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Breastfeeding: is my baby getting enough milk?

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How to tell if your breastfed baby is getting enough milk, signs your baby is properly attached and feeding well, plus ways to boost your breast milk supply.

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National Breastfeeding Helpline - Helpline

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This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website.

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LLL Hertfordshire [Wheathampstead] – La Leche League GB

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Welcome to La Leche League Hertfordshire! Anyone who is pregnant or interested in breastfeeding is very welcome to join our meetings, whatever age and stage you

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Social sources of support in Hertfordshire

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Social sources of support in Hertfordshire

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Breastfeeding Social Group - Free drop in
The BECC Family Centre, Borehamwood, WD6 2FD
Weekly Wednesdays 09:30 - 10:30

Breastfeeding Social Group - Free drop in
De Havilland Family Centre, Hatfield, AL10 8TQ
Weekly Fridays 12:30 - 14:30

Breastfeeding Social Group - Free drop in

St. Georges URC, HP1 2HX Friday mornings 09.30 to 10.30

Breastfeeding Social Group - Free drop in

Selections Family Centre, Hertford, SG14 2DG

Weekly Thursdays,13:00 - 15:00

Breastfeeding Social Group - Free drop in
Oughton Family Centre, Hitchin, SG5 2NZ
Weekly Wednesdays 10:00 - 11:00

Breastfeeding Social Group - Free drop in
The Ark Family Centre, Hoddesdon, EN11 8HT
Weekly Tuesdays 14:30 - 15:30

Breastfeeding Social Group – Free drop in
Broadwater Family Centre, Stevenage, SG2 8LT
Weekly Tuesdays 14:00 - 15:00

Breastfeeding Social Group - Free drop in
Westfield & Littlebury Family Centre, Watford, WD18 6NS
Weekly Thursdays 13:00 - 14:30

Breastfeeding Social Group - Free drop in
Woodhall Primary School, Woodhall Lane, South Oxhey, Watford WD19 6QX

Weekly Mondays 10:00 - 11:00

Breastfeeding Social Group - Free drop in
Weekly Mondays 10:00 - 11:00
London Colney Family Centre, AL2 1JG (Al2 1JF)
Weekly Thursdays 10:00 - 11:00

Breastfeeding Social Group - Free drop in

2B The Square, Sawbridgeworth, CM21 9AE

Weekly, Tuesdays, 13:00 - 15:00

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East and North Hertfordshire Teaching NHS Trust

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The benefits of colostrum/breastmilk for your baby - Watch from 28 weeks of pregnancy

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1pm - 4pm at Oughton Head Family Centre, Mattocke Road, Hitchin SG5 2NZ

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All about Government help with childcare costs, including 15 to 30 hours free childcare, Tax-Free Childcare, tax credits, Universal Credit, vouchers and support while you study

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Jenny Robinson runs an appointment only clinic on a

Friday

Hertford Wellbeing Hub.

Glenfield Court SG14 2HN

11.00 - 13.30

Please contact Jenny Robinson on 07918468740 to make an appointment. Jenny only sees babies up to 28 days

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

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

Why is breastfeeding important?

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

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

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

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

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

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

What do I need to know about breastfeeding?

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

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

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

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

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

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

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

Women and parents enjoy feeding more when they are comfortable and relaxed.

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

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

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

Here are 10 tips:

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

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

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

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

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

There's no need to eat anything special while breastfeeding, but it's a good idea to encourage your partner to eat and drink regularly.

Help them get specialist support if they're struggling with breastfeeding. As mentioned above, you can both talk to one of our breastfeeding counsellors on 0300 330 0700.

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

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

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

(Rempel et al, 2010)

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

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

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

Tips for being a hands-on partner with your baby

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

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

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

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

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

How can I share feeding our baby?

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

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

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

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

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

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

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

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

Many places now welcome breastfeeding and have special facilities for feeding in private.

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

At the end of the day...

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

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

You might find attending one of our NCT New Baby courses helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Visit our breastfeeding support contacts page.

NHS Choices breastfeeding information.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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How can partners support breastfeeding? | NCT

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This article looks at how partners can help support breastfeeding in the early days.

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This information can also be viewed as a PDF by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.
In 2012 the Chief Medical Officer in the UK made recommendations about supplementing all pregnant and breastfeeding mothers and children with Vitamin D. There seems to remain a lot of confusion as to who should take these supplements, why this is necessary and how to obtain them. The recommendations were updated in July 2016 in line with the SACN recommendations on vitamin D and health.

Breastfed babies from birth to one year of age should be given a daily supplement containing 8.5 to 10mcg of vitamin D as a precaution (SACN 2016)

Breastfeeding Mothers should also take a daily Vitamin D supplement of 10 µg per day

Vitamin D deficiency in the UK is a consequence of our weather and the latitude at which we live.

Breastmilk is perfect for babies

Vitamin D drops should be given to babies on a teaspoon as droppers are hard to sterilise

Healthy Start Vitamins remain an excellent, economic source of vitamin D and are provided free of charge in many areas. The daily dose of 5 drops contains 10µg www.healthystart.nhs.uk/for-health-professionals/vitamins/

Babies born to mothers with low vitamin D status are at risk of developing rickets. Taking into account that MOST of us are deficient between October and April at best and MANY of us will have low levels throughout the year, the recommendation that ALL pregnant women should take a supplement of 10 µg Vitamin D per day throughout pregnancy is sensible and cost effective (Prevention of rickets and vitamin D deficiency in Birmingham: the case for universal supplementation).

Babies born to mothers who have not taken a vitamin D supplement in pregnancy are likely to be born with low vitamin D status. Levels of vitamin D in that mother are also likely to be low and even if she begins to take a supplement herself at that time, cannot redress the baby's deficiency by breastfeeding. So the recommendation is that the baby should receive its own oral vitamin D drops containing 7-8.5µg per day from 4 weeks of birth until the age of 5 years. Waiting until the baby is 6 months may be too late to prevent development of symptoms. Mothers may also develop symptoms of deficiency themselves.

Although it was thought that levels of vitamin D stores laid down in pregnancy by a mother who has taken vitamin D supplements in pregnancy would be sufficient for a few months,
new recommendations (July 2016) are that breastfed babies from birth to one year of age should be given a daily supplement containing 8.5 to 10mcg of vitamin D, to make sure they get enough ( www.nhs.uk/Conditions/vitamins-minerals/Pages/Vitamin-D.aspx). In addition breastfeeding mothers should take a daily Vitamin D supplement of 10 µg per day - in fact as more and more conditions are linked with lack of vitamin D most of us would benefit from taking it regularly.

In children; rickets, delayed tooth eruption, increased risk of infection, decreased bone mass, hypocalcaemic seizures, delay in walking.

In adults; osteomalacia, muscle weakness, bone pain plus possible association in many other conditions.

Mothers who are diagnosed with vitamin D deficiency may be prescribed very high dose supplements. Papers looking at these doses are scarce. Hollis and Wagner (2004) concluded that "Maternal vitamin D intakes of 4000 IU/d appear to be safe and to provide sufficient vitamin D to ensure adequate nutritional vitamin D status for both mothers and nursing infants. Hollis et al 2015 that "Maternal vitamin D supplementation with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy her nursing infant's requirement and offers an alternate strategy to direct infant supplementation.

For information on high dose vitamin D prescribed for breastfeeding women see https://breastfeeding-and-medication.co.uk/fact-sheet/high-dose-vitamin-d-supplements-and-breastfeeding

Oily fish including trout, salmon, mackerel, herring, sardines, anchovies, pilchards, and fresh tuna

Cod liver oil and other fish oils

Egg yolk; 0.5 micrograms (20 IU) per yolk)

Mushrooms

Supplemented breakfast cereals typically contain between 2 and 8 micrograms (80-320 IU) per 100 g

Margarine

The average dietary vitamin D intake of young women in the UK approximates 3 micrograms per day and fewer than 1% consume more than the 10 micrograms (Williams 2007). The National Diet and Nutrition Survey of British adults suggest that if such a threshold were investigated in the UK population data, some 80-90% would be deficient (Henderson 2003).

The main source is Ultraviolet B sunlight exposure; more than 90% of mankind's vitamin D supply is derived from exposure UVB in sunlight. Deficiency of vitamin D in the UK is predominantly caused by poor weather, increasing use of high factor sunscreen (more than factor 8), and latitude: those born north of approximately Birmingham (40°N) are unlikely to be able to reach sufficient exposure.

Sunlight exposure needed is 2 hours per day (if only the face exposed), 20-30 minutes a day if the face, arms and neck are exposed without sunscreen. Sun protection factor in excess of 8 prevents absorption of the UVB sufficient to make vitamin D. Need increases for those with darker skins. In all cases it is important to avoid sunburn, particularly in babies.

Those who are eligible for Healthy Start vouchers receive free vitamin tablets and drops containing the correct dose of vitamin D for mothers and children.

Those not eligible for Healthy Start may purchase vitamin supplements form pharmacies and Health Food Stores - please check that they contain 10µg for adults and at least 7-8.5µg for children (usually 10 µg).

Vitamin D deficiency in the UK is a consequence of our weather and the latitude at which we live. The addition of vitamin D to formula milk does not make it better than breastmilk - it does not contain all the immunological properties that make breastmilk specific to cater for each baby's needs.

Some mother and infant groups have been shown to be at increased risk, including:

Babies of mothers with darker skin types

Pregnant and breastfeeding women.

Babies born in the winter months and not exposed to the sun

Babies and mothers who wear concealing clothing, preventing skin exposure to sunlight

Babies and mothers who spend a lot of time indoors or use sun creams, reducing exposure to sunlight

Babies of obese mothers (BMI >30)

Babies of mothers with gestational diabetes.

Ahmed SF et al. Recent trends and clinical features of childhood vitamin D deficiency presenting to a children's hospital in Glasgow. Arch Dis Child 2011;96:694-6 http://adc.bmj.com/content/96/7/694.full.pdf+html

American Academy of Paediatrics Prevention of Rickets and Vitamin D deficiency in infants, children and adolescents 2008 http://pediatrics.aappublications.org/content/122/5/1142.full.pdf+html

CMO Vitamin D supplements for at risk groups. dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_132508.pdf

Department of Health. Vitamin D an essential nutrient for all, but who is at risk of vitamin D deficiency? http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_111302.pdf

Henderson L, Irving K, Gregory J, et al. The National Diet and Nutrition Survey: adults aged 19 to 64 years. Vol 3. Vitamin and mineral intake and urinary analytes . London: Stationery Office, 2003: 1-160.

Hollis BW, Wagner CL. Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr. 2004;80(Suppl 6):1752S-1758S

Hollis BW, Wagner CL, Howard CR, Ebeling M, Shary JR, Smith PG,Taylor SN, Morella K, Lawrence RA,Hulsey TC, Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial. Pediatrics 2015;136 (4):

Jones W. Breastfeeding and Medication Routledge 2018

Michie C. Managing vitamin D deficiency in children. London Journal of primary care July 2010 londonjournalofprimarycare.org.uk/articles/3186685.pdf

NHS Choices. nhs.uk/news/2012/01January/Pages/vitamin-d-medical-advice-and-supplements.aspx

Prevention of rickets and vitamin D deficiency in Birmingham: the case for universal supplementation. infantfeedingwm.org.uk/documents/Website_VitD.pdf

SACN Update on Vitamin D 2007. sacn.gov.uk/pdfs/sacn_position_vitamin_d_2007_05_07.pdf

SACN Vitamin D and Health 2016 www.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network June 2020

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Vitamin D and Breastfeeding - The Breastfeeding Network

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

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How much vitamin D to take

If you're breastfeeding, you should consider taking a 10mcg daily vitamin D supplement.

If your baby is only having breast milk (no first infant formula top-ups), you should give them a daily vitamin D supplement of 8.5 to 10mcg.

Vitamin D is found in certain foods - including oily fish like salmon, sardines and mackerel; red meat; and some breakfast cereals - but it's hard to get enough from food alone.

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Find out which vitamins mum and baby need when breastfeeding.

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Breastfeeding antenatal workshop - Getting breastfeeding off to a good start

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This is "Breastfeeding antenatal workshop - Getting breastfeeding off to a good start" by HCT NHS Trust on Vimeo, the home for high quality videos and…

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How to express your breast milk - Start for Life

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Find out how to express your breast milk and how to store it safely.

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Why combine breast and bottle feeding?

Mixed feeding may be a good option if you want to share the feeding responsibility with your partner or family members.

It may also be suitable if you're:

mainly breastfeeding but also want to offer expressed milk or infant formula

bottle feeding but want to start breastfeeding

returning to work or study and need to provide bottle feeds while you're away

struggling with breastfeeding and need to give your baby some formula

Whatever your reasons for mixed feeding, it's recommended that you breastfeed exclusively for 6 to 8 weeks after the birth (to allow you time to get the hang of it).

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Introduction to mixed feeding - Start for Life

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Learn more about the different reasons to combine breast and bottle feeding, and find out which method is best for you.

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Hayley Dean runs a clinic at Royston Family Centre, Burns Road, SG8 5EQ every Wednesday 09.30am - 11.00am. For more information contact Hayley Dean on 07918468660 or email hayleydean@nhs.net

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•Please come along to our free breastfeeding workshop for more information and support on feeding your baby

•Workshops are held two evenings a month, in Bancroft at Lister hospital

•Run by our Infant feeding coordinators Jenny and Steph

•You are welcome to bring a partner or friend

•Please Phone Jenny –Certified Lactation Consultant 07789935612/or Steph 07833294916

•Or email infantfeeding.enh-tr@nhs.net in advance to book onto a workshop

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Breastfeeding Out and About in Hertfordshire

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National Breastfeeding Helpline night - 9:30pm – 9:30am

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National Breastfeeding Helpline night - 9:30pm – 9:30am

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Thursday

Letchworth Infant feeding drop in clinic.

Icknield Family Centre, Archers Way, Letchworth SG6 4UN.

13.00-16.00. No need to book

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How to tell if your baby is getting enough milk

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How to tell if your baby is getting enough milk

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Is Your Baby Getting Enough Milk – Breastfeeding Series

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Positions for Breastfeeding - Breastfeeding Series

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Breastfeeding/Chest feeding videos in different languages

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Breastfeeding/Chest feeding videos in different languages

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Early Initiation of Breastfeeding - Breastfeeding Series

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Attaching Your Baby at the Breast – Breastfeeding Series

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The Infant feeding team are here to support you regardless of feeding method.

