of the antiinfective properties of the milk and may lower some nutrient levels, but this is not likely to be an issue unless all of the milk that baby is receiving has been heat-treated.

Per Lawrence & Lawrence, bile salt-stimulated lipase can also be destroyed by heating the milk at 144.5 F (62.5 C) for one minute (p. 205), or at 163 F (72 C) for up to 15 seconds (p. 771).

What if your milk tastes/smells sour, or even rancid, rather than soapy?

If your milk tastes/smells sour or rancid rather than soapy, the cause may be chemical oxidation rather than lipase (Mohrbacher, p. 461). Mom's intake of polyunsaturated fats may be involved, or free copper or iron ions in her water. When this happens, Mohrbacher has a few suggestions to try:

avoid your usual drinking water (either drinking it or having milk come into contact with it)

avoid fish-oil and flaxseed supplements, and foods like anchovies that contain rancid fats

increase your antioxidant intake (including beta carotene and vitamin E).

If you have frozen milk in your freezer that your child refuses

Some options:

Try mixing the "rejected" frozen milk with fresh milk. Start with half frozen, half fresh and adjust the amount of frozen milk up or down depending on your child's preferences.

Consider donating your frozen milk to a milk bank. Lipase and other taste issues are not typically an problem for milk banks. Visit HMBANA for more information and to find your closest milk bank.

Additional information

Breastmilk Storage & Handling @

Storage and Handling of Breastmilk from Lactation Education Resources

Storage and Handling of Breastmilk by Becky Flora, BS, IBCLC (see "What about soured or "off" milk?")

Excess Lipase details one mom's experience with excess lipase, with lots of great information (including donating her unusable milk to a milk bank!)

References

Berkow SE, Freed LM, Hamosh M, Bitman J, Wood DL, Happ B, Hamosh P. Lipases and lipids in human milk: effect of freeze-thawing and storage. Pediatr Res. 1984 Dec;18(12):1257-62.

Bitman J, Wood DL, Mehta NR, Hamosh P, Hamosh M. Lipolysis of triglycerides of human milk during storage at low temperatures: a note of caution. J Pediatr Gastroenterol Nutr. 1983;2(3):521-4.

Dupuy P, Sauniere JF, Vis HL, Leclaire M, Lombardo D. Change in bile salt dependent lipase in human breast milk during extended lactation. Lipids. 1991 Feb;26(2):134-8.

Freed LM, Berkow SE, Hamosh P, York CM, Mehta NR, Hamosh M. Lipases in human milk: effect of gestational age and length of lactation on enzyme activity. J Am Coll Nutr. 1989 Apr;8(2):143-50.

Hamosh M, Dewey KG, Garza C, et al. Nutrition During Lactation. Institute of Medicine, Washington, DC, National Academy Press, 1991. pp. 138.

Jones F, Tully MR. Best Practice for Expressing, Storing and Handling Mother's Milk in Hospitals, in Homes and in Daycares, 2nd ed. Raleigh, NC: Human Milk Banking Association of North America, 2006: 14-15, 20.

Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005: 156-158, 203-205, 771, 781.

Lawrence RA. Storage of human milk and the influence of procedures on immunological components of human milk. Acta Paediatr Suppl. 1999 Aug;88(430):14-8.

May JT. Table 7: Effect of heat treatment or storage on antimicrobial factors in human milk. From: May JT. Molecular Virology: Tables of Antimicrobial Factors and Microbial Contaminants in Human Milk. Accessed 9/8/05.

May JT. Antimicrobial properties and microbial contaminants of breast milk-an update. Aust Paediatr J. 1984 Nov;20(4):265-9.

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, Texas: Hale Publishing, 2010: 460-461.

# data[].attributes.attachment_link.title
My expressed breastmilk doesn't smell fresh. What can I do? * KellyMom.com

# data[].attributes.attachment_link.description
Human milk that has truly soured has a very distinct sour taste and odor - much like soured cow's milk. If your milk doesn't smell distinctly sour or rancid, then it should be safe to give to your baby.

# data[].attributes.headline
Choosing a teat and bottle for a breastfed baby

# data[].attributes.subject
Choosing a teat and bottle for a breastfed baby

# data[].attributes.attachment_link.readable_text
There is a vast selection of bottles and teats available online or in the High Street. Many of them claim to be closer to breastfeeding in some way, whether it is the shape or size of the teat, the rate of flow of milk, the softness of the material or something about the sucking mechanism. Unfortunately, most of these claims are poorly researched and simply a ploy to increase sales. Although there is no single "best bottle" for breastfeeding, and we can't rely on advertising claims, there are certain bottle teat characteristics that seem to help preserve a baby's breastfeeding technique.

Find an IBCLC

Search for a breastfeeding expert near you

This article discusses pros and cons of a selection of newborn teat shapes with respect to how they might influence breastfeeding. The information should be read alongside Tips to Bottle Feed a Breastfed Baby and try to check customer reviews from other breastfeeding mothers before you buy.

The aim of the game

When choosing a bottle teat for a breastfed baby, the goal is to try to recreate the same mouth position and tongue action with the bottle that your baby uses at the breast:

Choose a short or medium length teat (artificial nipple), with a rounded tip (not flattened on one side) and a medium-wide base. The aim is for your baby to take most of the bottle teat in his mouth all the way to the screw cap. This will give him a wide open mouth around the base of the artificial nipple and the tip of the bottle teat will be deep in his mouth, close to the junction of his hard and soft palate. This recreates the deep latch wide-mouthed jaw position that is desirable when your baby breastfeeds.

Comparing bottle teats

Expensive branded teats with fancy packaging are not necessarily any better than cheaper unbranded makes. Many lactation consultants recommend starting with a cheaper teat and see how that works before spending more money on expensive brands.

#1 The wide based bottle teat

A popular choice with manufacturers is to make a bottle teat that looks like a breast i.e. a short bottle nipple protrudes from a wide base. However when the angle between the nipple and base is very steep, it makes it more difficult for a baby to make a wide mouth on the teat because they can slip off it and be forced to make a narrow mouth on the nipple tip. If the artificial teat is also made of a relatively inflexible or rigid silicone, this will be even harder for the baby to shape and hold with their tongue and will feel very different to a breast. The particular teat photographed has multiple rings of ridges on the inside surface of the nipple base which will make it more difficult to keep clean.

#2 The long narrow nipple

Some bottle teats have a very long nipple compared to the base. If the length of the nipple is too long this might be longer than a newborn baby's mouth possibly making them gag. If the nipple is too long, it will also prevent the baby opening their mouth wide on the base of the teat. Whether this style will suit your baby will depend on the gradient between nipple and base, the size of your baby's mouth, and the height of the teat. The greater the number of parts inside the teat, the more difficult it will be to keep clean.

#3 The small based teat

When the base of the teat is smaller, the contrast between the nipple and the base of the teat will be less severe. A baby is more likely to be able to get both the nipple and base in his mouth up to the screw cap to mimic a deep latch (attachment) at the breast, however, if the base is too small, this will result in a smaller gape. Also be aware with small teats that if the total height is too short it might not reach deep enough into baby's mouth to mimic the correct position for breastfeeding and may encourage a shallow latch when baby returns to the breast. Ideally the material used for the teat will not be too soft that it collapses in baby's mouth, nor too rigid.

#4 The very soft teat

Some teats are made of very soft material. The teat in the following picture is made of latex and has a slanted nipple tip. The softness of this type of teat has proved popular with premature babies or babies with neurological issues who are having difficulties with a regular teat. However if the teat is so soft that it collapses in baby's mouth when they feed, this can create a very closed, clenched mouth position which is not desirable for breastfeeding. Slanted or "orthodontic" bottle nipples may cause a baby to retract and hump the back of his tongue during bottle feeding which if repeated at the breast will compress the mother's nipple . A mother's nipple should not be compressed or distorted during a feed-this indicates the nipple has been rubbing in baby's mouth causing pain, soreness or vasospasm.

Latex is an allergenic material and some babies could be allergic to latex .

#5 The flattened teat

If a teat is sculptured on two opposite sides it will create a slightly flattened, angular teat. Depending how deeply a baby can take the teat in their mouth the flattened shape may prove difficult for baby to get a good seal with his lips and the edges of the sculptured areas could contribute to lip blisters. However if the silicone material is soft and the sides are not too steeply graded with a medium wide base, this style may suit some babies.