The team includes from left to right Jenny Larkins Vick Hollyman and Steph Harrison-Barker

Any questions please ring:

Jenny Larkins 07789935612

Steph Harrison-Barker 07833294916

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Breastfeeding a baby with Down syndrome baby

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Breastfeeding a baby with Down syndrome baby

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https://indd.adobe.com/view/4f0411c6-148c-4551-ba2a-05f9a94adc1e

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Brilliant series of social media posts from National Breastfeeding Helpline and The Breastfeeding Network.

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Brilliant series of social media posts from National Breastfeeding Helpline and The Breastfeeding Network.

# data[].attributes.attachment_caption
Brilliant series of social media posts from National Breastfeeding Helpline and The Breastfeeding Network.

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Brilliant series of social media posts from National Breastfeeding Helpline and The Breastfeeding Network.

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https://www.laleche.org.uk/caesarean-birth-and-breastfeeding/

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During pregnancy your body is preparing to give birth and your breasts are getting ready to feed your baby. If you are told you need to have a caesarean birth you may wonder if you will still be able to breastfeed as you planned. Mothers successfully breastfeed after a caesarean birth and you can expect your healthcare professionals to support you with getting breastfeeding established straight away.

Whichever way we give birth, our bodies need time to recover and to adjust to feeding a new baby. Birth by caesarean usually means a longer hospital stay, and a longer recovery time because this is major abdominal surgery so practical support from friends and family can make a big difference to you.

Before the birth
Common concerns
A good start for breastfeeding
Practical help and support

Before the birth

Whichever way you will be giving birth, find out as much as you can beforehand about labour and breastfeeding. Whilst some aspects will be out of your control, choosing your place of birth and your caregiver can reduce your chance of a caesarean.

An induced birth can lead to more interventions, increasing the chance you'll need a caesarean.

Continuous support during labour from a woman you feel comfortable with and trust can reduce the risk of a caesarean birth.

Simple things like eating and drinking, moving around and relaxation can improve your experience of labour.

Tell hospital staff beforehand that you plan to breastfeed and to emphasise:

You want to keep your baby with you, provided neither of you needs special care.

You don't want your baby to be given bottles or dummies without your permission, because this will interfere with breastfeeding.

An unplanned caesarean
A caesarean after a long or difficult labour can leave you feeling extremely tired and frustrated. However the hormones released during labour have already prepared you and your baby for breastfeeding.

A planned caesarean
Knowing in advance that you will be having your baby by caesarean can let you prepare, both emotionally and practically. When possible, going into labour first can help get breastfeeding off to an easier start. If you have had a previous caesarean, it is not always necessary to have one the next time. Discuss your options with your health professionals.

After an caesarean
Whether or not your caesarean was planned, you may still feel upset or sad about what happened and mourn the loss of the birth experience you were hoping for. It is quite understandable to feel this way and these feelings may affect the way you feel about your baby and breastfeeding at first.

Breastfeeding can give you confidence in your body's abilities. When you breastfeed, your baby needs you. The close physical contact can also help you to feel better emotionally. Breastfeeding helps your womb to contract, which will help you heal more quickly. And it's nature's way of ensuring you spend time sitting or lying down, resting and recovering.

Common concerns

IVs or drips
To make holding and feeding your baby easier, ask that your IV drip be inserted into your forearm, rather than in the back of your hand (and without the supporting board if one is used). You can request that your catheter be inserted after your spinal anaesthetic has taken effect, to make the procedure more comfortable.

The extra fluid from an IV can increase engorgement. Before breastfeeding, you can easy any swelling back by pressing your fingers around the nipple area (reverse pressure softening) and see Engorged Breasts-Avoiding and Treating for suggestions.

IV fluid will also transfer to your baby. This can lead to an artificially high brith weight which may result in a higher percentage weight loss in the early days. Weighing your baby at 24 hours old may give a more accurate baseline weight.

Anaesthetic
Any anaesthetic in your system will not be harmful to your baby. However the anaesthetic may make your baby very sleepy during the first few days-you may have to wake them up and encourage them to nurse. Keep them close and offer the breast whenever they stir.

Antibiotics and pain relief
Pain relief and antibiotics are routinely given after a caesarean. Pain relief will be essential to help you through the early days. Over the counter pain medications, such as paracetamol and ibuprofen, are considered safe for breastfeeding. If you need something stronger, then discuss this with your health care team, who can check which drugs are compatible with breastfeeding. You may need further antibiotics, but be aware that these increase the risk of a thrush infection for you and your baby.

A good start for breastfeeding

Express your milk
Separation or feeding problems are more likely if your baby is born early, if you have an induced birth, or if you have a health problem such as diabetes. It can be very helpful to express and store colostrum before the birth so that your milk will be available for your baby if separation occurs. See Antenatal Expression of Colostrum.

If your baby is a bit sleepy at first you can hand express drops of colostrum and give it on a spoon. You partner could help with this.

It can sometimes take a little longer to have a plentiful milk supply after a caesarean birth. Hand expressing frequently will encourage this process. If you baby needs a supplement offer it with a spoon, syringe, feeding cup or supplementer.

Breastfeed as soon as possible
You can breastfeed as soon as you are alert enough to hold your baby, in the recovery room or even on the delivery table. At this stage you will be free from pain as the anaesthetic will not have worn off. Although you may be lying flat on your back and may need some help positioning your baby, you don't need to be sitting up to breastfeed. Simply lying there, skin-to-skin is enough to prompt a baby to nuzzle onto your breast themself. If you are drowsy your partner can help by holding your baby close to you.

Skin-to-skin contact with your baby
It's important and never too late, to enjoy skin-to-skin contact with your baby. Tuck a blanket over both of you to keep warm. Skin-to-skin

Encourages your baby to latch on and feed frequently.

Helps colonise your baby's skin with your own individual 'good' bacteria.

Calms your baby and regulates their temperature.

Encourages bonding.

If your need for medical care prevents this happening straight away, your birth partner can step in. Babies still benefit from sking-to-skin contact even when they can't be with you.

Get comfortable for breastfeeds
Getting your baby attached well at the breast helps them to feed effectively and helps prevent nipple damage. Lying down, laid back or using the underarm position may be easiest at first. Use extra pillows for support and comfort-behind your back, under your arms or between your knees. A rolled up towel or small pillow can cover and protect your incision. . See Positioning & Attachment for tips. Be aware that pain relief can mask pain during breastfeeding. If your nipples are squashed or flattened after feeds, or look sore or damaged, seek help without delay.

Baby feeding cues
Mothers often find they need help responding to their babies' early feeding cues. If you feel groggy after birth, it helps if the people supporting you are aware of the signs your baby needs to feed. These include, in increasing urgency:

Opening their mouth, making sucking motions and turning their head (rooting) looking for the nipple.

Moving their tongue.

Furrowing their eyebrows-perhaps showing tension in their face.

Clenching and unclenching their fists.

Flexing their arms.

Moving their hands to their mouth.

Followed by restless movement.

Then crying-the last resort.

Practical help and support

It is useful to check hospital policies on visitors, so you can arrange as much help as possible. Even in hospital, it will be much easier with your partner, family member or friend to help you care for your baby. If you are on your own, ring for help from hospital staff when you need it.

Once at home, extra help will be essential. You will be recovering from major abdominal surgery and need to rest, recover and concentrate on nursing your baby. You may be advised not to drive for about six weeks. Organise as much help as possible with meals, laundry and essential housework, and with caring for any older children. Drink enough fluids to keep your urine pale, and eat a balanced diet. Simple meals will be easier to prepare.

See Supporting a Breastfeeding Mother and Adjusting to Motherhood include practical tips on making life easier after birth.

Support for breastfeeding
Try to contact an LLL Leader, attend an LLL meeting or join an LLL Facebook group before your baby arrives to establish your support network. The LLL Leaders and other mothers will be able to give you ongoing support and enouragement, along with useful practical ideas. You can find your local LLL group here.

Written by Sara Walters, Karen Butler, Sue Upstone, Bronwyn Davies and mothers of LLLGB.

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
NICE Clinical Guidance: Caesarean Section. www.nice.org.uk/guidance/ng192

Antenatal Expression of Colostrum
Birth and Breastfeeding
Beginning Breastfeeding
Comfortable Breastfeeding
Engorged Breasts - Avoiding and Treating
Hand Expression of Breastmilk
My Baby Won't Breastfeed
Positioning and Attachment
Sleepy Baby - Why and What to do
Supporting a Breastfeeding Mother
Treating Thrush

References
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.
Impacts of Birthing Practices on Breastfeeding 2nd edition, Smith, LJ. Jones and Bartlett Publishers, 2010.

You can buy this information in a printed leaflet from the LLLGB Shop here

Updated March 2022

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Caesarean Birth and Breastfeeding - La Leche League GB

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Breastfeeding Info A to Z

This information is on topics of interest to parents of breastfed children. It is general in nature and may not be pertinent to your family's lifestyle. It is not intended to be advice, medical or otherwise. If you have a serious breastfeeding problem or concern, please talk directly to a La Leche League Leader who will provide you with support, encouragement, and evidence-based information. LLLI does not engage in the practice of medicine; please consult a healthcare professional on any medical issue.

Food Allergies and Breastfeeding

Babies are more likely to develop allergies if there's a history of eczema, asthma, hay fever or food allergies in the family. If your baby has a family history of these conditions, breastfeeding your baby exclusively for the first six months will help to lower their risk.

Full Baby Wearing Article Spotlight On Baby Wearing In Kuwait
Llevar al bebé

Why Carry Your Baby in a Carrier or Sling?

Carrying your baby in a carrier or sling is a lovely way to meet needs for warmth and closeness. All parents can nurture their babies in this way; your baby's carer may also find it an invaluable tool while you are working or studying.

Babies carried in slings are calmer and cry less. In most cultures, where babies are held almost constantly, they are typically in a quiet alert state and rarely cry for more than brief periods.

Slings provide a gentle way of transitioning babies from the calm environment of the womb to that of the outside world. Babies in carriers continue to be rocked by their mothers' movements and to hear their heartbeats or learn a new caring adult's rhythms. This helps babies to regulate their own systems.

BIRTH CONTROL

Non-hormonal methods of contraception are compatible with breastfeeding though no method is 100% effective against pregnancy regardless of whether you are breastfeeding or not. Examples include:

Barrier methods (condom, diaphragm, cervical cap, sponge )

Non-hormonal IUD (coil)

Spermicides

LAM (Lactational Amenorrhea Method)

Natural Family Planning

Some hormonal methods of contraception may affect milk supply especially in the early months after birth. Examples include:

Contraceptive pill, including combination and progesterone only

Contraceptive implants, injections and patches

Hormonal IUD (coil)

Vaginal ring

Full Birth Control Article

WHAT SHOULD I DO IF MY BABY BITES ME?

A baby may bite during a nursing session for many different reasons - distraction, teething, cold or ear infection (it's hard for your baby to swallow while breastfeeding with a blocked nose). Once it has happened, it may cause you to be tense or fearful at the next feeding. Here are some thoughts that may help you based on questions that arise at this time:

MY BABY BIT ME! DOES THIS MEAN I HAVE TO WEAN?

Weaning is rarely the answer when a baby bites. It is important to identify the cause and work to correct it.
Full Biting Article

Words Used to Describe Breastfeeding

Breastfeeding is the word that is most often used to describe what happens when your baby suckles your milk at the breast. Your baby actively drinks and swallows your milk. You and your body respond to your baby in a shared relationship and experience that is both physical and emotional. Feeding your own baby directly from your own breast confers the maximum benefits for both you and your baby and LLLI considers this the optimal way of feeding a baby.
Full Words Used To Describe Breastfeeding Article

Breastfeeding and want a coffee? Consuming moderate amounts of caffeine is unlikely to impact your full term, healthy baby.

Human milk comes in a variety of colors. If you pump your milk you may see lots of variation in color: whereas formula milk always looks the same, the composition and appearance of human milk changes throughout the day, and even throughout a pumping session or feed.

Breastmilk may be white, yellow, clear or have a blue tint to it. Ingredients in many foods and beverages that you might ingest can also tinge your milk in a variety of ways. The following are possible variations:

Diets high in pureed or mashed yellow-orange vegetables (yams, squash, carrots etc) lead to high levels of carotene in milk, which can turn it yellow or orange. Carotene is completely harmless to babies - read our post on *link* carotenemia.

Food dyes used in carbonated sodas, fruit drinks, and gelatin desserts have been associated with milk that is pink or pinkish orange.

Greenish milk has been linked to consuming green- colored sports beverages, seaweed, herbs, or large amounts of green vegetables (such as spinach).

Full Color of Milk Article

Breastfeeding, Childbirth, and COVID-19
We continue to emphasize the critical importance of breastfeeding all babies whether newly born or older and whether someone has tested positive for COVID-19 or not. Being knowledgeable about the benefits of breastfeeding and risks of not breastfeeding is important for families as they make childbirth and infant feeding decisions.

Breastfeeding is the best means of protecting a baby from getting sick or of reducing the severity of a baby's illness if a baby does become ill.

LLLI supports the World Health Organization (WHO) recommendation for breastfeeding immediately after birth even when a positive COVID-19 test has been obtained. Breastfeeding is important for an infant who is born to anyone who tests positive for COVID-19 or who has a close family member who has tested positive. It is critical that all newborns be supported in breastfeeding within one hour after birth so they can benefit from the immunological components that colostrum provides.

Please see our full media release for more information.

Cup feeding can be used from birth. It is suitable for both expressed breastmilk and infant formula. You can use any clean, open cup with a smooth surface.

Cup feeding has no notable difference to bottles for average time per feed.
Full Cup Feeding Article

Breastfeeding is the most natural and normal way of feeding and nurturing your baby, and is highly valued in many cultures. Many mothers also find that although they feel proud of nursing their baby, they feel concerned about how to do this in a public place without drawing unwanted attention to themselves.

Being modest doesn't have to keep you and your baby at home (or hidden in the restrooms). It's easy to breastfeed discreetly in public if you wear the right clothes. A loose-fitting shirt or top that lifts or can be unbuttoned from the waist will let you feed your baby without exposing your breast, because the baby will cover the nipple and lower breast. You can also buy special nursing blouses, dresses, or shirts, with hidden slits and panels, or modify your existing clothes. If you wear a nursing bra, it's easiest to breastfeed discreetly if the bra can be pulled up or unfastened and re-fastened with one hand. Layering of clothes can often be helpful so that you can use the "one up, one down" method and lift your outer layer up and pull down a vest underneath. This is good for warmth too.
Full Discretion Article

Drip-Drop Feeding encourages babies to suckle at the breast. It helps you produce more milk through breast-nipple stimulation and makes moving from bottle to breast easier.

Every drop of breastmilk is precious, protecting your baby against germs that can make them sick. Breastfeeding saves lives, especially during emergencies.

Watch the video here.
Full Drip-Drop Feeding Article

Brand new baby? Tight, full breast? Baby having trouble latching on? You probably have "first week engorgement." And there may be some simple solutions.
Mothers have come to see engorgement as the natural follow-up to birth. But it's more often a natural follow-up to modern expectations of age-old biology. In a nutshell, babies and breasts expect a lot more cuddling and nursing than many new mothers expect.

You've been making milk since your first trimester. Maybe you leaked, maybe you didn't. But that first milk - colostrum - was there. Colostrum is thick and yellowish and sluggish and more salty than sweet, but it's full of antibodies and protein. Call it "practice milk" for your newborn. It coats your baby's stomach and intestines with antibodies. It fuels but it doesn't flood.

Now wait a couple days. Your hormones shift. The blood supply to your breasts increases to start up the milk factory, causing fullness. (If you've had IV fluids, that fullness may be more than normal.) Sugar enters your early milk, which pulls water into it. It turns white. From now on, your milk will be sweet and sloshy, and there will be a lot more of it... provided your body gets the message it's looking for.
Full Engorgement Article

Whether you are used to running marathons or want to start some gentle activities to help with your fitness and/ or weight loss goals you might be wondering if your milk supply will be affected by exercise.

It's worth remembering that women with babies have always worked - the bottom line is that throughout history and in many cultures they couldn't afford not to. Often this work involved fairly strenuous manual labor and we know these moms continued to breastfeed their babies without problems.

Most people feel better when they get some exercise, and this is certainly good for both mother and baby.
Full Exercise Article

LINKS TO RESOURCES FOR INFANT FEEDING IN EMERGENCIES (MULTILINGUAL)

Breastfeeding can have an effect on your fertility, particularly in the early months. While for some mothers this is a benefit, it can also be a source of frustration for those hoping to grow their families.

CAN I GET PREGNANT WHILE I'M NURSING?

The simple answer is that you can get pregnant while nursing.

However, many moms experience a time of delayed fertility during breastfeeding. This is very common and is referred to in many places as the Lactation Amenorrhea Method of contraception.

As described in THE WOMANLY ART OF BREASTFEEDING, the Lactation Amenorrhea Method of using breastfeeding to delay fertility needs all the following to be true:

Your periods have not returned.

Your baby is exclusively and frequently fed from your breasts- this is especially important to remember when your little one begins sleeping through the night. It means not just that your baby does not have bottles, but also that they do not use a pacifier, in other words that all of your baby's sucking needs are met at your breast.

Your baby is less than 6 months old. If your little one is older and eating solid foods, your chances of ovulating and risk of pregnancy increases. Some moms will find it takes more than six months for their cycles and fertility to return, while other mothers find that their cycles and fertility return earlier than six months. It is also important to mention that after six months, there is a higher chance that you might ovulate and possibly become pregnant before your first postpartum period. If you suspect you are pregnant, you will want to check with your health care professional.

Full Fertility Article

The food any family chooses will depend on personal preference, climate, culture and finances. There are no foods you need to avoid while breastfeeding (unless you're allergic to them of course).

This information is for birth parents with babies born at full term or close to full term and addresses the normal course of breastfeeding.

How often should I feed my baby in the first 24 hours after birth?

How often should I breastfeed my baby in the first few days?

How does nursing frequently prevent my baby from becoming jaundiced or help if he/she does become jaundiced?

How can I tell whether my baby is getting enough milk from me?

Should I put my baby on a schedule?

How will I know when my baby is hungry if I don't use a schedule?

How often should I breastfeed my baby in the first weeks?

How often should I breastfeed my baby in the first six months?

Do I need to breastfeed my baby at night?

I'm not sure I'm making enough milk-my baby is fussy! How can I increase my milk supply?

People say I'm spoiling my baby by nursing her/him too often. How often is right?

Why does my baby suddenly want to breastfeed constantly?

Full Frequency of Feeding FAQs

When your baby is spitting up many times a day and seems very unhappy with feedings, he may have gastroesophageal reflux disease. Although baby will need assessed by his doctor, symptoms include:

Frequent spitting up, often with pain

More uncomfortable when sitting than when upright on chest

Gagging, choking, coughing, burping or frequent hiccuping

Bad breath

Uncomfortable when laid down, sleeps poorly

Full GERD - Gastroesophageal Reflux Disease Article

Hand expression is a useful technique, and what's more it's convenient and free! It's a handy way to relieve engorged breasts. You can use it to stimulate milk production if you need to increase your supply, and to provide milk for your baby. You can also combine hand expressing with pumping.

The Womanly Art of Breastfeeding explains that "there is almost nothing you can do for your child in his whole life that will affect him both emotionally and physically as profoundly as breastfeeding."

During the first week of life, more than half of all newborns have jaundice. Usually, jaundice is a normal part of adjusting to life outside the womb, but occasionally it may be a sign of serious health problems. Sometimes, the treatment of jaundice is challenging for mothers and babies.

WHAT CAUSES JAUNDICE?

After birth, the infant no longer needs the extra red blood cells that transport oxygen in utero. During the first days after birth, the excess red blood cells break down producing the yellow pigment bilirubin. The liver processes (conjugates) bilirubin into a form transported to the intestines and from there, carried out of the body in the stool. However, a newborn baby's liver may not be able to process bilirubin efficiently and the newborn's gut easily absorbs unconjugated bilirubin, so bilirubin levels increase in blood circulation. The excess is deposited in the skin, muscles, and mucous membranes of the body.

How long should I breastfeed?

There is no limit on how long you should breastfeed your little one. You may breastfeed for as long as you and your baby choose. Sometimes mothers decide on a certain number of weeks or months as a breastfeeding goal before their baby's birth. Surprising even themselves, many continue past their original goal because they love to see their baby growing so well, they are enjoying the nursing relationship, and see no reason to wean at their original preconceived goal. It is important to always pursue another opinion if told to wean for a medical reason. There are very few contraindications to breastfeeding. Most medications are compatible, or another medication can be safely substituted for the medication that is prescribed. See https://llli.org/breastfeeding-info/medications-quick-guide-parents/
Full Length of Time Article

LUMP IN BREAST

Finding a lump in your breast is scary! Fortunately, most lumps in the lactating breast (breasts that produce milk are called lactating breasts) are either milk-filled glands or an inflammation, such as a blocked duct or mastitis. If the lump is tender, it is probably mastitis. See our Mastitis article for information on treating this condition.

Some people, especially those with lighter skin tones, may notice a red coloring to their skin on the breast as a sign of worsening infection. If the lump does not go away after a week of careful treatment for a blocked duct/mastitis or if you are feeling generally unwell or have a warm or hot breast or high fever, please consult your doctor. A small percentage of cases of mastitis go on to develop a breast abscess that requires antibiotics and drainage.
Full Lumps and Imaging Article

One of the most common questions that mothers ask their health care providers is- "Can I safely take medication while breastfeeding?" Sometimes mothers are told that they cannot continue breastfeeding while taking a certain medication. Some are told to wean, or to "pump and dump" for a certain number of days.

According to Dr. Thomas Hale, author of Medications and Mother's Milk 2017, "most drugs do not enter milk in levels that are hazardous to a breastfed infant." However, it is important to check reliable sources for up-to-date research-based information.

Many health care providers rely on the package insert of the medication that they are prescribing. The package insert almost always cautions against prescribing the medication to pregnant or lactating mothers. However, there are many reliable resources for finding more accurate answers.

Human milk is the natural food for human babies, not only supporting optimal nutrition but also contributing to reaching their health potential. Yet for many reasons, not all parents are able to nurse their babies or produce enough milk to meet their needs.

Some mothers produce more milk than their babies need, and would like to give others the benefit of this amazing food. Families may practice cross-nursing or other arrangements where babies receive human milk from people who are not their parents or co-nursing when both parents participate, either directly from the breast or by pumping and bottle-feeding.
Full Milk Donation and Sharing Article

Is it OK to mix human milk and artificial baby milk (formula)?

Mixing refers to giving your baby your own milk and artificial baby milk in the same container. This is actually a form of supplementation. Supplementation means giving your baby liquid nourishment in addition to breastfeeding. Giving your milk and any supplement separately is advantageous for these two reasons:

Your baby will receive the immunological benefits of human milk and

Less will have the chance to be wasted than if the milks were mixed.

Reasons supplementation of a breastfed baby may be necessary include if the nursing parent's supply is low or if the baby is separated from the parent. However, there are many options in these cases, including the possibility of supplementing with breast milk, donor human milk or formula, so be sure to contact your La Leche League Leader to discuss your particular circumstances.
Full Mixing Milk Article

The term nipple confusion or nipple preference has been used to describe an infant's fussiness at breast or frustration when they are having problems switching from a bottle nipple and breast, before breastfeeding is well established. A baby uses a totally different technique to remove milk from the breast than he uses to drink from a bottle. Some babies have difficulty alternating between a bottle and the breast and some do not. There is no way to predict who will have problems breastfeeding after drinking from a bottle. Babies that are born early or babies with a weaker or more uncoordinated suck may be more vulnerable to nipple confusion. Breastfeeding experts disagree to what extent baby's have difficulty with nipple preference or confusion.

Ways To Avoid Nipple Confusion:

Wait until breastfeeding is well established and feels like part of your daily routine. Many mothers recommend postponing a bottle at least 4 weeks.

If baby needs to be supplemented then consider other alternatives like a feeding cup or a supplemental nursing system.

Inform hospital staff of your wish to not give a pacifier or supplement to baby unless medically indicated.

Full Nipple Confusion Article

Nipple piercings have become increasingly popular in recent years and you may be wondering if it safe to breastfeed your baby if you already have pierced nipples. You might be thinking of getting your nipples pierced and wish to continue breastfeeding without interruption.

IS IT SAFE TO BREASTFEED WITH NIPPLE PIERCINGS?

That depends on whether you are breastfeeding with holes from previous piercings or breastfeeding with jewelry still in place. Nipple piercings can impact breastfeeding for both mother and baby. Common concerns for mom may include nerve damage that impacts the milk ejection reflex or scarring that obstructs the milk flow which can, over time, affect milk production. There have been reports of mastitis and abscesses from previous nipple piercings as well. Often the longer the time since the piercings were initially placed and the birth of the baby the better the outcome.
Full Nipple Piercings Article

Sometimes a mother may make more milk than her baby needs. Although this may sound like a good problem to have, too much of any good thing can cause challenges - for baby and mother.

WHAT ARE SOME SIGNS OF OVERSUPPLY?

Baby is restless during the feeding, may cry or pull off and on the breast.

Baby may cough, choke, splutter, or gulp quickly at the breast, especially with each let-down. See Positioning

Baby may clamp down at the nipple to try to stop or slow the rapid flow of milk. This may cause sore, creased nipples. See Biting

Baby may arch or stiffen, often with painful cries.

Each feeding feels like a struggle or battle.

Feedings may be short but frequent because baby fills up quickly on air and the lower fat milk from the early part of a feeding and not get to the higher fat that comes further into the feeding.

Baby may have green, loose, or explosive stools. Some may have signs of blood.(See section on digestion concerns, below)

Baby may be very gassy and have frequent, large spit ups. See Breastfeeding and Reflux and Breastfeeding and GERD .

Mother may notice a strong, forceful milk release, also know as Overactive Milk Ejection Reflex (OMER). This can cause coughing or choking. This may also result in excessive leaking from the side where baby is not feeding.

Mother's breasts may never feel fully empty and seem to refill very quickly after a feeding.

Mother may have frequent bouts of plugged ducts or mastitis.
NOTE: Some mothers may benefit from having their thyroid levels checked as overactive thyroids can contribute to oversupply.

Full Oversupply Article

When you are pumping milk for your baby, it is important to clean your pumping accessories properly, whether at work or at home.

ITEMS TO BRING WITH YOU IN ADDITION TO YOUR PUMP KIT

Mild, unscented dish soap (washing up liquid).

Bottle brush.

Wash basin (many hospitals provide these to their patients); two if you can - one for washing and the other for drying.

Full Cleaning and Sanitizing Pumping Accessories Article

Breast Massage

One type of breast massage involves using your fingertips to apply gentle pressure to your breast and move your fingers in a circular motion. After a few seconds, you can move your fingers to another spot. Start at the top of your breast and spiral the breast toward the areola using the circular motion. Then switch to the other breast.

Check for Flat or Inverted Nipples

In order for the baby to suck effectively, he will need to draw your nipples far back in his mouth. If you have flat nipples, the baby may have a problem latching. On the other hand many mother have successfully breastfeed with flat or inverted nipples.
Full Preparing Article

Safe Sleep for Breastfeeding Babies

Sleeping with our babies is an instinct as old as motherhood itself. Yet today, some authorities say it's risky. What are the facts?

Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS), Crib Death, or Cot Death is the unexpected and unexplainable death of a baby. The highest risk is during the first six months. The greatest SIDS risk factors are smoking during your pregnancy and placing your baby face-down for sleep. 1 Formula-fed children have double the risk of SIDS.2 Parents who smoke and share a bed with their infant also increase the risk, regardless of where or when the parent smokes. One in five SIDS deaths occurs in daycare. 3
Full Sleep: Safe Sleep Article

SLEEP: TALKING WITH YOUR DOCTOR ABOUT BEDSHARING

Some parents choose not to discuss their sleeping arrangements with medical caregivers, even if asked. If you do choose to, here are some points you may find helpful.

I really do appreciate your willingness to listen. It's one of the reason's we came to you.