#6 The medium based teat with a medium height nipple

In theory the medium based teat with a short to medium height nipple is a shape thought to work well for a breastfed baby. Success will vary depending on the softness of the material used for the teat (not too firm, not too soft), the gradient between nipple and base, and the size of your baby's mouth.

#7 The gently sloping teat

Some bottle teats do not have a clearly defined difference between the nipple and the base, they look more like a nipple shield. Depending on the slope between nipple and base and the height of the teat, this shape could allow a baby to have a wide open mouth on the teat base to recreate the deep latch position desired in breastfeeding. According to reviews, some mothers found their breastfed babies accepted these when they refused other bottle teat shapes.

What about the bottle?

The bottle shape and size are not as important to preserving breastfeeding technique as the bottle teat. However the size of the bottle is worth considering. Some bottles have a very large capacity e.g. 260ml (9oz) or 330ml (11oz) yet a newborn breastfed baby typically does not take anything like these volumes at each feed. In the first few weeks, volumes per feed might be around 60-80ml (2-3oz) and between one month and six months of age, it is estimated that breastfed babies take an average 89-148ml (3-5oz) per feed . Smaller capacity bottles (e.g. 150ml/5oz) will give a more realistic estimate of both your baby's appetite and the volume of breast milk you might expect to pump in one go. See Tips to Bottle Feed a Breastfed Baby for ideas to help control the flow of milk to your baby to resemble what happens during breastfeeding.

Cleaning bottles and teats

Bottle feeding equipment needs to be kept scrupulously clean to avoid being an infection hazard. Ridges, crevices and internal parts in teats make them much more difficult to keep clean. See Sterilising Baby Bottles (National Health Service website, 2016) for comprehensive information on how to clean your baby's feeding equipment.

Alternatives to bottle feeding?

When introducing bottles to your breastfed baby, there is a risk that your baby could start to prefer a bottle teat over the breast (sometimes called nipple confusion or bottle preference) and this could undermine breastfeeding. Particularly if the reasons they are having bottle feeds are to do with difficulties breastfeeding or low milk supply. While the choice of teat shape and our Tips to Bottle Feed a Breastfed Baby can help to minimise problems, there are other feeding methods to consider such as Cup Feeding, or Breastfeeding With a Supplemental Nursing System. An IBCLC lactation consultant can help you decide on the best choice of feeding method for your baby's situation.

Low milk supply?

If you are struggling with low milk supply, contacting an IBCLC lactation consultant or other breastfeeding specialist for help can be invaluable, and see How to Make More Breast Milk. If you're considering using industrially made milks, Supplementing With Formula includes information on preparing formula safely and answers other frequently asked questions.

Summary

There are many different bottle teat shapes made of different materials with differing flexibility and flow rates. Manufacturers' statements that their bottles are "closer to breastfeeding" are just marketing claims designed to sell their products. Expensive brands are not necessarily better than cheap ones. Certain features of a bottle teat such as the length of teat, or width of the base can help mimic breastfeeding more closely. Babies come in different shapes and sizes with different sucking skills so one teat is not going to suit all babies making it difficult to recommend specific brands. Parents may have to try a few different styles to find the best bottle teat for their baby that doesn't seem to interfere with breastfeeding, and recreates the same open mouth position needed at the breast. The ideal shape will likely be a medium wide base with a short to medium nipple. Using bottles could undermine breastfeeding for some babies and cup feeding or supplementing at the breast are other feeding options to consider. This article should be read in conjunction with Tips to Bottle Feed a Breastfed Baby.

# data[].attributes.attachment_link.title
Best Bottle for a Breastfed Baby? - Breastfeeding Support

# data[].attributes.attachment_link.description
Which is the best bottle for breastfed babies? This article discusses pros and cons of a selection of newborn teat shapes in relation to breastfeeding.

# data[].attributes.body
tips on how to feed a baby with a bottle

# data[].attributes.body
Useful if you are pumping

# data[].attributes.attachment_link.readable_text
All babies need to be fed little and often in the early days. A baby needs to feed frequently, and may or may not offer feeding cues. Trying to visualise numbers can be a distraction, and we have taken the decision to stop using our milk volume posters because we were concerned they might lead people to look at numbers instead of the things they can observe.
LLL seeks to give clear information on how to tell if your baby is getting enough milk.

LLL Resources

Signs of effective feeding in the early days
Positioning & attachment
Beginning breastfeeding
Comfortable breastfeeding - easy read
Is my baby getting enough milk?
My baby needs more milk
Get support from LLLGB
The following posters show normal behaviours for healthy, breastfed newborn babies. They are available to download for free from our Shop:

Breastfeeding concerns

Occasionally there is reason to be concerned about a baby's weight gain or the way he is breastfeeding. Here are some signs that your baby may not be getting enough milk at the breast:

If your baby has not regained his birth weight by two weeks of age

If baby is passing less urine and pooing less frequently than described above, or his poos remain dark, then seek additional support and give more milk. Older babies may have bowel movements less frequently

If baby is nursing fewer than eight to twelve times in 24 hours in the early weeks

If baby is not waking to nurse at night

Your baby is never satisfied after feeds

Breastfeeding is very painful all the way through a feed

You don't feel signs of your milk coming in after day three

If you are concerned about your baby or s/he shows any of these signs, seek help with breastfeeding from your healthcare team and La Leche League.
Find LLL support or call our national helpline on 0345 1202918.

Any if the following are signs of dehydration and the need to seek medical help immediately:

less than two wet nappies in 24 hours from the third day

listlessness

lethargy

weak cry

skin loses its resilience (when pinched it stays pinched looking)

dry mouth, dry eyes

the fontanel (soft spot) on the head is sunken or depressed

fever

This list is not exhaustive and we stress that you should consult your Doctor, Midwife, Health Visitor, or other healthcare provider if you have any concerns about the health of your baby. Breastfeeding support can continue alongside any necessary medical treatment. A La Leche League Leader (breastfeeding counsellor) can provide further information on breastfeeding management. Get LLL support .

# data[].attributes.attachment_link.title
How much milk does a newborn need at each breastfeed? - La Leche League GB

# data[].attributes.attachment_link.description
All babies need to be fed little and often in the early days. A baby needs to feed frequently, and may or may not offer feeding cues. Trying to visualise numbers can be a distraction, and we have taken the decision to stop using our milk volume posters because we were concerned they might lead people to look at numbers instead of the things they can observe.

# data[].attributes.attachment_link.readable_text
1. Mothers may express milk for many reasons, and at many different times. A mother with gestational diabetes might express colostrum before her baby is born; mothers also express if they are separated from their baby, if their baby won't latch on, or to relieve engorgement. Once breastfeeding is established, many families share feeding using bottles of expressed milk.

2. Different pumps may be useful in different circumstances. Hospital-grade electric pumps can be hired locally. If you are only expressing now and then, a manual pump might be suitable. Colostrum can be expressed by hand without a pump.

3. Expressed breastmilk can be stored at room temperature for about 8 hours, in the fridge for 5 days, and in the freezer for 6 months. Defrost in the fridge and warm if necessary by putting the container of milk into hot water.

4. If you are giving both breastmilk and formula milk, you might want to offer them separately, giving the breastmilk first to maximise the amount taken, rather than diluting it with formula.

5. Expressed breastmilk can be given to the baby with a syringe, a spoon, a feeding cup, or a bottle. These will need to be sterilised.

6. If you are only expressing and your baby is not feeding at the breast, it is helpful to express very frequently: around 10 times in 24 hours, including once during the night, to mimic the feeding pattern of a baby.

7. Expressing in addition to breastfeeding usually increases the milk supply. Expressing instead of breastfeeding may decrease the milk supply.

8. Closeness with your baby stimulates release of the hormone oxytocin, which helps the flow of milk. Closeness with your breastpump is less likely to have this effect. Some women find that their milk does not flow easily for the pump. Therefore, the amount of milk you can pump is NOT a good indication of the amount of milk you can produce.

9. Warmth, gentle massage, and the sight/sound/smell of your baby can stimulate oxytocin and help milk to flow. Sometimes expressing in a warm bath can be effective.

10. The best time of day to express is whenever you have the time. Breasts produce more milk when they are frequently used, so it is possible to express before, after, or even during a feed. If you can't find time to express, and you don't have to, then leave it for a little while until things settle down.

For support with any aspect of infant feeding, you can call the NCT Feeding Line from 8am to midnight, every day, on 0300 3300 700.

# data[].attributes.attachment_link.description
1. Mothers may express milk for many reasons, and at many different times. A mother with gestational diabetes might express colostrum before her baby is born; mothers also express if they are separated from their baby, if their baby won't latch on, or to relieve engorgement.

# data[].attributes.attachment_link.readable_text
If you are pregnant or breastfeeding, milk expression by hand is a useful technique to learn. It's a handy way to relieve engorged breasts. You can also use it to stimulate milk production and provide milk for a baby who is not breastfeeding well or needs more milk.

Why hand expression?
If you use a pump
Practice helps
How breasts work
Before you start
Relax and get comfortable
How to hand express Step by step How long will hand expressing take? Hand expressing shouldn't hurt

Why hand expression?

Skin-to-skin contact with hand expression encourages the milk ejection reflex (MER) or 'let-down reflex'.

Mothers usually get more milk using hand expression alone or combined with pumping than using just a pump.

It requires no special equipment and is always available, even in emergencies.

It's convenient and free.

Hand expression is particularly useful if you need to express colostrum during late pregnancy (see Antenatal Expression of Colostrum) or in the first few days after birth. It makes it easy to save every drop of precious colostrum.

If you use a pump

Whatever pump you may use, combining pumping with hand expression can help you express more milk more effectively.

Breast massage and hand expression can be used at the beginning to get your milk flowing.

Breast massage while pumping increases the amount of milk you can express.

Continuing to hand express can release milk remaining, even after the pump flow has stopped.

And if your pump breaks down, or there is no electricity, you always have your hands.

Practice helps

How breasts work

When milk is removed more often, your breasts feel soft and comfortable and produce milk faster. When milk is removed infrequently, your breasts may feel full but produce milk more slowly. Frequent milk removal is the key to maintaining milk production whether you are breastfeeding or expressing. Expressing stimulates your breasts-though not as effectively as a baby-to make and release milk.

For more information on how milk production works, click here.

Before you start

Wash your hands. Have a suitable clean container available to collect your milk: colostrum can be expressed into a small (5ml) container or even onto a teaspoon for immediate feeding. Once milk production has increased milk may spray in several directions so a bowl, wide mouthed container or a bottle with a funnel might be more practical.

Relax and get comfortable

Milk tends to flow better when you are feeling comfortable, relaxed and warm. Tension or anxiety inhibits milk flow. Relaxation techniques can help increase the amount of milk you can express. The sound of running water may help, or you could practise in the bath or shower.

Seek privacy; try the breathing exercises you learnt for use during labour; visualise flowing milk. Have your baby nearby, or think of him. Use photos or recordings of your baby and smell his clothing. All these will help stimulate milk flow. Take a few deep breaths, drop your shoulders and release tension with each exhalation. Bending forward with your breasts suspended means gravity can help milk flow.

How to hand express

One basic approach

1. Start by encouraging milk flow in both breasts.

2. Then hand express from each breast until milk flow slows right down. If you need to increase milk production, continue expressing for a couple of minutes after milk flow has stopped.

3. Repeat these two steps at least twice more. You will find milk flow slows or stops sooner each time you repeat.

4. Most mothers adapt the above approach to suit themselves, so experiment to find what works best for you.

Step by step

Encouraging milk flow
Stimulating your milk ejection reflex (MER or 'let-down') is the key to expressing. It can take a few minutes. You may see drops of colostrum or breastmilk, or even experience a tingling sensation, but many mothers don't see any milk until they start actually expressing. Experiment with the following suggestions to find out what works best for you.

Massage your breast starting at the top, using a firm circular pressure on one spot. After a few seconds, lift up your fingers to move to the next area on the breast. Spiral around the breast towards the areola and nipple.

Stroke your breast from the top of the breast to the areola and nipple. Light stroking with fingers is one option, or use a soft item with a light tickle-like stroke. Continue this stroking motion from the chest wall to the nipple around the whole breast.

Shake your breast gently while leaning forward so gravity can help your milk flow.

Hand position

You can use either or both hands on one breast, or express both breasts at the same time. Hold your hand in the shape of a letter 'C', with your thumb and forefinger behind the base of your nipple, feeling for the change in texture of your breast. Move you fingers closer to, or away from your nipple to find the best place for you.

To express

Start with the pad of your thumb at the top of your breast, and your finger pads below.

Support your breast, then press the breast towards the chest wall to put pressure on the milk ducts.

Now compress the breast between your fingers and thumb to move the milk forward towards your nipple.

Release and repeat rhythmically: press-compress-relax (like a baby breastfeeding) until milk flow stops

Then rotate your hand around the breast a little and repeat. Do this for each section of your breast until it feels soft and comfortable. Keep your fingers and thumb opposite one another as you rotate.

Remember that when a baby breastfeeds, milk doesn't flow immediately, so it's normal for it to take a little time for milk to start flowing when you express. Switch back and forth between breasts as the flow slows to encourage further MERs.

This video has a good demonstration of hand expression of breastmilk

How long will hand expressing take?
Allow plenty of time at first: the whole process may take 20 or 30 minutes, but you can always stop and start again later if you need to. Frequent short sessions are usually more effective than infrequent, longer expressing sessions.

Switching between breasts several times as milk flow slows can help trigger further milk ejection reflexes. The more MERs you stimulate, the more milk you will be able to express and make.

Hand expression shouldn't hurt
Squeezing, pulling and sliding fingers along the skin can cause discomfort, bruising and skin burns. Pain or discomfort inhibit the MER and are signs that something needs adjusting. If your breast feels engorged or tender try warm moist heat immediately before expressing. Start expressing from the most comfortable areas.

Removing milk from areas around a blocked duct can reduce the discomfort, making it easier to express from the tender area later.

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

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Breastfeeding Answers Made Simnple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.

Antenatal Expression of Colostrum
Birth and Breastfeeding
Expressing Your Milk
Engorged Breasts - avoiding and treating
My Baby Needs More Milk
Sleepy Baby - why and what to do
Storing Your Milk
Working and Breastfeeding
Bottles and other tools

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

LLLI Resources
The Power of Hand Expression

Copyright LLLGB 2016

# data[].attributes.attachment_link.title
Hand Expression of Breastmilk - La Leche League GB

# data[].attributes.attachment_link.description
If you are pregnant or breastfeeding, milk expression by hand is a useful technique to learn. It's a handy way to relieve engorged breasts. You can also use it to stimulate milk production and provide milk for a baby who is not breastfeeding well or needs more milk. Why hand expression?

# data[].attributes.headline
Using breast massage to improve hand expression

# data[].attributes.subject
Using breast massage to improve hand expression

# data[].attributes.attachment_link.readable_text
We detected a high number of errors from your connection. To continue, please confirm that youâ€™re a human (and not a spambot).

# data[].attributes.attachment_link.title
The Basics of Breast Massage and Hand Expression

# data[].attributes.attachment_link.description
"The Basics of Breast massage and Hand Expression" video by Maya Bolman, IBCLC and Ann Witt, MD, FABM, IBCLC

# data[].attributes.body
Tips to make pumping sessions more effective

# data[].attributes.attachment_link.readable_text
This material was developed by Jane Morton, MD and produced for educational purposes only. Reproduction for commercial purposes is prohibited. Utilization of the materials to improve care of pregnant women and their newborns is encouraged with proper citation of source.

# data[].attributes.attachment_link.description
This material was developed by Jane Morton, MD and produced for educational purposes only. Reproduction for commercial purposes is prohibited. Utilization of the materials to improve care of pregnant women and their newborns is encouraged with proper citation of source.

# data[].attributes.body
Answers to just about every question you might ask

# data[].attributes.attachment_link.readable_text
Your breastmilk is the best possible food to help your baby grow and develop, combined with antibodies, live cells, and other substances to protect him from infection. It's worth the effort to provide expressed milk for your baby when you can't be there to nurse him. Although some of the nutrients and anti-infective properties change with storage, expressed milk is still much better nutritionally for your baby than infant formula. This page gives guidelines on storing your milk.