Although the public health campaigns suggest that all bedsharing with babies is dangerous, the research shows that the issue is complex, and not a one-size fits-all.

Most of the research mixes up SIDS and suffocation. There are ways to make bedsharing safely comparable to a crib's.

Full Sleep: Talking With Your Doctor About Bedsharing Suggestions

Imagine that you're in your third trimester of pregnancy, and you're hungry or sleepy a lot of the time. It's evening, not "time for bed" yet, but you're sleepy, so you turn in early. And then you can't get to sleep. You change your position and shift your pillow and covers and turn on the white noise, you count sheep and try to meditate, and finally you watch a movie or read until you fall asleep. Around 3 am, or maybe 4, you wake up hungry. You forgot to put a snack by the bed, so you get up, pee, and get something to eat. Happily you wake up only once that night; the night before, you made 3 trips to the bathroom.

In other words, you went to bed because you were tired, not on someone else's timetable. When you couldn't sleep you chose from an assortment of "self-soothing" techniques, each of which required a problem-solving thought process. You shifted your position when you wanted, ate when you wanted, and woke at different times from the night before.

A small baby can do every single one of those things too, but only with a caring and responsive support system, which is usually Mama. The Mama-support-system has arms that help with shifts in position. It has warmth, comfort, and reassuring sounds. It has a snuggly breast that offers food, comfort, and sleep-encouraging hormones; and it has an adult brain that does the problem-solving. The problem-solving may go something like this: Breast? No. Position? No. Diaper? No. Try breast again? Yes. Take away that responsive, problem-solving support system and you have a baby who's totally helpless.

In fact, you have a baby who is at risk....
Full Sleep Training... or not Article

According to recommendations from the World Health Organization (WHO), the American Academy of Pediatrics (AAP), and the American Public Health Association (APHA), human milk is the only food that healthy, full-term babies need for about the first six months of life. The composition of human milk changes in response to a variety of cues, so that each mother provides milk that meets her own baby's unique needs. Human milk provides immunity factors for as long as the baby nurses, and many of the health benefits of breastfeeding continue well into childhood and beyond.

Feeding complementary foods to your baby before he is ready is typically messy and inefficient as he will naturally push the food out with his tongue as long as the tongue-reflex is functioning. By waiting for him to be developmentally ready, he becomes an active participant in eating, rather than merely a passive recipient. This helps to put him in charge of how much he eats, teaching him important fullness cues. Starting solid foods before your baby is ready will not increase his sleep at night, is not necessary for larger babies, and does not initially increase calories.
Full Starting Solids Article

It is essential to properly store your expressed (pumped) milk to maximize its nutritional, immunological and antioxidant qualities. Human milk has anti-bacterial properties that help it to stay fresh and when stored per recommendations, human milk can maintain many of its nutritional qualities making it safe for use. Over time nutrients may break down in expressed milk lowering the quality and as such, it is important to try to give your baby the freshest expressed milk to ensure its rich quality.

Prior to expressing and storing milk ALL mothers should:

Wash their hands before expressing;

Use containers that have been washed in hot, soapy water, rinsed and air dried

STORAGE GUIDELINES

This information is based on current research and applies to mothers who have healthy, full-term babies. Babies who are preterm/ in NICU/or ill should use more conservative guidelines.
Full Storing Human Milk Article

TANNING BEDS

No evidence exists that the use of tanning beds has any effect on human milk or breastfed babies. However some mothers have reported getting burnt nipples and breasts when using tanning beds: this is extremely painful so be sure to cover your nipples and breasts and use caution. If you are offered any vitamins or medications to enhance the tanning process you can check them with your health care provider before taking them.

FAKE TAN

You do not need to avoid using tanning lotion, or having a spray tan, when you're breastfeeding. You do however need to take care when applying fake tan (or indeed any cosmetics) when your baby is close, and you need to ensure the fake tan is dry or has been rinsed off before having skin-to-skin contact to avoid accidentally 'tanning' your baby.

The active ingredient in most fake tans is DHA, and some self tanners use erythrulose. Both are non toxic: neither substance can absorb beyond the outermost layer of your skin, and so cannot contaminate your breast milk or harm your baby.
Full Tanning Beds and Fake Tans Article

In many countries both breastfeeding and tattooing are enjoying a resurgence in popularity.You may be wondering if it safe to breastfeed your baby if you already have a tattoo. You might be thinking of getting a tattoo or having a tattoo removed and wish to continue breastfeeding without interruption.

IS IT SAFE TO GET A TATTOO WHILE BREASTFEEDING?

Tattoos are created by injecting ink into the dermal (second) layer of the skin. Tattooists use a hand-held electric machine that is fitted with solid needles coated in the ink. The needles enter the skin hundreds of times a minute to a depth of up to a few millimeters. The ink that is used in tattoos in the United States is subject to FDA regulation as cosmetics, but none are approved for injection under the skin. Tattoo inks are made from various compounds, including heavy metals such as, cadmium, cobalt and manganese. There are synthetic and vegan brands of ink available. It is generally assumed that ink molecules are too large to pass into breastmilk during the tattoo process. Once injected into the skin the ink is trapped, however it is unknown whether the ink can pass into breastmilk as it slowly breaks down in the body months to years later.
Full Tattoos and Breastfeeding Article

Is thrush causing my sore nipples? Perhaps you recently had a baby and you have sore nipples. Perhaps your baby is a few months old and you suddenly are experiencing an uncomfortable latch. The internet, other parents, or your healthcare provider may suggest thrush as a diagnosis. But is this the most likely cause of this pain? Finding the source of discomfort is an important step in treatment.
Full Thrush Article

Early Start

Put baby to the breast to nurse as soon as possible.

Hold baby skin-to-skin

Avoid pacifiers

Sore Nipples

Correct positioning and latch on are very important for preventing sore nipples.

Break suction before taking baby off the breast.

Offer the least sore breast first.

Use only plain water for washing.

Gently apply your own milk, ultra pure modified lanolin, or hydrogel pads to speed healing.

Check with a La Leche League Leader for help.

Full Tips Article

HOW DO I TRAVEL WITH MY BABY?

Traveling with a baby can be difficult! In many cases, babies travel well. Bringing your baby with you to a special event can be exciting... or nerve-racking!

There are a few things many families have found work when traveling with babies. As always, take what feels right for your family and leave the rest.

FOR A ROAD TRIP:

The car seat - do some research to make sure the car seat you buy for your baby suits your needs. Do you need a car seat that has a base and detachable bucket or would you prefer to have an all-in-one non-detachable seat that will serve as your baby's seat for several developmental stages? Whichever one you choose, look for one you feel confident installing, removing, and moving around. It is also helpful to be very well acquainted with how the car seat buckles and tightens. Many families find it beneficial to practice how to get their babies into and out of their car seats from the front passenger seats and a seat on the side of the car seat. It can be difficult to take your little one out of the car seat and carry them to you in your seat - especially if it is cold or rainy outside. Practice which seat in your vehicle you are able to nurse in the best and learn how to get your baby out of and back into their car seat from your nursing seat safely. Having an additional adult on hand can help boost your confidence - and help ensure baby's safety - while you practice.
Full Travel Article

VITAMINS AND OTHER NUTRITIONAL SUPPLEMENTS FOR BABY

Advertisements, family members and even health professionals often urge mothers to add "something" to baby's perfect diet of mother's milk. According to the our comprehensive guidebook, THE WOMANLY ART OF BREASTFEEDING, if a breastfeeding mother is getting an adequate supply of vitamins in her diet, her milk will contain adequate nutrients in the perfect balance for her baby. If your baby is healthy and doing well, there is no need for vitamins, iron, or other supplements in the early months (apart from vitamin D). Furthermore, many mothers have found that vitamin or fluoride supplements may cause fussiness or colic in their infants. By treating each mother and baby as a unique pair, unnecessary supplementation can often be avoided.
Full Vitamins and Other Nutritional Supplements Article

Exclusively breastfed babies do not need water supplements - your body makes the perfect milk for your baby, actually changing the composition as he needs more or less water.

Giving water to newborn babies can contribute to jaundice and slow weight gain: water may fill a baby's tummy and so reduce the amount of colostrum or breastmilk they get. Water supplements may also stop you establishing your milk supply as your baby will ask to breastfeed less.

Even in very hot weather your baby doesn't need additional water, as long as you respond to his cues to feed he will get all the fluids he needs in your milk. This article from LLL Canada gives more information about breastfeeding and hot weather.
Full Water Supplements Article

WOULD WEANING MAKE MY LIFE EASIER?

Are you thinking about weaning? Your child may be a few weeks or months old, or may be a breastfeeding toddler. Some mothers decide to continue breastfeeding until the baby outgrows the need. This is called natural weaning or child-led weaning. In modern Western society, this is rather unusual. At a typical LLL meeting, you may find many mothers practice extended or natural weaning. You can review the Toddler Nursing article if this seems right to you.

I WANT TO WEAN

Are you still in the early weeks, and experiencing difficulties with breastfeeding?

Maybe you'd like to breastfeed longer, but feel overwhelmed or are experiencing discomfort?

We are here to help, don't hesitate to call your local La Leche League Leader if you are having problems! They can help you with any difficulties you may experience. Sometimes just talking to an experienced parent who has "been there," who understands what you're going through, can be so helpful. All LLL Leaders have breasted at least one baby, for at least one year.
Full Weaning: I Want To Article

Unexpected Weaning

Were you planning on continuing breastfeeding, but your baby has other ideas? Do you worry baby is trying to wean?

First, make sure it isn't just a nursing strike.

Common Reasons for an Early Weaning

Bottles, pacifiers or increased solids. Try cutting down on any of these activities. If your baby is getting bottles at daycare while you are at work, and is over six months old (approximately), it's probably time to go to the cup for the child's feeds while away from you. With dummies, reduce use to your baby won't be meeting his sucking needs, and will be more eager to nurse, when you are together. If you started solids early (before six months), you can always cut back on the size of these meals, gradually, of course. If baby is under 12 months of age, make sure you are offering breast before solids. Your milk supply will build back up, as the baby spends more time at the breast. Remember, your milk is by far the most nutritious food for your baby, for the first year, not to mention the immunological benefits.
Full Weaning: Unexpected Article

HOW CAN I LOSE WEIGHT SAFELY WHILE BREASTFEEDING?

You are not alone in wondering about losing weight. Many women are anxious to return to their pre-pregnancy shape and weight after childbirth. Do try to remember that your pregnancy weight wasn't gained overnight so it won't disappear that quickly, either.

While breastfeeding burns about 500-700 calories extra per day to fuel milk making, this may not always contribute to weight loss postpartum - many factors like pre-pregnancy weight, diet, physical activity level, etc will impact weight loss after birth (Institute of Medicine, 2002; Dewey, 1994). On average, exclusively breastfeeding mothers may see a loss of 1-2 pounds a month and over time, breastfeeding moms tend to lose more weight than mothers who do not breastfeed.

WHEN CAN I START LOSING WEIGHT?

It is recommended that you wait at least 6-8 weeks postpartum to start to lose weight, as your body needs this time to recover from childbirth and establish a good milk supply. Many mothers lose weight in the early months by following a well-balanced diet and eating to hunger.
Full Weight Loss: For Mothers

Going back to work and leaving your baby in someone else's care can be one of the most difficult parts of returning to work. Choosing the right person and right setting takes care. You want to find a setting that will provide the kind of care and attention you would give. You want a setting that respects breastfeeding and your expressed breastmilk. This may take some homework on your part. Visits to the locations you are considering will be important. Here are some things to consider:

IN HOME CARE WITH A FAMILY MEMBER, CLOSE FRIEND, OR NANNY

This allows your baby to stay in your home, where all is familiar.

It works best with someone the baby already knows or who is willing to come to your home several times before your return date.

Full Choosing a Child Care Provider Article

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Breastfeeding Info - La Leche League International

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This information is on topics of interest to parents of breastfed children. It is general in nature and may not be pertinent to your family's lifestyle. It is not intended to be advice, medical or otherwise. If you have a serious breastfeeding problem or concern, please talk directly to a La Leche League Leader who will provide you with support, encouragement, and evidence-based information.

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Every Monday from 10am-11.30am at Little Hadham Village Hall, Little Hadham (SG11 2BP)Buntingford

Every Tuesday from 10.30am-12pm at Seth Ward Community Centre, Buntingford (SG9 9SG)

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Family centres are a great source of feeding support and also offer free vitamins and many classes from first aid to baby massage 

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Family centres are a great source of feeding support and also offer free vitamins and many classes from first aid to baby massage 

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Hertfordshire Family Centre Service website.

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https://twinstrust.org/site-search.html?q=sleep

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Twins Trust offer a variety of courses for those who are expecting twins, triplets and more. We also offer parenting courses and webinars.

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Tuesday

Welwyn Garden City Infant feeding Drop In at Applecroft Family Centre, Applecroft Road, Welwyn Garden City, AL8 6JZ. Every Tuesday 09.30 - 11.30 just turn up no need to book. Any questions please contact Sarah Hill on 07918468724

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Our emails include NHS trusted advice and support on your pregnancy, baby, and parenting. They are tailored to your stage of pregnancy, or your child's age.

From preparing for labour, feeding your baby, choosing childcare and getting the benefits you're entitled to - it's all in the emails!

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Sign up for weekly pregnancy and baby emails to get NHS-approved expert advice, videos, information and tips on pregnancy, birth and beyond.

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Breastfeeding can take practice - read our guides on breastfeeding to find out what works best for you

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Do you have any breastfeeding questions? From how to breastfeed to coping with breastfeeding challenges - we have lots of useful advice and tips.

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Directory that lists infant feeding support groups

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Directory that lists infant feeding support groups

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Search results | Hertfordshire MarketPlace

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Find local services, organisations and events in Hertfordshire for adults, children and families. From childcare and adult care to things to do in Herts.

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Support with breastfeeding or bottle feeding: our infant feeding line | Baby & toddler, Feeding articles & support | NCT

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When it comes to feeding - breastfeeding, bottle feeding or a bit of both - we know how physically and emotionally challenging it can be. It can take time to feel confident about feeding your baby. If you need information, support or just someone to talk to, give one of our trained breastfeeding counsellors a call on 0300 330 0700* (option 1). The line is open every day from 8am to midnight, including bank holidays

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Support with breastfeeding or bottle feeding: our infant feeding line | Baby & toddler, Feeding articles & support | NCT

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Find out more here about our infant feeding support line and the help available if you have any questions or concerns about feeding your baby.