Storing breastmilk for healthy full-term babies

Breastmilk's antibacterial properties help it stay fresh. The live cells and antibodies that discourage the growth of bacteria in your baby's intestines also guard against bacterial growth when your milk is stored in a container.

The guidelines that follow apply to milk that will be given to full-term healthy babies. If your baby is premature or sick, hospital staff can give you information on stricter storage guidelines, to ensure your baby gets as much benefit from your milk as possible.

Cleanliness
Good hygiene is important when storing your milk. Reduce the risk of contaminating your milk by:

Washing hands before expressing or handling milk

Keeping your pump clean, using hot soapy water for all parts which come into contact with your milk. Some mothers sterilize as well

Keeping your fridge, freezer, coolbag and icepacks clean

Placing containers of milk in a clean bag or lidded box before storing

Keeping your milk away from meat, eggs, etc

Storage containers

Hard-sided containers, either glass or plastic, do the best job of protecting your breastmilk. Avoid containers made with the controversial chemical bisphenol A, identified with a number 3 or 7 in the recycling symbols. A safer alternative is polypropylene, which is soft and semi-cloudy and marked with a 5 or letters PP.

Use containers with well-fitting tops

Wash containers in hot, soapy water, rinse well, and allow to air-dry before use. Or wash and dry in a dishwasher

Leave 2.5cm of space at the top to allow the milk to expand as it freezes. Plastic milk storage bags, designed for freezing breastmilk are convenient and take up less room in the freezer

Avoid bags that are not designed for freezing-they may burst or tear. Double bagging can prevent accidents

Some milk storage bags can be attached directly to a breast pump, so you can collect and store milk in the same container

Allow 2 to 3 cm for the milk to expand when frozen and squeeze out the air at the top before sealing

Stand the bags in another container on the fridge shelf or in the freezer

Remember to date the containers-it can help to put a use-by date too. Add your baby's name if he will receive the milk at a childminder's or nursery.

How much milk will I need?

Store milk in 60 to 120ml (2 to 4 oz) quantities to avoid waste, at least until you know how much milk your baby takes at a feed. Small quantities thaw quickly and can be combined if needed. You can also store smaller quantities of 30ml for when your baby is extra hungry, or wants to be fed just before you're due back.

You can combine milk pumped at different times, if you:

Cool fresh milk for 30 minutes in the fridge first

Add fresh milk to frozen milk only if there is less fresh milk than frozen

Use it within the time limit of the oldest expressed milk

Looks are deceptive!
It's perfectly normal for expressed milk to look thin, bluish, yellowish or even brownish in colour and for it to separate into a milk layer and a cream layer when stored.

Preparing to use

Thaw and heat with care
High temperatures or even moderate temperatures over a period of time affect many of the beneficial properties of breastmilk, so:

NEVER warm breastmilk in a pan on a cooker

NEVER warm breastmilk in a microwave

Microwaves do not heat liquids evenly, so there may be hot spots in the container of milk, and this can be dangerous for babies.

Defrosting frozen breastmilk Your milk can be defrosted in the fridge, avoiding unnecessary heating. Use within 24 hours.
To defrost your milk more quickly:

Hold the container under cool running water and gradually increase the temperature of the water to heat the milk to feeding temperature, or;

Immerse the container in a bowl of warm water. Take the milk out and reheat the water if necessary. Do not stand in a pan of water heating on the hob.

Refrigerated Milk: Warm for a few minutes under a tap or in a container of water. Test for temperature on the inside of your wrist.
Avoid contamination: Dry the containers before opening, with paper kitchen towels or a clean tea towel.
Breastmilk separates naturally: Gently swirl the container to remix.

Storage

Breastmilk is remarkably resilient - it stores well due to its antibacterial properties.
Temperature
Store milk in the coldest part of fridge and freezer. Self-defrosting freezers can have warm spots. Use fridge and freezer thermometers to determine where the temperature is most constant. The fresher your milk, the better

Milk stored in the fridge will have more goodness than frozen milk. Some of the anti-infective properties are lost when milk is frozen-but it still helps protect babies from disease and allergies and is far superior to any formula. Although you probably won't plan to keep your milk in the fridge for seven or eight days it's good to know you can use safely any you find hidden at the back of the fridge. When your baby gets your milk within a few days of being refrigerated, it's also reassuring to know it is well within its usable limits.

Keeping milk for the next feed

It's best to throw away leftover frozen or heated milk, which will have lost some of its antibacterial properties. It isn't known how safe it is to keep fresh breastmilk left in the bottle after a feed. It should certainly be used within 1-2 hours. Avoid wasting precious milk by offering small amounts at a feed.

Away from home

Expressed breastmilk can be kept in a common fridge at work or at the childcare centre. Label clearly. If a fridge isn't available, place it in an insulated container with deep frozen ice packs. With enough icepacks, milk will stay at fridge temperatures for up to 24 hours. Icepacks are also useful when carrying milk home from work or to childcare, especially on warm days. But breastmilk can be safely refrigerated or frozen after short periods of storage at higher temperatures.

Soapy smell? Rancid smell?

If you plan to store large amounts you could try freezing a small batch for a week before defrosting and tasting it. Some mothers notice their milk smells slightly soapy once defrosted, due to high levels of lipase, the enzyme that breaks down fat. The milk is still safe to use but some babies refuse to drink it. Heating milk to a scald (bubbles around the edges, not boiling) then quickly cooling it before freezing can deactivate the lipase.

Thrush

Freezing deactivates yeast but doesn't kill it, but there is no current evidence that milk frozen when you and your baby have thrush will reinfect you later.
There isn't yet complete agreement about storage times. But it's always preferable to store milk for as short a time as possible to ensure:

Minimal growth of bacteria

Minimal loss of antibodies and nutrients

Laboratory studies have shown that breastmilk becomes less resistant to bacteria with time, but most of the bacteria found in breastmilk are harmless skin bacteria and not illness-causing ones.

The longer you store your milk, the more care you need to take about

Cleanliness while expressing, storing and handling milk

Storing milk at appropriate temperatures (use fridge and freezer thermometers)

Checking for bad taste and smell, which will show if your milk has gone off. Discard any milk that smells bad

If any family members are ill, especially with sickness and diarrhoea, your baby will be better off with fresh milk rather than frozen. The most recent milk from your stores will offer him the best protection from the illness. You may prefer not to freeze your milk until everyone is better.
Making it work

This information can help you decide how to store your milk to meet your needs. LLL meetings are a good source of support, whatever your reasons for expressing your milk. Or contact your local LLL Leader for one-to-one support.

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

Further Reading

The Womanly Art of Breastfeeding
Expressing your milk
Hand expression of breastmilk

This information is available to buy from our shop

References
Breastfeeding Answers Made Simple
ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants.

Hands, A. Safe storage of expressed breast milk in the home. MIDIRS Midwifery Digest 2003; 13( 3): 378-85.

Ogundele MO. Techniques for the storage of human breast milk: Implications for anti-microbial functions and safety of stored milk. Eur J Pediatr 2000; 159( 11); 793-797.

Ogundele, MO. Effects of storage on the physicochemical and antibacterial properties of human milk. Br J Biomed Sci 2002; 59: 205-11.

Copyright LLLGB 2016

# data[].attributes.attachment_link.description
Your breastmilk is the best possible food to help your baby grow and develop, combined with antibodies, live cells, and other substances to protect him from infection. It's worth the effort to provide expressed milk for your baby when you can't be there to nurse him.

# data[].attributes.body
This leaflet has milk STORAGE times and tips on pumping

# data[].attributes.body
Useful information to help you if you are having supply problems

# data[].attributes.attachment_link.readable_text
Maureen Minchin BA(Hons), MA (Melb), TSTC is a medical historian and health educator, and author of Milk Matters. She is all that, AND she is an active contributor in our Breastfeeders in Australia community on Facebook. Maureen recently sent me this post and asked me to share it far and wide, so I'm uploading it onto our website to facilitate that. Maureen is a very educated person, and some of the language used in her post may feel overwhelming. I can not stress this enough - if you have questions, please ask, as we are all learning, and we are all here to help each other. You can comment with questions, you can email us at breastfeedersinaustralia@hotmail.com or you can join our Facebook group and post there.
"The basics: hormonal stimulation + emptying of milk from breast
Obviously you need to allow baby to feed as needed.
And feeding must be effective and no obstacles put in the way of milk drainage.