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Royston and villages | Local activities & meet-ups | NCT

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Breastfeeding drop-ins available to book through this link, Fridays from 10-12

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Royston and villages | Local activities & meet-ups | NCT

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NCT Royston and villages welcomes every new parent. Our local groups, activities and events are run by volunteers. We help forge friendships and raise money for all of NCT's work, locally and nationally.

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Please visit this page for publications from the Lullaby Trust in various languages

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Order copies

Single copies of our publications can be downloaded below.

To order multiple copies, visit our shop or call us on 0203 150 3638 or email lullabytrust-orders@partridgesuk.com

PDF versions of publications

We regularly review research and data, and consequently update the information and advice we provide in line with current evidence.

It is therefore important that organisations do not directly host Lullaby Trust PDF publications on their websites (this represents a breach of copyright), but instead only use links to publications on The Lullaby Trust website. This ensures that the most up-to-date version of a publication is shared by professionals with families and minimises the likelihood of a governance risk.

Thank you for your understanding and your continued support of our work at The Lullaby Trust.

Free downloads

Antenatal publications

Click here to view our antenatal publications

Safer sleep for babies

Click here to view our 'safer sleep for babies' publications

Safer Sleep for babies: a Guide for Parents and Carers
This leaflet provides parents with all the advice on safer sleep and reducing the risk of sudden infant death.

Safer Sleep: Saving Babies Lives a Guide for Professionals
Leaflet written for all professionals working with families with young babies, giving the most up to date advice on safe infant care advice to reduce the risk of sudden infant death.

Safer Sleep for Babies quick reference card
A quick reference guide to the ABCs of safer sleep and tips for safer bedsharing

Safer sleep product guide
A guide for parents on the products they need and those to avoid and what the marketing means

Easy read card
A 2-side card giving key advice for reducing the risk of sudden infant death.

This leaflet is also available to download in the following languages:

If you require the artwork of any of these translations (to supply to a printer), please email communications@lullabytrust.org.uk

Posters

Click here to view our posters

Poster: Safer Sleep
Our newly designed safer sleep poster details the ABCs of Safer Sleep.

Poster: Sofa sharing
A3 poster which provides information on sofa sharing

Poster: Baby Check App advert
An A4 printable poster advertising the free Baby Check smartphone app. Available in portrait and landscape.
Portrait version Landscape version
Infection prevention

Click here to view our infection prevention resources

These resources have been created in consultation with British Paediatric Allergy, Immunity and Infection Group (BPAIIG), an affiliated speciality group of the Royal College of Paediatrics and Child Health (RCPCH).

Baby check app

Click here to view publications related to our Baby Check app

Baby Check Health Visitor Card
A two-sided card card explaining the use of the Baby Check App

Baby Check poster
An A4 printable poster advertising the free Baby Check smartphone app. Available in portrait and landscape.
Portrait version Landscape version
Premature babies

Click here to view our publications about premature babies

Safer Sleep Advice for Premature Babies booklet
A booklet written in collaboration with Bliss and Twins Trust featuring safer sleep advice for parents of babies born prematurely or of a low birth weight. Includes additional information for parents of twins, multiples or more.

Safer sleep advice for Emergency Situations

Click here to view our 'safer sleep advice for Emergency Situations' resources

Little Lullaby / Young parents

Click here to view our Little Lullaby publications

About Little Lullaby Booklet
Top Ten Tips for Health Professionals
A4 Poster for Health Professionals

A Young Parent Guide to Loneliness
Produced in collaboration with the Mental Health Foundation.

Safer sleep advice for emergency situations: A Guide for Young Parents and Carers (Little Lullaby version)
Produced in collaboration with Shared Health Foundation.

Games

Click here to view our games

Make a room game
A visual toolkit demonstrating the ideal sleeping environment for a baby

Spot the risk game
A visual toolkit to facilitate discussions on reducing the risks of SIDS

Fact sheets

Click here to view our list of fact sheets

Bereavement publications

Click here to view our bereavement publications

When a baby or young child dies suddenly and unexpectedly
A booklet for parents who have lost a baby or young child, covering what you might experience now and in the future (practically and in terms of thoughts and feelings).

Bereavement support leaflet
Advice and information for bereaved families, including The Lullaby Trust services and other sources of support.

Unicef Baby Friendly Publications

Click here to view the Unicef Baby Friendly publications

The Lullaby Trust has worked with Unicef in the wording on two publications to support families and professionals with the challenge of addressing co-sleeping given the association with SIDS. You might be interested in reading the two Unicef Baby Friendly publications, which are both endorsed by The Lullaby Trust

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Order copies Single copies of our publications can be downloaded below. To order multiple copies, visit our shop or call us on 0203 150 3638 or email lullabytrust-orders@partridgesuk.com PDF versions of publications We regularly review research and data, and consequently update the information and advice we provide in line with current evidence.

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Safer sleep overview - The Lullaby Trust

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

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There are a range of ways LLLGB can offer you support with breastfeeding, by telephone, in writing, or using our online information and printed materials. If the blue “chat now” button is showing, then you can also use our online chat service to have an instant conversation with one of our breastfeeding counsellors.

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There are a range of ways LLLGB can offer you support with breastfeeding, by telephone, in writing, or using our online information and printed materials. If the blue "chat now" button is showing, then you can also use our online chat service to have an instant conversation with one of our breastfeeding counsellors.

LLLGB Breastfeeding Information

Getting breastfeeding started

Life with a new baby

Common Concerns

Milk supply issues

Milk expression and storage

Family Foods

Working and separation

Breastfeeding an older baby

Can I breastfeed if...?

Issues

Breastfeeding Today (LLLI)
Information & stories
article index
Please note: The breastfeeding information on this website has been put together by La Leche League Leaders, who are accredited by La Leche League to provide breastfeeding information. Please note that Leaders have a wide knowledge and experience of breastfeeding but are not medically trained. If you have a medical query, or are concerned about your health or the health of your child please consult your doctor.

Information, references and links on this website are taken from La Leche League resources, unless stated otherwise. Please note that La Leche League GB does not endorse information from outside sources, extra information is provided for you to consider.

Information supplied is not intended as advice. You are in the best position to make a decision as to how the information offered will affect you and your baby.

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There are a range of ways LLLGB can offer you support with breastfeeding, by telephone, in writing, or using our online information and printed materials. If the blue "chat now" button is showing, then you can also use our online chat service to have an instant conversation with one of our breastfeeding counsellors.

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NCT Breastfeeding Cafe - Hitchin & Letchworth

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NCT Breastfeeding Cafe - Hitchin & Letchworth

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Herts North's NCT BabyCafe is at Hitchin library on the second and third fourth Tuesday of each month from 10.30am to 11.45am. We also run a BabyCafe as part of our Bumps and Babies group in Letchworth. This takes place at the Mrs Howard Memorial Hall every 1st and 3rd Tuesday of the month, also at 10.30am to 11.45am.

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Bumps & Babies @ Baby Café | Herts North

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Brasserie is our feeding support group on every Friday from 11-12 at Shefford Children’s Centre. Join us for a cuppa and meet other local families, share advice and support on feeding your baby. There is one to one breast feeding support available as well as a private feeding room if required.
All ages welcome

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We need to change the conversation around breastfeeding; it is time to stop laying the blame for the UK’s low breastfeeding rates in the laps of individual women and instead acknowledge that this is a public health imperative for which government, policy makers, communities and families all share responsibility. We are calling on UK and devolved governments to implement four key actions to create a supportive, enabling environment for women who want to breastfeed, and to protect all babies, whether breast or formula fed, from harmful commercial interests.

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Baby Friendly Initiative | Call to Action

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What to Expect in the First Week - A New Mum's Diary

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What to Expect in the First Week - A New Mum's Diary

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Why do I need to think about breastfeeding antenatally?

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Why do I need to think about breastfeeding antenatally?

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Learning about breastfeeding will help you to feel empowered and prepared to feed your baby, right from the moment they are born. Have a read through this information to help build on your knowledge and speak to your midwife about anything you have questions about.

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The Breastfeeding Friend, a digital tool from Start4Life, has lots of useful information and advice on breastfeeding. And because it's a digital tool, it's available whenever you need it 24 / 7. All the information provided is NHS-approved and based on questions asked by thousands of new mums.

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

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

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

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

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More than 1.3 million women worldwide have had COVID-19 vaccines in pregnancy.

Studies following up nearly 350,000 pregnant women in the US and UK who were vaccinated in pregnancy have not raised any safety concerns. Since most of these women received mRNA vaccines, such as Comirnaty/Pfizer BioNTech and Moderna Spikevax, the JCVI advises that it is preferable for these mRNA vaccines to be offered to pregnant women in the UK, where available.

The UKHSA (formally Public Health England) and Public Health Scotland have reported that well over 150 000 pregnant women have received a COVID-19 vaccine in England and Scotland, with no serious adverse effects recorded. UKHSA data from April to June 2022 reported that 72.6% of women who gave birth had received at least one dose of COVID-19 vaccine prior to giving birth.

Current research indicates COVID-19 vaccines do not contain ingredients that are known to be harmful to pregnant women or to a developing baby. Studies of the vaccines in animals to look at the effects on pregnancy have shown no evidence that the vaccines cause harm to the pregnancy or to fertility.

The COVID-19 vaccines being used in the UK are not 'live' vaccines and so cannot cause COVID-19 infection in you or your baby. Vaccines based on live viruses are avoided in pregnancy in case they infect the developing baby and cause harm. However, non-live vaccines have previously been shown to be safe in pregnancy (for example, flu and whooping cough).

Studies have shown that protective antibodies from vaccination do cross the placenta, helping with the baby's immunity to COVID-19. We know that catching COVID-19 during pregnancy can cause severe illness in a pregnant woman, which is why COVID-19 vaccine in pregnancy is so strongly recommended.

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COVID-19 vaccines, pregnancy and breastfeeding FAQs | RCOG

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These Q&As on COVID-19 vaccines, pregnancy and breastfeeding are reviewed as new information and advice emerges.

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If you're pregnant, it's important to get vaccinated to protect you and your baby. The antibodies your body produces in response to the vaccine can also give your baby protection against COVID-19.

You're at higher risk of getting seriously ill from COVID-19 if you're pregnant. If you get COVID-19 late in your pregnancy, your baby could also be at risk.

Evidence shows that most pregnant women with COVID-19 who need hospital treatment or intensive care in the UK have not been vaccinated.

If you're pregnant and have not had your first 2 doses and booster dose yet, it's important to get your vaccinations as soon as possible.

If you're pregnant and have been vaccinated, you should have a seasonal booster dose this autumn.

It's safe to have the vaccine during any stage of pregnancy, from the first few weeks up to your expected due date. You do not need to delay vaccination until after you have given birth.

Getting vaccinated against COVID-19 reduces the risk of having a stillbirth.

There's no evidence COVID-19 vaccination increases the risk of having a miscarriage, pre-term birth or other complications in your pregnancy.

The COVID-19 vaccines do not contain any live viruses and cannot give you or your baby COVID-19.

They have been widely used during pregnancy in other countries and there have been no safety concerns. In the UK, over 100,000 pregnant women have been vaccinated.
Find out how to get a COVID-19 vaccine

You'll be able to discuss having a COVID-19 vaccine during pregnancy at your vaccination appointment.

You can also speak to a GP or your maternity team for advice.

You may find the COVID-19 vaccination in pregnancy decision aid from the Royal College of Obstetricians and Gynaecologists (PDF, 405KB) helpful.

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If you're pregnant, it's important to get vaccinated to protect you and your baby. The antibodies your body produces in response to the vaccine can also give your baby protection against COVID-19. You're at higher risk of getting seriously ill from COVID-19 if you're pregnant.

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Introduction

Breastfeeding is the cornerstone of infant and young child survival, nutrition and development and maternal health. The World Health Organization recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. 1 Early and uninterrupted skin-to-skin contact, rooming-in 2 and kangaroo mother care 3 also significantly improve neonatal survival and reduce morbidity and are recommended by WHO.

However, concerns have been raised about whether mothers with COVID-19 can transmit the SARS-CoV-2 virus to their infant or young child through breastfeeding. Recommendations on mother-infant contact and breastfeeding must be based on a full consideration of not only of the potential risks of COVID-19 infection of the infant, but also the risks of morbidity and mortality associated with not breastfeeding, the inappropriate use of infant formula milks, as well as the protective effects of skin-to-skin contact. This scientific brief examines the evidence to date on the risks of transmission of COVID-19 from an infected mother to her baby through breastfeeding as well as evidence on the risks to child health from not breastfeeding.

WHO recommendations

WHO recommends that mothers with suspected or confirmed COVID-19 should be encouraged to initiate or continue to breastfeed. Mothers should be counselled that the benefits of breastfeeding substantially outweigh the potential risks for transmission. 4

Mother and infant should be enabled to remain together while rooming-in throughout the day and night and to practice skin-to-skin contact, including kangaroo mother care, especially immediately after birth and during establishment of breastfeeding, whether they or their infants have suspected or confirmed COVID-19.

Methods

A living systematic review of evidence that followed the procedures of the Cochrane handbook for systematic reviews of interventions was carried out with the latest search done on 15 May 2020 to identify studies including mothers with suspected or confirmed COVID-19 and their infants or young children. 5 The search was conducted on Cochrane Library, EMBASE (OVID), PubMed (MEDLINE), Web of Science Core Collection (Clarivate Analytics) and the WHO Global Database. A total of 12,198 records were retrieved, 6945 were screened after removing duplicates, and 153 records with mother-infant dyads in which the mother had COVID-19 were included in full-text review.

Results

A total of 46 mother-infant dyads had breastmilk samples tested for COVID-19. All mothers had COVID-19, while 13 infants tested COVID-19 positive. Breastmilk samples from 43 mothers were negative for the COVID-19 virus while samples from 3 mothers tested positive for viral particles by RT-PCR. Among the 3 infants whose mothers' breastmilk tested positive for virual RNA particles, not live virus, one infant tested positive for COVID-19 but infant feeding practices were not reported. The two other infants tested negative for COVID-19; one was breastfed, and the other newborn was fed expressed breast milk after viral RNA particles were no longer detected. In the single child with COVID-19, it was unclear through which route or source the infant became infected, i.e. through breastmilk or droplet from a close contact with the infected mother.

A preprint article reported secretory immunoglobulin A (sIgA) immune response against the COVID-19 virus found in 12 of 15 breastmilk samples from mothers with COVID-19. 6 The implications of this finding on the effect, duration and protection against COVID-19 for the child was not addressed.

Limitations

To date, studies of mother-infant dyads with data on feeding practices and COVID-19 infection have come from case reports, case series or a report of a family cluster. Other study designs such as cohort studies or case-control studies were eligible for inclusion, but none were identified. We are thus unable to measure and compare risks of infection based on feeding practices.

Although 1 of the 3 infants of mothers with viral particles in breast milk had COVID-19, it was unclear through which route or source the infant was infected, i.e., through breastfeeding or close contact with the mother or other infected person. RT-PCR detects and amplifies viral genetic material in samples, such as breastmilk, but does not provide information on viability or infectivity of the virus. Documented presence of replicative COVID-19 virus in cell culture from breast milk and infectivity in animal models are needed to consider breast milk as potentially infectious.

The presence of IgA in breast milk is one of the ways in which breastfeeding protects infants against infection and death. IgA antibodies with reactivity to the COVID-19 virus have been detected in breastmilk of mothers previously infected with COVID-19 but their strength and durability have not yet been adequately studied to address protection from COVID-19 among breastfed infants.

Discussion

Detection of COVID-19 viral RNA in breastmilk is not the same as finding viable and infective virus. Transmission of COVID-19 would need replicative and infectious virus being able to reach target sites in the infant and also to overcome infant defense systems. If in the future COVID-19 virus from breastmilk were shown to be replicative in cell culture it would need to reach target sites in the infant and overcome infant defense systems for transmission of COVID-19 to occur.

The implications of transmission risk need to be framed in terms of COVID-19 prevalence in breastfeeding mothers and the scope and severity of COVID-19 infection in infants when transmission occurs compared to the adverse consequences of separation and using breastmilk substitutes and also separation of newborns and young infants from mothers.

Children appear to be at low risk of COVID-19. Among the cases of confirmed COVID-19 in children, most have experienced only mild or asymptomatic illness. 7,8 This is also the case with other zoonotic coronaviruses (SARS-CoV and MERS-CoV), which seem to affect children less commonly and to cause fewer symptoms and less severe disease compared with adults. 9

Secretory IgA have been detected in breastmilk of mothers with previous COVID-19 infection. Although the strength and durability of sIgA reactive to COVID-19 have not yet been determined, multiple bioactive components have been identified in breastmilk that not only protect against infections but improve neurocognitive and immunologic development of the child since Lars A Hanson first described sIgA in breastmilk in 1961. 10-12

Skin-to-skin contact and kangaroo mother care facilitate breastfeeding as well as improve thermoregulation, blood glucose control, and maternal-infant attachment, and decrease the risk in mortality and severe infection among low birth weight infants. 13,14 Beyond the neonatal period, positive effects of mother-infant holding include improved sleep patterns, lower rates of behavioural problems in the child and higher quality parental interaction. 15,16

Exclusively breastfed infants, the risk of mortality is 14-fold higher in infants who are not breastfed. 17 Over 820 000 children's lives could be saved every year among children under 5 years, if all children 0-23 months were optimally breastfed. For mothers, breastfeeding protects against breast cancer and may protect against ovarian cancer and type 2 diabetes. 18 On the other hand, children are at low risk of COVID-19.

Knowledge gaps

It is still not clear whether the virus can or cannot be transmitted though breast milk. Risk of transmission based on feeding practices have not been quantified, compared, or modelled against the benefits of breastfeeding and nurturing mother-infant interaction.

Conclusion

At present, data are not sufficient to conclude vertical transmission of COVID-19 through breastfeeding. In infants, the risk of COVID-19 infection is low, the infection is typically mild or asymptomatic, while the consequences of not breastfeeding and separation between mother and child can be significant. At this point it appears that COVID-19 in infants and children represents a much lower threat to survival and health than other infections that breastfeeding is protective against. The benefits of breastfeeding and nurturing mother-infant interaction to prevent infection and promote health and development are especially important when health and other community services are themselves disrupted or limited. Adherence to infection prevention and control measures is essential to prevent contact transmission between COVID-19 suspected or confirmed mothers and their newborns and young infants.

Based on available evidence, WHO recommendations on the initiation and continued breastfeeding of infants and young children also apply to mothers with suspected or confirmed COVID-19.

References

World Health Organization, UNICEF. Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland: World Health Organization; 2003.

World Health Organization. Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. Geneva, Switzerland: World Health Organization; 2017.

World Health Organization. WHO recommendations on interventions to improve preterm birth outcomes. Geneva, Switzerland: World Health Organization; 2015.

World Health Organization. Clinical management of COVID-19: Interim guidance (27 May 2020). Geneva, Switzerland: World Health Organization; 2020.

Centeno-Tablante E, Medina-Rivera M, Finkelstein JL, Rayco-Solon P, Garcia-Casal MN, Ghezzi-Kopel K, Rogers L, Peña-Rosas JP, Mehta S. Transmission of novel coronavirus-19 through breast milk and breastfeeding. A living systematic review of the evidence. PROSPERO 2020 CRD42020178664.

Fox A, Marino J, Amanat F, Krammer F, Hahn-Holbrook J, Zolla-Pazner S, Powell RL. Evidence of a significant secretory-IgA-dominant SARS-CoV-2 immune response in human milk following recovery from COVID-19. medRxiv preprint doi: https://doi.org/10.1101/2020.05.04.20089995.

Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for .Disease Control and Prevention. JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648

Zimmermann P, Curtis N. COVID-19 in Children, Pregnancy and Neonates, The Pediatric Infectious Disease Journal: June 2020 - Volume 39 - Issue 6 - p 469-477 doi: 10.1097/INF.0000000000002700.

Zimmermann P, Curtis N. Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children. Pediatr Infect Dis J. 2020;39(5):355‐368. doi:10.1097/INF.0000000000002660.

Hanson LA. Comparative immunological studies of the immune globulins of human milk and of blood serum. Int Arch Allergy Appl Immunol. 1961;18:241‐267. doi:10.1159/000229177.

Hanson LA, Silfverdal SA, Hahn-Zoric M, et al. Immune function. Adv Exp Med Biol. 2009;639:97‐111. doi:10.1007/978-1-4020-8749-3_8

Bardanzellu F, Peroni DG, Fanos V. Human Breast Milk: Bioactive Components, from Stem Cells to Health Outcomes. Curr Nutr Rep. 2020;9(1):1‐13. doi:10.1007/s13668-020-00303-7.

Moore ER, Bergman N, Anderson GC, Medley N. Early skin‐to‐skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub4.

Conde‐Agudelo A, Díaz‐Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD002771. DOI: 10.1002/14651858.CD002771.pub4.

Korja R, Latva R, Lehtonen L. The effects of preterm birth on mother-infant interaction and attachment during the infant's first two years. Acta Obstet Gynecol Scand. 2012;91(2):164-73.

Howard K, Martin A, Berlin LJ, Brooks-Gunn J. Early mother-child separation, parenting, and child well-being in Early Head Start families. Attach Hum Dev. 2011;13(1):5-26.

Sankar, M.J., Sinha, B., Chowdhury, R., Bhandari, N., Taneja, S., Martines, J., Bahl, R., Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis, Acta Paediatric 2015;104:3-13.

Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasavec A, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016;387:475-90. doi.org/10.1016/S0140-6736(15)01024-7.

WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO will issue a further update. Otherwise, this scientific brief will expire 2 years after the date of publication.

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Breastfeeding is the cornerstone of infant and young child survival, nutrition and development and maternal health. The World Health Organization recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond.

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Breastfeeding Safely During the Pandemic

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Breastfeeding Safely During the Pandemic

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Breastfeeding safely during the COVID-19 pandemic

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How to nourish your child following the latest expert guidance

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BFN Update on Coronavirus and Breastfeeding

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BFN Update on Coronavirus and Breastfeeding

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This information about coronavirus and breastfeeding is checked regularly and will develop in response to guidelines and evidence. This page was last updated on 31th August 2022.

BfN's Statement on COVID-19 Vaccines while breastfeeding

This statement aims to address the questions we are receiving. It is for information only and not intended to promote the vaccine or replace advice from a healthcare professional.

If you are breastfeeding or giving your expressed milk, you can have any of the vaccines currently available in the UK as long as you meet the other conditions for receiving the vaccine, as set out by the Medicines and Healthcare products Regulatory Agency (MHRA) and Joint Committee on Vaccination and Immunisation (JCVI). As with other vaccines, there is no evidence that anything other than antibodies passes into your breast milk. These antibodies are not harmful to your baby, and may give some protection against the virus. There is no need to avoid giving your baby your breast milk directly after you have the vaccine, either by missing breastfeeds, or expressing and dumping milk.

The JCVI has recommended that the vaccines can be received whilst breastfeeding. This is in line with recommendations from the USA and the World Health Organization.

FAQs - COVID-19, Vaccines and Breastfeeding, including information on the latest research

If you are feeling unwell and think you may have coronavirus, you can continue to feed and care for your baby as usual, if you are able to (see FAQ "Can I breastfeed if I have COVID-19?"). You should consider additional hygiene measures to avoid passing the infection to your baby.

The main points include:

Wash your hands before touching your baby, breast pump or bottles

Try to avoid coughing or sneezing on your baby while feeding, whether breastfeeding or giving a bottle.*

Consider wearing a face mask while breastfeeding, bottle feeding or caring for your baby. If your baby is older it may be safer to leave your mask off to avoid them pulling at it and touching your secretions. Discuss options with your midwife, health visitor or GP.

Follow manufacturers recommendations for pump cleaning after each use.

If you are feeling too unwell to breastfeed directly consider asking someone who is well to feed your expressed breast milk to your baby.

If you choose to feed your baby with formula or expressed milk, it is important that you follow the sterilisation guidelines https://www.nhs.uk/conditions/pregnancy-and-baby/sterilising-bottles/ (link checked 26/04/22).

If you are expressing breast milk in hospital, a dedicated breast pump should be used. The hospital may have guidance about bringing the bottles into the neonatal unit

*This is to ensure good respiratory hygiene when close to your baby such as when feeding, or changing their nappy.

If you are feeling unwell, and have symptoms of coronavirus, the general information provided in these links should be helpful.

The NHS has information on what to do if you have coronavirus symptoms here: https://www.nhs.uk/conditions/coronavirus-covid-19/ (checked 31.08.22)

England: https://www.gov.uk/guidance/people-with-symptoms-of-a-respiratory-infection-including-covid-19 (checked 30.08.22)

Wales: https://gov.wales/coronavirus (checked 31.08.22)

Scotland: https://www.gov.scot/coronavirus-covid-19/ (checked 31.08.22)

Northern Ireland: https://www.nidirect.gov.uk/campaigns/coronavirus-covid-19 (checked 31.08.22)

If you would like to know more about donor milk as an option while you are ill follow this link to find your nearest milk bank. Supplies are limited, they will do what they can. http://www.ukamb.org/

Some people report headaches, flu-like symptoms, general aches and pains, nausea, and gastrointestinal symptoms [1]. Taking paracetamol and drinking plenty of fluids to keep you hydrated may help alleviate symptoms. Paracetamol can be taken as normal when pregnant or breastfeeding. See our Drugs in Breastmilk factsheets for more details and information on taking other medicines whilst breastfeeding or the FAQ "Can I take medicines for COVID-19 symptoms while I am breastfeeding?"

As some people report feeling tired in the day or two after the vaccine, you might want to have your vaccine when someone is around to help you care for your baby and bring them to you for feeding. If you usually express milk, you could express some extra ahead of time in case you want to use it. Remember that missing feeds may lower your supply and could lead to blocked ducts or mastitis.

If you believe you have experienced an adverse reaction to a vaccine, you can report this via the yellow card system: https://coronavirus-yellowcard.mhra.gov.uk/ (checked 31.08.22)

[1] Coronavirus vaccine - weekly summary of Yellow Card reporting - GOV.UK (www.gov.uk) (Updated 04.08.22, checked 30.08.22)

If you are breastfeeding, you can have any of the licenced vaccines offered in the UK. The Pfizer and Moderna vaccines are recommended for people aged under 40 and pregnant women [1, 2]. Children aged under 18 will only be offered the Pfizer/BioNTech vaccine [1].

One study has found that the SARS-CoV-2-specific IgA antibodies (which could provide breastfed infants with protection against COVID-19) were present more frequently in breastmilk after vaccination with the Pfizer or Moderna mRNA-based vaccines, compared with the Astra-Zeneca and Johnson & Johnson/Janssen vector-based vaccine. After the second dose, almost all participants who had the Pfizer or Moderna mRNA-based vaccines had this type of antibody in their breastmilk, compared to less than half of those who had two doses of Astra-Zeneca vaccine, or the single dose Johnson & Johnson/Janssen vaccine.

Additionally, a second type of antibody, IgG, was present in all participants after receiving two vaccine doses, independent of vaccine type. The researchers suggest that an mRNA-based vaccine may be the optimal choice for lactating women when they want to transfer antibodies to their infants. However, all vaccines provide protection against COVID-19 for the mother and result in some antibodies in breastmilk for most women. [3]

[1] https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/ (updated 21.07.22, checked 30.08.22)

[2] Mahase E. Covid-19: Pregnant women should be offered Pfizer or Moderna vaccine, says UK advisory committee BMJ 2021; 373 :n1013 https://doi.org/10.1136/bmj.n1013

[3] Juncker, H. G., Mulleners, S. J., Coenen, E. et al.(2022). Comparing Human Milk Antibody Response After 4 Different Vaccines for COVID-19. JAMA pediatrics, e220084. Advance online publication. https://doi.org/10.1001/jamapediatrics.2022.0084

Vaccination is recommended during pregnancy and breastfeeding so you can have the jab, including boosters, as soon as you are invited. Vaccination during pregnancy may protect your baby from COVID-19 after birth, and vaccination whilst breastfeeding may provide passive antibody protection to your nursling via your breastmilk. See sections above on "Can vaccination in pregnancy protect my baby?" and "Can my breastmilk protect my baby from COVID-19?" for more information.