Stimulation creates and maintains a basal level of prolactin, essential to getting increases in supply from birth, and later if supply has dropped . (But by three months a happily breastfeeding mum's basal prolactin levels are comparable to a non -lactating mum - it is the repeated bouts of sucking-stimulated prolactin level rises that does the job of enabling lactose and so milk production, with prolactin returning to baseline in between if intervals allow).

Initially breasts overproduce, and then supply drops down to the level of milk taken on a daily basis. Lactation is energetically expensive, and thoughout human history women have never been able to afford to waste energy. So volume is regulated by need, and responds rapidly to change in demand. How?

Regulatory controls are within the breast itself. If a feedback chemical (FIL) reaches a certain level in the breast, it signals that milk is not needed and secretion is inhibited, and eventually stops.

The second internal down-regulator is high pressure. If enough pressure flattens the rectangular-ish secreting cells, then they stop work; over time they regress and disappear. That can be a local or a whole breast pressure. So habitual finger pressure that prevents drainage from one area, or an underwire bra that sticks into a particular spot, or surgical scarring, or a tight crop top, can have an effect. As can over-distension because of too long a gap between feeds from a breast. Or from sleeping/lying on one's stomach, OK for some mums, hopeless for others (check out massage, might be best not to be too long facedown, and much massage can be done seated). If pressure gets high enough, it not only squashes the secretory cells, it can cause milk from the ducts and cells to leak into surrounding tissues and trigger inflammation. (mastitis) (SO feed before massage, time appt for the afternoon preferably; be prepared for some leakage. Towels and large absorbent pads in bed can be useful, save bed changes..)

Milk is made continuously, and is mostly water based, with about 7% cream. (The most variable component of milk, and babies drink less by volume of a high fat milk.) The watery part of the milk flows out of cells rapidly, the fat has to be extruded, sort of squeezed out by the cell into that aqueous fluid. The oxytocin contracts tiny muscles around those cells and pushes milk out into the ducts (the let down). A vacuum in the baby's mouth is created when the baby's jaw drops, and baby sucks. The seal needed for vacuum is created by tongue, cheek pads, and upper gum ridge etc. The vacuum - lower pressure area - allows milk to flow out from the breast - higher pressure area with letdown pushing milk out.

The relative amount of cream in milk varies over a feed, between feeds, between breasts, over the day, over time, following the general rule that the emptier the breast and the more letdowns it has been exposed to, the higher the fat levels. So after an interfeed interval, milk from the start of the first breast is 'waterier' than the milk at the start of the second breast will be, because the second breast has had oxytocin squeezes while the first is being fed from. And swapping back to the first breast after the second can mean an even richer milk again. Babies can be trusted to know when they are satisfied, and it sometimes takes the extra cream of a 'third' breast to do so.

Once lactation is established, the interfeed intervals are heavily influenced by the interaction between breast storage volume, and infant stomach volume. Over a day a baby takes about 750mL. A breast with storage capacity of 800mL could theoretically mean one feed a day, except that a baby's stomach capacity won't allow that! SO: a breast with very small storage volume will mean more frequent feeds at shorter intervals. So too does a small tummy. A baby with a big tummy capacity means fewer feeds per day if the mum's storage capacity allows that tummy to be filled up (it can even get down to 3-4 feeds in 24 hours in some thriving babies under 6 months old.) They say the size of the baby's stomach is roughly the size of its fist, but it can be distended comfortably. (If over-distended the baby will blurt back the extra - sometimes too much comes up, so yet another feed is indicated to settle things.) Being creamy, sometimes only a few extra mouthfuls are needed to get bub to drop off drunk.

Rates of milk synthesis vary over the day, and are governed by the degree of breast fullness. When the breast is close to its residual baseline (it's never truly empty), synthesis rates are faster. When breasts are fuller, synthesis rates are slower. The small breast that empties quickly also refills quickly.

During the night sleep, longer intervals and higher-at-night prolactin levels combine to produce a full breast by morning. Take out a single feed then, and refilling will be slow: the 600mL capacity breast might have dropped to 500mL, but there's still plenty there, so no rush to refill. By the next feed volume might be back to 540mL, and drop down to 450 after that feed. Over the day, by evening you can come close to running on empty, with baby staying at breast and drinking pretty much as you produce it. That milk may move from the stomach on into the small intestine at much the same rate, so baby doesn't get that satisfactory FULL STOMACH feedback signal and fall off looking drunk, or else will sleep for a short time but wake up and want more. [There's stuff that could be said here about gastric hormones and signalling, but no need.]

But take out a lot of milk in the am, by feeding on one side and pumping the other breast, then letting baby have the second side for as long as wanted, and milk synthesis rates speed up to replace milk in both breasts. SO this is the ideal time to express milk for storage or as a reserve. (Don't be persuaded to think about expressing after every feed unless it's for a medical reason: it creates too much work, keeps breasts cold, and is a pain.) And while you would freeze that extra expressed morning milk, it can be stored in the fridge during the day till it's clear there's enough been made to keep baby full that day; if not, you can pour off some and feed it to baby bu spoon, cup, syringe, whatever.

I developed this strategy to deal with what I called six o'colck starvation, when I just could not satisfy baby wioth a full feed. Before I tried this, I had to keep baby at breast for hours, contentedly getting small dribs of milk but refusing to leave or drop off to sleep. Topping baby up in the evening with some of the morning milk meant she went off to sleep, my empty breasts refilled before she woke again a few hours later, and in between I got my other two kids to bed and cleaned up. This was where the Kaneson pump came in handy, as it's a simple silent no-strain one-handed pump: draw back the outer cylinder a tiny bit to create the slight suction needed to relax the ring of muscle around the nipple and milk pours out of the second breast when oxytocin hits both breasts and triggers letdown). But not until mums are comfortably feeding and can multi-task should they think about trying this. Getting position and attachement right and baby feeding well and breasts producing well is the first priority. When mums can feed and drink a cuppa they can do this no trouble. If they want to get milk to store. Or to give an older child a glass, or make breastmilk ice blocks. Or whatever it's needed for.

Breasts being peripheries, they are colder than other parts of the body. They need to be warm for blood circulation to bring in nutrients for milk making. Simple things like hotpacks or having a small patch of wool, silk or fleece to tuck into the bra around the breast not in use can make a difference to refilling rates. So can an afternoon nap. I never ran dry on days when I snuggled down with a baby and had a full-body after-lunch rest. I always did if I worked through the day and only sat down for feeds. Some mums can cope with strenuous exercise and still lactate successfully; others can't. (Babies don't like the taste in milk of lactic acid created by exercise, but it disappears after about 30 minutes.)

So increasing milk production means increasing sucking stimulus, and frequency, increasing synthesis rates by breast emptying, and decreasing any competing activities. In short, go to bed with baby and sleep and feed feed feed, and (optional) express first thing in the am. After 2 days of more frequent feeding, basal prolactin levels rise - they may have fallen too far - and milk-making increases. A babymoon it's sometimes called. Not possible for many mums with children and dogs and household tasks. Using drugs to increase prolactin has its risks and in any case will not work if the problem is insufficent breast emptying and natural feedback down-regulation of supply.

Decreasing milk production is equally simple. Increase intervals between feeds, for example by one-breast feeding with only short times on the second breast, back to the emptier first breast for a couple of hours, monitoring the unsuckled breast and expressing only to comfort and to avoid mastitis. Within 24-48 hours of one-breast feeding supply will drop, sometimes catastrophically. It's disaster to suggest this to new mums with oversupply, as many hospital-based midwives have done. The mums go on for more than 24-48 hours and then wonder why their milk has gone. Lying face down compressing boobs, wearing a tight crop top or bra, creating pressure feedback, and you may achieve the same outcome via mastitis. (In a breast with no skin damage, most mastitis starts with milk leaking into breast tissue where it shouldn't be, under pressure.)

Mums need to know what an efficient working breast feels like: soft and flexible even when heavy with milk, filling up, softening again after a feed; maybe tight and tense to touch if the interval is too long but immediately relieved by milk removal. Warm but not heated, not reddened skin. Not lumpy, even up in the armpits where there is some glandular tissue in many women. There's always a reason for any change and thinking though exactly what's happened can find it, and prevent recurrences.

There is a lot more in Breastfeeding Matters 1998 edition that would be of interest and relevance, in chapters on milk supply, nipple problems and mastitis. Breastfeeding is a skill that has to be learned, and without early practical support and understanding of how supply is regulated, women struggle."

# data[].attributes.attachment_link.title
Milk Production - What All Breastfeeders Need To Know by Maureen Minchin

# data[].attributes.attachment_link.description
Maureen Minchin BA(Hons), MA (Melb), TSTC is a medical historian and health educator, and author of Milk Matters. She is all that, AND she is an active contributor in our Breastfeeders in Australia community on Facebook. Maureen recently sent me this post and asked me to share it far and wide, so I'm uploading it onto our website to facilitate that.

# data[].attributes.attachment_link.readable_text
By Kelly Bonyata, BS, IBCLC

Introduction

Milk supply normally varies somewhat throughout the day and over weeks and months. As long as baby is allowed to nurse on cue, your milk supply will typically accommodate baby's needs. However, when you are pumping part-time or full-time, pumping output can become an issue due to a few factors:

The ability to measure how much milk you are pumping makes any decrease in pumping output more obvious and more worrying, even when it's a normal variation.

You generally need to pump x amount of milk for baby for a particular day, and it can be quite stressful when you do not pump this amount.

No pump can remove milk from the breast as well as an effectively nursing baby, so pumping does not maintain milk supply as well as a nursing baby. Because of this, the greater the percentage of baby's nourishment provided by pumping (rather than direct breastfeeding), the greater the possibility that you may have to work harder to maintain supply.

What is normal when it comes to pumping output and changes in pumping output?

It is typical for a mother who is breastfeeding full-time to be able to pump around 1/2 to 2 ounces total (for both breasts) per pumping session. Mothers who pump more milk per session may have an oversupply of milk, or may respond better than average to the pump, or may have been able to increase pump output with practice. Many mothers think that they should be able to pump 4-8 ounces per pumping session, but even 4 ounces is a rather large pumping output for a mom who is breastfeeding full-time.

It is not unusual to need to pump 2-3 times to get enough milk for one feeding for baby (remember that the pump cannot get as much milk as a baby who nurses effectively).

Many mothers are able to pump more milk per session when they are separated from baby or if they are exclusively pumping. Milk pumped when you are breastfeeding full-time is "extra" milk - over and beyond what baby needs. Don't get discouraged if you are trying to build up a freezer stash when breastfeeding full time and don't get much milk per pumping session - this is perfectly normal and expected.

It is very common to have more milk than baby needs in the early weeks, which regulates down to baby's needs over the first few weeks or months. When your milk supply regulates (this change may occur either gradually or rather suddenly), it is normal for pumping output to decrease. For moms who have oversupply, this change often occurs later (6-9+ months postpartum rather than 6-12 weeks).

It is normal for pumping output to vary from session to session and day to day. Having an occasional low volume day is not unusual.

During a growth spurt, don't be surprised if baby drinks more expressed milk than usual, making it harder for mom to provide enough expressed milk. Growth spurts are temporary - try increasing nursing and adding a pumping session or two until the growth spurt is over.

Menstruation or ovulation can result in a temporary drop in milk supply. You might also notice cyclical dips in milk supply before your period returns, as your body begins the return to fertility. Hormonal changes also cause milk supply to decrease during pregnancy.

Remember that the amount of milk that you pump is not a measure of the milk supply available to your baby at the breast!

What can cause a decrease in pumping output?

First, consider the possibility that baby is being overfed by bottle when you and baby are separated. If this is the case, you may actually not need to be expressing as much milk as is being requested. This is certainly not always the case, but it is not at all uncommon. See How much expressed milk will my baby need? for additional information.

When you do need to pump more milk, the first thing to check is your pump:

Are you using an appropriate pump for the amount of pumping that you do?

How old is your pump? If you have an older electric pump (particularly older than a year), or if you are pumping more often than the pump was designed for, the motor may be wearing out.

Many times a decrease in pumping output is because pump parts need to be replaced. Have you checked your pump and replaced any parts that are worn or that haven't been replaced in the last 3-6 months?

Do you have a type of pump (check your user manual) that benefits from occasionally boiling the boilable parts?

Switching to a larger pump flange makes a difference in pumping comfort and/or output for some moms. See Choosing a Correctly-Fitted Breastshield for more information.

Supply-demand cycle:

Have you reduced the number of pumping or nursing sessions recently, or cut back on nursing/pumping in other ways? Milk production is a demand-supply process. More nursing/pumping results in a greater milk supply. If you consistently decrease nursing or pumping for several days, your overall milk supply will decrease and you can expect to see a decrease in pumped amounts.

Has baby started solids recently? As baby eats more solids and takes in less milk, overall milk supply naturally decreases and you may see a decrease in pumping output. You may not notice a change in nursing pattern, as some babies nurse just as often, but take in less milk during those sessions. If baby started solids early (before around 6 months) or is eating lots of solids early on, you are more likely to notice a drop in supply. A very gradual start to solids around 6 months or later is less likely to affect milk supply.

Hormonal causes of decreased milk supply:

Have you started hormonal birth control recently? Hormonal birth control, particularly that containing estrogen, can significantly decrease milk supply.

Are you expecting either ovulation or your period soon, or has it recently started?

Are you pregnant?

Taking care of mom:

Have you started a strict diet? Are you getting enough calories? Snacking during the day on healthy, protein-rich foods may be helpful.

Are you drinking to thirst? Some moms, particularly when they are at work, will get busy and forget to drink enough fluids.

Are you getting enough rest? This can be hard to do when you have a baby. Try to go to bed a little earlier and to take a nap each day on your days off. Consider co-sleeping so you can get more sleep. Just a little added rest may make a big difference.

Have you been under an unusually large amount of stress? Stress can affect let-down and pumping output.

Have you been sick? Illness, especially if you have a fever, mastitis or get dehydrated, can result in a temporary decrease in milk supply. Some medications can also decrease milk supply (hormonal birth control, pseudoephedrine, ethanol/alcoholic beverages, bromocriptine, ergotamine, cabergoline...).

See also Hidden Hindrances to a Healthy Milk Supply

How can I increase pumping output?

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

Increasing frequency

Nurse more often when you are with your baby.

Are you pumping frequently enough? Is there any way you can add a pumping session at work? If necessary, when pumping times are very limited, adding even a short 5 minute pumping session is better than not pumping at all.

Add a pumping session or two outside of work hours or on the weekend. Try pumping after baby nurses, or pump one side while baby nurses on the other side. You might also try pumping while baby is napping, at night, or when baby goes longer than usual between nursings.

Does your baby complain about slower milk flow when you pump between nursings? If so, try single pumping between nursings, instead of double pumping. Although single pumping is not as effective for increasing milk supply, this leaves one breast more full, so the milk will flow more quickly. See also these tips for babies who want a faster milk flow.

Try cluster pumping, instead of a regular nursing/pumping session. Sit down with your baby and your pump, and nurse and pump every half-hour to hour for several hours.

Some moms find it helpful to do a 2-3 day long power pump every couple of weeks to "super charge" their milk supply. This is simply a nursing vacation with pumping added in. On these days, get lots of rest, nurse very frequently and pump after as many nursing sessions as possible.

Removing more milk from the breasts

Are you pumping long enough? When pumping to increase milk supply, it's recommended that you (double) pump for at least 15 minutes; to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. If you don't always have time to pump this long, remember that adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.

Use a good double pump. Double pumping generally results in better pumping output and is better for maintaining milk supply. Pump quality can make a huge difference in pumping output, and different moms have better results with different pumps. However, some moms with abundant milk supplies do not respond well to pumping (even using the best of pumps) and do not get much milk when pumping. These moms may get better results using manual expression.

Use breast massage and breast compression.