Pasteurised donor milk may be obtained from a milk bank. This remains safe during the COVID-19 pandemic. There is no evidence that COVID-19 is transmitted through breastmilk [1]. Milk banks use rigorous screening, hygiene measures and pasteurisation to ensure the safety of the milk they supply [2]. Pasteurisation has been shown to leave intact protective antibodies to COVID-19 that may be present in the milk [3].

Priority is given to the sickest, most premature babies. Mothers with their own breastfeeding challenges may be able to get donor breastmilk if there are sufficient supplies. For more information, see

https://ukamb.org/ (checked 31.08.22)

https://heartsmilkbank.org/ (checked 31.08.22)

[1] Pietrasanta, C., Artieri, G., Ronchi, A., et al. (2022). SARS-CoV-2 infection and neonates: Evidence-based data after 18 months of the pandemic. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 33 Suppl 27, 96-98. https://doi.org/10.1111/pai.13643

[2] https://heartsmilkbank.org/faqs/ (checked 31.08.22)

[3] Perez, S. E., Luna Centeno, L. D., Cheng, W. A. et al. (2022). Human Milk SARS-CoV-2 Antibodies up to 6 Months After Vaccination. Pediatrics, 149(2), e2021054260. https://doi.org/10.1542/peds.2021-054260

If your baby needs to be cared for in a Neonatal Unit (NICU) these links have general information and specific details about COVID-19.

Specific guidance can be seen on the British Association of Perinatal Medicine website, here: https://www.bapm.org/pages/182-perinatal-covid-19-resources (checked 31.08.22). It includes a document called "frequently asked questions within neonatal services" (last updated 13/01/22). This is detailed and written for clinicians.

The section "How do we manage provision of expressed breast milk (EBM) in the NNU when mother is SARS-Co-V positive?" states:

To date viral RNA has been reported only very rarely in fresh breast milk of COVID-19 confirmed mothers. The database is, however, small. The main risk of breastfeeding for the infant is the close contact with the mother, who is likely to share infective airborne droplets. National advice for well babies of COVID-19 suspected or confirmed mothers is that the benefits of breast feeding outweigh any theoretical risks.

For unwell or preterm babies in the NNU the evidence is less clear.

Practitioners should discuss with parents the pros and cons of provision of EBM to babies in the NNU, noting the current uncertainty. A joint decision should be informed by factors including the gestation and clinical condition of the baby, transfer of protective maternal antibodies, the availability of donor breast milk and parental choice. Other coronaviruses are destroyed by pasteurisation.

SARS-CoV-2 positive mothers who are expressing milk must be facilitated to practise excellent hand hygiene, and care taken to ensure that bottles containing EBM are not externally contaminated. The virus is deactivated by chlorine disinfectants. EBM of COVID-19 suspected or positive mothers should be stored in a separate fridge or freezer from that of non- suspected or negative mothers. NNUs should have clear guidelines around handling, storage and use of EBM in these circumstances and suspected/infected mothers should have exclusive use of a breast pump.

If it is decided to withhold mother's own breast milk, the mother should be encouraged to express and discard her milk, to maintain lactation until she is no longer considered infectious (10 days after onset of symptoms). Repeat testing of mother is not necessary. Parents should be signposted to appropriate feeding and emotional support during this period and reassured that breastfeeding can still take place after a period of using donor breast milk / formula if lactation is maintained.

Consider testing a sample of EBM for SARS-CoV-2 once lactation is established as this may help with future understanding of this virus.

Lactation is not a contra-indication to COVID-19 vaccination and breastfeeding mothers should be advised to continue breastfeeding after receiving vaccine.

Bliss has a detailed statement covering the care of babies in neonatal units during the pandemic, including what to do if a mother has symptoms of COVID-19 or tests positive. (Statement updated 22.04.22, link accessed 31.08.22). This statement may be of help when discussing the care of your baby with staff on a neonatal unit.

BAPM guidance states that ''it is essential that the mother and her partner are never considered to be visitors within the neonatal unit - they are partners in their baby's care and their presence should be encouraged and facilitated as much as possible.'' The guidance also stresses the importance of parents being present together, unless this is clearly detrimental to other babies or staff, and that mothers and their babies should be considered 'the same biological entity'. Their guidance also notes that parental involvement in the delivery of basic tasks and their baby's care may prove beneficial to units where there are staffing pressures.

The Bliss statement explains that parents who have tested positive for COVID-19 may not be able to access the neonatal unit until they have completed self-isolation, but this should be discussed with the individual neonatal unit. Some units may have solutions to this, particularly in the case of end of life care, when every effort should be made to facilitate parental presence.

If you want to talk through any worries you have related to breastfeeding and COVID- then you can contact the National Breastfeeding Helpline. Trained volunteers will be able to offer you information and support. You can also talk to your midwife, health visitor or doctor.

If your concern is linked to the vaccine or other medications, you can contact our Drugs in Breastmilk team, where trained volunteer pharmacists will be able to discuss your questions or worried with you.

There are a number of other organisations offering support to breastfeeding mothers, and many support groups are running again now. Details of peer support offered by The Breastfeeding Network can be found here. Information on other organisations offering support can be found here

Eye Infection and Breastfeeding
Eye Infection and Breastfeeding

Chickenpox and Breastfeeding
Chickenpox and Breastfeeding

Antibiotics and Breastfeeding
Antibiotics and Breastfeeding

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Coronavirus and breastfeeding - The Breastfeeding Network

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Information on coronavirus (corona virus/Covid-19) and breastfeeding for mums and families in the UK

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If your baby is not able to breastfeed straight away, the staff at the hospital will help you to express (collect) your breast milk as soon as possible after your baby is born. This means that your baby will still get the benefits of breast milk until they are ready to feed from the breast or bottle, as it can be given to them by a feeding tube.

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Expressing milk can take time to learn. Find out how to express in neonatal care and how to look after yourself while expressing.

Expressing means collecting breast milk which you can store and feed to your baby later. You can express milk by hand or with a breast pump, which can be electric or manual.

Expressing can be helpful:

If your baby is not well enough or strong enough to feed from the breast straight away

So that both partners or others are able to share feeding

If you are too sick to feed your baby from the breast

If you cannot be near your baby and want to establish a good milk supply

If your baby has difficulty latching on to the breast, but you still want to give them your breast milk.

If your baby is not able to breastfeed straight away, the staff at the hospital will help you to express (collect) your breast milk as soon as possible after your baby is born. This means that your baby will still get the benefits of breast milk until they are ready to feed from the breast or bottle, as it can be given to them by a feeding tube.
It is important to express in the way that is most comfortable and convenient for you.
A small amount of milk is produced in the first few days after a baby is born. This milk is called colostrum, and is often thicker and more yellow in colour than breastmilk. Colostrum is really important for your baby. It helps to boost your baby's immune system, protect them from infections and helps them grow.

Some parents are worried that they are not producing enough milk in these first few days. This is normal - most parents start by expressing less than 1ml of milk at a time. This will increase gradually the more times you express. Around two to four days after giving birth, you will notice your milk becoming more white and your breasts might feel fuller. This is often referred to as your milk 'coming in'.

Later on, the amount of milk you express may change depending on the time of day and how you feel.

After expressing your milk, the milk can be kept in the fridge or be frozen and stored until your baby is ready to have feeds. We have some more information about how to store breast milk at the bottom of this page.

Your milk is best suited to your baby's needs, but sometimes premature or sick babies need more nutrients than are provided in breastmilk alone. If this is the case for your baby, your baby's doctor may prescribe a preterm fortifier (which is usually a powder made from cow's milk) to go in your milk. This will provide more nutrients that will help with your baby's growth and bone health.

Many parents tell us that expressing can feel like a big pressure. It is important not to be too hard on yourself if you are not able to express a lot of milk in the early stages. No matter how much or how little you can express, your baby will benefit.

Many parents find comfort in expressing as it is something positive and important they can do for their baby. Try not to compare the amount you are expressing with others, as they may have faced different challenges or situations to you.

Expressing breast milk can also take time to learn. The staff looking after your baby will give you support and practical help with this. Speak to your neonatal nurse, feeding specialist or midwife for more support.

In this section, we have more specific information about:

If you have any questions about expressing or are not sure what to do, you should always ask questions or seek more support. Most units will provide specific support with expressing, and your neonatal nurse will be happy to help with any questions that you have.

How often should I be expressing milk for my baby?

It is important to start expressing milk as soon as possible after your baby is born - ideally within two hours. It is recommended you express frequently to keep your milk supply up. To begin with, this is around eight to ten times in 24 hours, including at least once at night. This is because breast milk is produced on a demand and supply system, so you are likely to produce less milk overall if long periods of time are left between expressing.

In time you will find what works best for you. You may find that your milk flow responds to a fixed routine and will trigger a let-down reflex (see below), which will make it easier to express. This might include actions when you prepare to express, such as removing equipment from the steriliser, or putting the pump together.

The let-down reflex

When you express milk, you may notice tingling or prickling in your breasts and nipples, or a feeling as if the milk is rushing in to fill them. This is called the let-down reflex (it is sometimes called the milk ejection reflex). During the let-down reflex, a hormone called oxytocin is released, which helps with milk flow. This takes a few minutes to appear at first, but later it will happen in a few seconds.

The let-down reflex feels different to different women. Some mothers describe a slight pain and some mothers have no sensations at all. Your body may respond to certain things you do, which can trigger your let-down reflex. For example, it is normal for the let-down reflex to happen in response to having a warm bath or shower, or to breast massage (see below). It can also happen in response to being close to your baby, hearing your baby cry or having a picture or something close by that smells of them.

Staying as relaxed as possible and having skin-to-skin contact with your baby can all help to trigger the let-down reflex. Taking some deep breaths and concentrating on your breathing can help with this. It will also help to express at your baby's cotside if this is possible, so you can be close to your baby. Speak to the staff looking after your baby about this.

Gentle breast massage

Breast massage before expressing can help to trigger the let-down reflex and stimulate your milk flow. You can do this by gently stroking, rolling, kneading, and tapping your breasts with warm hands before hand expressing and/or using a breast pump. You should do this for at least two minutes. Breast massage during expressing can help to drain your breasts.

Looking after yourself when expressing

Expressing milk for your baby can be a great way for parents to feel more empowered and in control of their baby's care. Many mothers also tell us how difficult and exhausting it can be to express, especially at night. This can be a particularly difficult experience if their baby is not with them.

It can be a very stressful time, but it is important that you try to stay as relaxed as possible when expressing, as this helps with the let-down reflex and milk flow. Some research has shown that higher stress levels may contribute to the delay of milk production. Some parents find that having a photograph or something that smells of their baby nearby when expressing helps. It may also help to distract yourself by doing something like reading a book or watching TV when you express. Listening to soothing music, meditation or taking time to focus on your breathing may also help you to relax.

Partners can help with expressing. For example, they can offer encouragement, help you to relax, or get equipment ready.

It is not unusual to find feeding your baby a difficult experience. In our survey of over 100 parents, over 60% said that their mental health got slightly or significantly worse during the experience of feeding their premature or sick baby. It is okay to find the experience difficult, no matter your situation. Every parent will have a very different experience of neonatal care.

It is important to talk to someone if feeding your baby is having an impact on your mental health. This could come from your feeding specialist, neonatal nurse, midwife, doctor, partner, or friends and family. We have lots of information about the impact having a premature or sick baby can have on your mental health, and where you can get support.

How to store expressed milk safely

You can store milk if your baby is unable to drink it at the time it is expressed. It is very important that expressed milk is stored safely. This is something that partners can be involved with. On the neonatal unit, breast milk is stored in fridges and freezers that only store infant milk.

Many units supply sterile disposable bottles and labels for you to use. You should label each container with your baby's name, the date and time of collection.

If you will be using your breast milk within 48 hours of expressing, you should refrigerate it. If you are at home, breast milk that has recently been expressed will keep in a refrigerator for 48 hours (24 hours if it is defrosted). The breast milk should be stored at the back of the fridge and not in the fridge door. This is because the temperature in the door compartments goes up and down when the fridge is opened and closed.

If you will not be using your breast milk within 48 hours of expressing, it should be frozen. Milk can be frozen for up to 6 months in a home freezer. If you are freezing your milk, always leave at least one centimetre of free space at the top of the milk container. This is because milk will expand when frozen.

If you are on the neonatal unit, ask the unit staff about the best way to safely refrigerate and freeze milk. Different units may have different guidelines.

Once your milk is defrosted, it will need to be used within 24 hours. Try to use small containers to freeze your milk so that no milk is wasted. Defrosted milk may have a slightly soapy or sour smell, but this will not be harmful to your baby.

Fortified b reast milk that has been supplemented with addi tives should be used with the following one to two feeds. It is not suitable f or freezing and defrosting.

Talk to the hospital staff looking after your baby for more guidance on storing and defrosting breast milk.

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Expressing milk can take time to learn. Find out how to express in neonatal care and how to look after yourself while expressing. Expressing means collecting breast milk which you can store and feed to your baby later. You can express milk by hand or with a breast pump, which can be electric or manual.

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Does my Breastfed Baby a Supplementary Feed?

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Does my Breastfed Baby a Supplementary Feed?

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There may be times when it is necessary to supplement breastfeeding with other milk, this can be your own expressed milk, donor milk, or formula. When clinically indicated we should be attempting to minimise the disruption to breastfeeding as much as possible, this can be through facilitating you to pump your milk, and providing as much opportunity for you to breastfeed your baby as possible.
Sometimes parents wish to give a supplementary feed for reasons which are not clinically indicated, in these instances it is important to understand the potential risks that this may pose to breastfeeding so that you are able to make an informed choice. This column should help you in making that choice and help you in continuing your breastfeeding journey.

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Potential Risks/Problems of Supplementing Breastfeeding with Formula

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Potential Risks/Problems of Supplementing Breastfeeding with Formula

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We are delighted to co-publish this new poster about cup feeding.
The poster is intended to help healthcare professionals and organizations working in emergencies and families themselves.
It is also intended to be a useful resource for anyone who needs to feed their own expressed milk or a supplement to a baby.

The poster can be downloaded and printed for use in your communities, or shared on social media.