If your pump has a soft shield or shield insert available (for example, the Medela Comfort breastshield or the Ameda Flexishield insert), then try using the pump with and without it. Some moms get better results with the softer shield; some get better results without it.

Switching to a larger pump flange increases pumping output for some moms. Scroll down here for more information on sizing the flange.

Galactagogues

Many working and pumping moms have found that eating oatmeal and staying hydrated is very helpful for increasing pumping output. It can be helpful to snack on protein-rich foods during the day and to have something to drink every time you sit down to pump or breastfeed.

Many moms have gotten good results using fenugreek or other herbs to increase supply, either on a short- or long-term basis. This is most effective when combined with increased nursing/pumping.

Other things to try

The following things are useful for maximizing nursing and minimizing the amount of expressed milk that baby needs while you are away.

Nurse right before you leave baby and immediately after you return from work. Make sure your care provider does not feed baby right before you are due to return.

Has your baby started solids? If so, have your care provider offer all (or most) solids, and only (or mainly) breastfeed when you are with baby. By doing this, baby may need less milk when you are apart (due to the solids) and will nurse more when you are together. This can both help your supply (more nursing) and decrease the amount of pumped milk you need to provide.

Encourage baby to " reverse cycle " - reverse cycling is when baby nurses frequently when mom and baby are together (usually at night) and takes little milk when mom & baby are separated.

One study has shown that the moms of hospitalized babies who listened to guided relaxation or soothing music while pumping had an increased pumping output. When mom listened to a recording that included both music and guided relaxation while pumping, in addition to looking at photos of her baby, pumping output was increased even more. In this study, the interventions led to moms producing 2-3 times their normal pumping output. Milk fat content also increased for these moms in the early days of the study.

Additional information

Increasing Low Milk Supply @KellyMom

Let-down Reflex: Too slow? @KellyMom

How Much Milk Should You Expect to Pump? by Nancy Mohrbacher, IBCLC, FILCA

What to Expect When Pumping by Paula Yount

How much expressed milk will my baby need? @KellyMom

To Pump More Milk, Use Hands-On Pumping by Nancy Mohrbacher, IBCLC, FILCA

Breastpumps - troubleshooting and general info @KellyMom

Ouch! What If Pumping Hurts? by Nancy Mohrbacher, IBCLC, FILCA

Working & Pumping Tips @KellyMom

See the Working, Pumping, Bottle Feeding menu for information on formula and other foods

Keith DR, Weaver BS, Vogel RL. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 2012 Apr;12(2):112-9.

# data[].attributes.attachment_link.title
I'm not pumping enough milk. What can I do? * KellyMom.com

# data[].attributes.attachment_link.description
Milk supply normally varies somewhat throughout the day and over weeks and months. As long as baby is allowed to nurse on cue, your milk supply will accomodate baby's needs. However, when mom is pumping part-time or full-time, pumping output can become an issue due to a few factors.

# data[].attributes.headline
Technique for maximising milk production during pumping

# data[].attributes.subject
Technique for maximising milk production during pumping

# data[].attributes.attachment_link.readable_text
For premature babies, mother's milk is like a medicine. Any infant formula these babies receive increases their risk of serious illness, so these mothers were under a lot of pressure to pump enough milk to meet their babies' needs.

Amazingly, when these mothers used their hands as well as their pump to express milk, they pumped an average of 48 percent more milk than the pump alone could remove. According to another study, this milk also contained twice as much fat as when mothers used only the pump. According to previous research, in most mothers exclusively pumping for premature babies, milk production falters after three to four weeks. But the mothers using this "hands-on" technique continued to increase their milk production throughout their babies' entire first eight weeks, the entire length of the study.

Hands-on pumping is not just for mothers with babies in special care. Any mother who pumps can benefit from it. How does it work? For a demonstration of this technique, watch the online video "How to Use Your Hands When You Pump" HERE. As a summary, follow these steps:

1. Massage both breasts.

2. Double pump, compressing your breasts as much as you can while pumping. (Search "hands free pumping" online for devices that fit any brand of pump and allow you to double pump with both hands free.) Continue until milk flow slows to a trickle.

3. Massage your breasts again, concentrating on areas that feel full.

4. Finish by either hand expressing your milk into the pump's nipple tunnel or single pumping, whichever yields the most milk. Either way, during this step, do intensive breast compression on each breast, moving back and forth from breast to breast several times until you've drained both breasts as fully as possible.

This entire routine took the mothers in the study an average of about 25 minutes.

These two online videos demonstrate two different hand-expression techniques that can be used as part of hands-on pumping HERE and http://ammehjelpen.no/handmelking?id=907 (scroll down for the English version).

Hands-on pumping can be used by any mother who wants to improve her pumping milk yield or boost her milk production. Drained breasts make milk faster, and hands-on pumping helps drains your breasts more fully with each pumping.

# data[].attributes.attachment_link.title
To Pump More Milk, Use Hands-On Pumping - Nancy Mohrbacher

# data[].attributes.attachment_link.description
Would you like an effective method for pumping more milk? Until 2009, most of us assumed that when a mother used a breast pump, the pump should do all of the milk-removal work. But this changed when Jane Morton and her colleagues published a ground-breaking study in the Journal of Perinatology.

# data[].attributes.body
These videos are useful for anyone who is pumping

# data[].attributes.attachment_link.description
We use cookies to improve your experience. By continuing to use this site you are agreeing to our use of cookies.

# data[].attributes.headline
Establishing and maintaining a supply when your baby is not directly breastfeeding

# data[].attributes.subject
Establishing and maintaining a supply when your baby is not directly breastfeeding

# data[].attributes.attachment_link.readable_text
By Kelly Bonyata, BS, IBCLC

It is important to express your milk to establish and maintain milk supply if your baby is not nursing at all or not nursing well. By expressing, you will also have your milk available to feed baby - every bit of moms' milk that baby gets (even the tiniest amount) is like liquid gold.

When should mom start pumping?

If baby does not nurse immediately postpartum, mom should begin pumping within 6 hours of baby's birth - starting early makes a difference for future milk production.

What pump is best?

If baby is not nursing, seriously consider renting a hospital-grade pump (a multiple-user double pump such as those made by Ameda, Hygeia or Medela) that will allow you to pump both breasts at the same time. A hospital-grade pump is the best choice for maintaining or increasing milk supply.

If you are not able to rent a hospital-grade pump, consider buying a pump (preferably a quality double pump) and/or hand expression.

How much milk should mom be pumping if baby is not nursing?

Aim for pumping 750-800 mL (25-27 oz) per day by 7-10 days postpartum. If you have twins or higher order multiples, aim for pumping 800-950 mL (27-32 oz) by 14 days postpartum.

It's useful to evaluate mom's 24 hour pumping output at 10 days. If supply is borderline (350-500 ml / 11-17 oz) or low (less than 350 ml / 11 oz), then galactagogues (prescription meds or herbs to increase supply) or other interventions should be considered.

The research tells us that milk production at 2 weeks is an indicator of breastfeeding outcome, so it is important to get a good start. Even if milk production doesn't start out well, however, don't get discouraged-many moms will see an increase (even as late as 9-15 weeks after birth) if they continue with regular pumping.

How often should mom pump?

8-10 times per day: Until supply is well established, it is important to get at least eight good nursing and/or pumping sessions per 24 hours. Ten sessions per day is better, particularly if you have twins or higher order multiples.

These sessions don't need to be evenly spaced, but you should be nursing/pumping at least once during the night in the first few months or anytime you notice a decrease in supply. Avoid going longer than 5-6 hours without pumping during the first few months.

When pumping during the night, milk yield tends to be better if you pump when you naturally wake (to go to the bathroom or because your breasts are uncomfortably full) than if you set an alarm to wake for pumping.

If you are having a hard time getting in enough pumping sessions, adding even a short pumping session (increasing frequency even if milk is not removed thoroughly) is helpful.

How long should mom pump at each pumping session?

If baby does not nurse at all:

The first few days, before mom's milk comes in, hand expression is often the most effective way to express colostrum. Double pump for 10-15 minutes per session for additional stimulation.

Once mom's milk is in, pump for 30 minutes per session, or for 2-5 minutes after the last drops of milk.

If baby nurses but does not soften the breast well
Double pump for 10-15 minutes after nursing.

Empty the breast as thoroughly as possible at each session. To ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. Use breast massage prior to pumping, and massage and compressions during pumping to better empty the breasts and increase pumping output.

Additional tips

Rest & relax as much as possible.

Skin-to-skin (Kangaroo care) can make a significant difference in pumping output.

One study has shown that the moms of hospitalized babies who listened to guided relaxation or soothing music while pumping had an increased pumping output. When mom listened to a recording that included both music and guided relaxation while pumping, in addition to looking at photos of her baby, pumping output was increased even more. In this study, the interventions led to moms producing 2-3 times their normal pumping output. Milk fat content also increased for these moms in the early days of the study. (Reference: Keith DR, Weaver BS, Vogel RL. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 2012 Apr;12(2):112-9.)

If double pumping is difficult to coordinate in the beginning, then single pump, alternating sides. Move to double pumping as soon as you can.

Avoid any medications that might interfere with milk supply (hormonal birth control, pseudoephedrine, ethanol/alcoholic beverages, bromocriptine, ergotamine, cabergoline)

If supply is not increasing as expected by 7-10 days after birth, consider the use of galactagogues. Fenugreek, metoclopramide (Reglan) or domperidone (Motilium) can be helpful for increasing milk supply.

See Got Milk? for more information on milk supply.

References and additional information

Note: Premature infants are certainly not the only breastfed babies who have problems nursing at the breast, but much of the writing and research in this area involves premature babies and their mothers. Talk to your lactation consultant about adapting these guidelines for older babies.

@KellyMom

@ other websites

References

Mohrbacher N. Cutting Edge Breastfeeding Trends, Orlando, FL, June 9, 2004.

Wight NE. La Leche League International Conference Session-The Premature Infant and Breastfeeding: Myth, Reality and Evidence-Based Practices, San Francisco, CA, July 5, 2003.

Furman L, Minich N, Hack M. Correlates of lactation in mothers of very low birth weight infants. Pediatrics. 2002 Apr;109(4):e57.

Meier PP. Breastfeeding in the special care nursery. Prematures and infants with medical problems. Pediatr Clin North Am. 2001 Apr;48(2):425-42.

Hill PD, Aldag JC, Chatterton RT. Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants. J Hum Lact. 2001 Feb;17(1):9-13.

da Silva OP, Knoppert DC, Angelini MM, Forret PA. Effect of domperidone on milk production in mothers of premature newborns: a randomized, double-blind, placebo-controlled trial. CMAJ. 2001 Jan 9;164(1):17-21.

Hill PD, Aldag JC, Chatterton RT. Effects of pumping style on milk production in mothers of non-nursing preterm infants. J Hum Lact. 1999 Sep;15(3):209-16.

Bier JA, Ferguson AE, Morales Y, Liebling JA, Archer D, Oh W, Vohr BR. Comparison of skin-to-skin contact with standard contact in low-birth-weight infants who are breast-fed. Arch Pediatr Adolesc Med. 1996 Dec;150(12):1265-9.

Anderson GC. Current knowledge about skin-to-skin (kangaroo) care for preterm infants. J Perinatol. 1991 Sep;11(3):216-26.

# data[].attributes.attachment_link.title
Establishing and maintaining milk supply when baby is not breastfeeding * KellyMom.com

# data[].attributes.attachment_link.description
It is important to express your milk to establish and maintain milk supply if your baby is not nursing at all or not nursing well. By expressing, you will also have your milk available to feed baby - every bit of moms' milk that baby gets (even the tiniest amount) is like liquid gold.

# data[].attributes.attachment_link.readable_text
Is your baby healthy? These guidelines are intended for full-term, healthy babies at home. If your baby is hospitalized, your hospital's milk storage guidelines are likely shorter than these. Preterm and sick babies are more vulnerable to illness, so pumping and storing recommendations may be stricter.

How much expressed milk does your baby get? If your baby gets most of her milk directly from your breasts, you don't need to worry about whether the small amount of expressed milk she gets is fresh, refrigerated, or previously frozen. If a large percentage of your baby's milk intake is pumped milk, consider your choices more carefully. Freezing kills antibodies, so rather than freezing all of your pumped milk, feed as much fresh or refrigerated milk as possible. But even without the antibodies, frozen milk is still a far healthier choice than formula.
Milk Storage Times for Full-term Healthy Babies at Home Room Temperature (66°F-72°F/19°C-22°C)
* Fresh, never frozen: 6-10 hr

* Frozen then thawed: 4 hr

* Frozen then thawed, warmed but not fed: Until feeding ends

* Frozen then thawed, warmed and fed: Until feeding ends
Room Temperature (73°F-77°F/23°C-25°C)
* Fresh, never frozen: 4 hr

* Frozen then thawed: 4 hr

* Frozen and thawed, warmed but not fed: Until feeding ends

* Frozen then thawed, warmed and fed: Until feeding ends
Insulated Cooler with Ice Packs
* Fresh, never frozen: 24 hr

* Frozen, thawed: Do not store

* Frozen then thawed, warmed but not fed: Do not store

* Frozen then thawed, warmed and fed: Do not store
Refrigerator (39°F/4°C)
* Fresh, never frozen: Ideal: 72 hr, Okay: 8 days

* Frozen then thawed: 24 hr

* Frozen then thawed, warmed but not fed: 4 hr

* Frozen then thawed, warmed and fed: Discard
Refrigerator Freezer (variable 0°F/-18°C)
* Fresh, never frozen: 3-4 mo.

* Frozen then thawed: Do not refreeze

* Frozen then thawed, warmed but not fed: Do not refreeze

* Frozen then thawed, warmed and fed: Discard
Separate Deep Freeze (0°F/-18°C)
* Fresh, never frozen: Ideal: 6 mo, Okay: 12 mo.

* Frozen then thawed: Do not refreeze

* Frozen then thawed, warmed but not fed: Do not refreeze

* Frozen then thawed, warmed and fed: Discard

Jones, F. Best Practices for Expressing, Storing and Handling Human Milk, 3rd edition. Raleigh, NC: Human Milk Banking Association of North America, 2011.

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

# data[].attributes.attachment_link.title
Why Do Milk Storage Guidelines Differ? - Nancy Mohrbacher

# data[].attributes.attachment_link.description
Is your baby healthy? These guidelines are intended for full-term, healthy babies at home. If your baby is hospitalized, your hospital's milk storage guidelines are likely shorter than these. Preterm and sick babies are more vulnerable to illness, so pumping and storing recommendations may be stricter. How much expressed milk does your baby get?

# data[].attributes.body
Some women find the cup bit of their pump uncomfortable. Here is a link to a way of measuring which flange insert to get. . . Issue then is getting one. . .

# data[].attributes.attachment_link.readable_text
Using the correct sized breastshield is so important. Here at Pumpables we understand that not all women are the same, which is why we've included 3 different sized breastshields with the Milk Genie. We sell breastshields ranging in size from 19mm to 30mm; and, you can find breasthields on the market as small as 15mm and as large as 36mm.

How do I find my breastshield size?

Not all nipples are the same size, so you might be wondering how to select the right breastshield size for you. Search no more - all you need is a pair of scissors, access to a standard sized printer* and our easy to use nipple ruler!

* Our nipple ruler works on both US Letter and A4 paper sizes. You can also print it on larger sizes like US Legal or A7, but you might have to trim off the extra. 🙂

The easiest way to measure your nipple

Our nipple ruler is so easy to use - no fussing with counting tiny tick marks because our measurements are printed big enough to see! Simply print it out, fold along the line, and carefully cut out the circles.

At the end of your pumping session, use the circles to measure the diameter of your nipple at the base. You should select a size that leaves 2-3mm of space around your nipple.

# data[].attributes.attachment_link.title
Breast Shield Sizing Guide: Free Nipple Ruler Print Out (Updated: 2017)

# data[].attributes.attachment_link.description
Using the correct sized breastshield is so important. Here at Pumpables we understand that not all women are the same, which is why we've included 3 different sized breastshields with the Milk Genie. We sell breastshields ranging in size from 19mm to 30mm; and, you can find breasthields on the market as small as 15mm and as large as 36mm.