We are in the process of translating the poster into multiple languages.

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COLOR POSTERS TO DOWNLOAD
BLACK AND WHITE POSTERS TO DOWNLOAD
COLOR POSTERS FOR USE ON SOCIAL MEDIA
BLACK AND WHITE POSTERS FOR USE ON SOCIAL MEDIA

A BABY NOT FED AT THE BREAST CAN BE FED WITHOUT A BOTTLE

Cup feeding can be used from birth. It is suitable for both expressed breastmilk and infant formula. You can use any clean, open cup with a smooth surface.

Cup feeding has no notable difference to bottles for average time per feed.

Cups are safer than bottles. Bottle teats and screw tops trap germs that can get into the milk and make babies ill. Cups are easily cleaned with washing in hot soapy water, and do not need sterilizing like bottles.

In emergencies, use disposable cups.

Feeding time is bonding time - lots of cuddles, eye-contact, talking, smiling, humming and singing.

CUP FEEDING IS AS EASY AS 1-2-3!

color posters to download

Black and White posters to download

COLOR POSTERS FOR USE ON SOCIAL MEDIA

Right click on a desktop, or hold and tap on a mobile device to bring up your options to copy or save the image.

English

Spanish

German

Greek

Lithuanian

Turkish

French

Swahili

Russian

Traditional Chinese
Simplified Chinese

Arabic

Vietnamese
Romanian

Polish

Ukrainian

BLACK AND WHITE POSTERS FOR USE ON SOCIAL MEDIA

Right click on a desktop, or hold and tap on a mobile device to bring up your options to copy or save the image.

English

Spanish

German

Greek

Lithuanian

Turkish

French

Swahili

Russian

Simplified Chinese

Traditional Chinese

Arabic

Vietnamese

Polish

Ukrainian

Adapted from The World Health Organization - Infant Feeding in Emergencies: A Guide for Mothers and UNICEF/WHO 20-hour Baby Friendly Hospital Initiative Course by Magdalena Whoolery (PhD Health Studies, BSc Nursing, Dip HE Nursing) and Julie Fogarty (BFA, GradDipTchg), January 2020 (updated April 2020). Poster endorsed by the following: International Baby Food Action Network (IBFAN, defending breastfeeding), Safely Fed Canada, Breastfeeding Advocacy Australia, La Leche League International (LLLI).

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Cup Feeding - La Leche League International

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We are delighted to co-publish this new poster about cup feeding. The poster is intended to help healthcare professionals and organizations working in emergencies and families themselves. It is also intended to be a useful resource for anyone who needs to feed their own expressed milk or a supplement to a baby.

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

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Pros and cons of cup feeding

Advantages of cup feeding

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

Cup feeding may help preserve breastfeeding by avoiding bottles. Studies show cup feeding premature babies instead of using bottles can increase the number of babies who breastfeed and increase the length of time they breastfeed

Cup feeding can prepare a baby for breastfeeding. Feeding technique (use of muscles) while cup feeding is thought to be closer to breastfeeding than using a bottle and may help prepare a baby for breastfeeding by encouraging the tongue to come forward for lapping/sipping

Open cups are easily available, inexpensive and very easy to clean in resource poor areas or emergencies compared with teats, bottles or feeding tubes

Suitable for very young babies. Cup feeding can begin from as early as 29 weeks gestational age.

Disadvantages of cup feeding

There is a risk of aspiration or choking if cup feeding is not done correctly

Feeds can take a long time

There can be a lot of spilled and wasted milk compared with bottle feeding or tube feeding

Long term cup feeding can dampen the sucking reflex or create a preference for the cup

Not suitable for sleepy babies as there is a risk of choking.

Can cup feeding help preserve breastfeeding?

One review found cup feeding had no significant benefit in maintaining breastfeeding after discharge from hospital and that the length of hospital stay was likely to be a lot longer with cup feeding in some settings. However more recent studies have found the opposite - more cup fed babies were exclusively breastfeeding at discharge, and beyond, with no apparent increase in hospital stay for term, late preterm and premature babies (Penny et al. 2018). The Academy of Breastfeeding Medicine states cup feeding may help preserve breastfeeding and the World Health Organisation recommends cups or spoons rather than bottles and teats for premature babies.

How to cup feed a baby

Cup feeding is best taught by a demonstration from your experienced health care professional if possible. They will advise you whether the technique is suitable for your baby. To cup feed a baby needs to be awake and alert, and in an upright position. Never cup feed a sleepy baby or a baby who is lying flat and never pour milk into a baby's mouth as these all increase the risk of your baby choking.

Cup feeding videos

Global Health Media has a lovely series of videos about breastfeeding, the first clip below (9 minutes long) discusses how to safely cup feed a small baby who isn't breastfeeding yet and includes spoon feeding, using a paladai (see below) and using a nifty cup:

Cup feeding description

The following description is summarised from the video above. Use a small cup with a smooth edge such as a medicine cup, sherry glass or shot glass-your maternity hospital may give you one. You can also buy little plastic cups specially for the purpose which can be shaped slightly during feeding. You may need a cloth under baby's chin in case any milk spills.

Half fill or two thirds fill a small cup with slightly warmed breast milk or infant formula

Ensure your baby is fully awake, alert and interested in feeding. Never cup feed a sleepy baby

If needed, wrap your baby to prevent him knocking the cup out of your hands

Sit your baby in a comfortable, upright position on your lap. Never cup feed a baby who is lying flat on their back

Rest the rim of the cup lightly on your baby's lower lip or their lower gum ridge

Tip the cup just enough so that milk reaches the rim of the cup, don't put the cup too far into baby's mouth

Your baby will quickly learn to sip or lap milk from the rim of the cup with his tongue

DO NOT pour the milk into his mouth, go slowly alwayskeeping the milk just at the rim of the cup

Leave the cup in position when baby pauses to rest between swallows and is not drinking, avoid putting pressure on the lower lip

Continue to tip the cup enough to keep the milk at the rim of cup resting lightly on baby's lower lip

Burp baby if needed during the feed.

Short film clips of cup feeding

In the following short clip from Global Health Media, a premature baby is cup feeding. Notice how the baby's tongue extends to lap the milk.

Jack Newman is a Canadian paediatrician and breastfeeding expert. Here is a clip of cup feeding from his International Breastfeeding Centre:

Using a paladai

Mothers in India have used a small spouted cup called a paladai for centuries. One study compared the use of a bottle, cup and a paladai in 100 newborn babies. Infants took the most milk in the least time and stayed calmest with the paladai . However a more recent pilot study comparing the paladai with bottle feeding in preterm infants found increased spillage, longer feed times and more stress cues .

Alternatives to cup feeding

Alternatives to cup feeding for the breastfed baby who needs supplementing include:

Supplementing at the breast. A breastfed baby who is latching well to the breast but who needs additional milk can be supplemented while they are breastfeeding by way of a small feeding tube alongside the nipple. The free end of the feeding tube is placed in a container of milk and provides milk when baby suckles with a good seal around breast and tube. For much more information about the pros and cons of this system see Supplementing at the Breast.

Finger feeding. Finger feeding is another method of providing supplemental milk to a breastfed baby by way of a feeding tube (above). In this case the feeding tube provides additional milk while the baby suckles on a clean finger. For more information on the pros and cons of finger feeding see What is Finger Feeding?

Bottle feeding. A traditional way to provide supplemental milk is by bottle and teat. Feeding from an artificial teat has a number of differences to breastfeeding which could cause nipple preference or confusion in some babies. However there are several ways to reduce the differences to help preserve breastfeeding, see Tips to Bottle Feed a Breastfed Baby and Best Bottle for a Breastfed Baby?

Summary

Used correctly, cup feeding can be a useful way to give a newborn baby supplementary milk for short term feeding. Other options for supplementary feeds include using a supplemental nursing system at the breast, or a bottle using our tips to minimise nipple confusion. Your breastfeeding specialist or health professional can help you decide which option is best for you and your baby.

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Cup feeding is an alternative to bottle feeding if a baby can't latch to the breast and needs to be

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

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

How supplementing at the breast works

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

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

Types of supplemental feeding system

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

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

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

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

Controlling the rate of flow of milk

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

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

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

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

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

Cleaning a supplemental nursing system

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

When to use an at-breast supplementer

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

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

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

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

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

Pros and cons of supplementing at the breast

Advantages

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

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

Mother is able to enjoy the full experience of breastfeeding.

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

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

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

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

Disadvantages

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

It is difficult to clean the little tubes thoroughly.

The system can leak, particularly homemade versions.

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

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

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

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

Reconstituted powdered formula may clog the tubing.

What supplements can be used with a supply line?

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

Taping the tube

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

Video of inserting a lactation aid with Dr. Jack Newman

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

Video using a commercial supplementation system by Natasha Batsford

Get help with breastfeeding

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

Summary

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

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

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Using Formula and Donor Milk to Supplement Breastfeeding

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Using Formula and Donor Milk to Supplement Breastfeeding

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Babies sometimes need more milk than they can take at the breast. This may be because they were born early or small, and don't yet have enough energy to do all the work of breastfeeding. Sometimes, mothers don't have as much milk as their baby needs. It is important that babies get enough milk to be healthy and to grow normally.

La Leche League groups welcome anyone who is breastfeeding or providing their own milk for a baby, or trying to do so. Please don't feel awkward about needing to give your baby extra milk at an LLL meeting! We would love to meet you and your baby!

Get support from LLLGB here.

Why a baby might need extra milk
How to tell if your baby is getting enough milk
Normal growth
Why protecting the milk supply is urgent
Why a mother might not be able to make a full milk supply
Giving extra milk - what kind of milk
Mothers' feelings about using formula milk
Extra milk - how to give it
Extra milk - when to give it
Extra milk - how much to give
Reducing the amount of extra milk
What if you need to keep using formula milk?

Why a baby might need extra milk

The most common reason for a baby to need extra milk is a slow start with breastfeeding, when not enough milk was removed from the mother's breasts in the early days after birth. This can happen when a baby is early, small, unwell, very sleepy, or unable to breastfeed at first. It can also happen when a baby isn't taking a deep enough mouthful of breast tissue to breastfeed effectively. In this case, the mother may get sore, damaged nipples and the baby may seem unhappy and unsatisfied, never wanting to let go of the breast. When not enough milk is removed, the mother's milk supply doesn't get a strong enough signal to increase to the level the baby needs.

You can read more about this here: My baby needs more milk.

How to tell if your baby is getting enough milk

When young babies aren't getting as much milk as they need, the first sign is usually that they don't poo as much as expected. A baby over 3 days old who isn't doing at least 3 yellow poos - the size of a 2p coin or larger - every 24 hours needs to be checked by a healthcare provider. After about 6 weeks, babies find their own pooing pattern, which may be less often. As long as the baby is well and growing normally, it doesn't matter by this stage how often they poo.

Weight loss is another important way to tell whether a baby is getting enough milk. Babies usually lose up to 7% of their birth weight in the first 3-5 days after birth. If they lose more than this, or keep losing weight after day 5, they need to be checked by a healthcare provider.

You can read more about this here (is my baby getting enough milk?) and here (what's in a nappy?).

Normal growth

Babies usually get back to their birth weight by 10-14 days after birth. In the first 3-4 months of life, boys grow at an average of about 40g a day, and girls at an average of 34g a day. A baby who puts on less than 30g a day on average, or whose growth curve drops down across more than one "centile line" on their weight chart, needs to be checked by a healthcare provider.

Why protecting milk supply is urgent

Whatever the reason, when a baby isn't taking as much milk as she needs at the breast, the mother's milk supply may not increase enough to meet all the baby's needs. Milk supply usually increases quickly in the early days after birth, reaching its peak level by the end of the first month. Most of this increase happens in the first 2 weeks, so the amount of milk that is removed at this time is really important. If too little is removed, it may limit how much milk a mother can make later.

When breastfeeding is going well, a baby nursing at the breast will remove milk much more effectively than any breast pump. However, if your baby isn't breastfeeding at all yet, or isn't taking as much milk as he needs at the breast, it is important to start expressing your milk as soon as possible. This will ensure that your body gets the signal it needs to make more milk. Babies who are not breastfeeding effectively may want to spend a lot of time at the breast, so it can be difficult to find time to express milk. Given the importance of protecting your milk supply at this stage, it may be necessary to limit the baby's time at the breast to free up enough time to express. This is an investment of time to make sure you have enough milk later. Find good breastfeeding support as soon as possible.

You can read more about expressing and storing milk here.

Why a mother might not be able to make a full milk supply

Occasionally, a mother may have a medical history or health issues which limit the amount of milk she can make. These reasons can include:

A history of infertility due to hormonal imbalances

Past breast surgery, especially breast reduction

Breast hypoplasia/Insufficient Glandular Tissue (IGT) - breasts may be unusually small, unevenly-sized, long and thin, with a wide space between them and there may be no breast changes (such as increase in size and tenderness) during pregnancy

PCOS (polycystic ovary syndrome)

Thyroid problems (over- or under-active)

Obesity (BMI over 30)

If any of these apply to you, you may still be able to make milk normally. However, if your breastfed baby isn't growing well it is important to find good breastfeeding support quickly.

Giving extra milk - what kind of milk

The first choice when extra milk is needed is your own expressed milk, which is tailor-made for your baby. The second choice is donated milk from another mother. This may be available from a Milk Bank if your baby is still in hospital.

You can read LLL's policy on informal sharing of breastmilk here.

When none of these is available in the amounts needed, infant formula milk may be necessary. If you are not sure what kind of formula milk to use, check with your midwife or health visitor. You can find independent information about infant milks in the UK here.

Mothers' feelings about using formula milk

When you were looking forward to breastfeeding your baby, it can feel disappointing to realise that he needs formula milk as well. You might even wonder whether it is worth carrying on breastfeeding, or whether your baby will come to prefer formula milk. It can help to think of formula milk as a kind of medication, to give your baby the energy he needs to breastfeed well. Babies are "hard-wired" to breastfeed and even a small amount of breastmilk can have a significant positive effect on health outcomes that no formula can provide. Even if your milk supply is very low, you and your baby can still enjoy the cuddly, calming, comforting aspects of breastfeeding, for as long as you want to. Breastfeeding is about much more than just milk!

Extra milk - how to give it

There are several options for giving extra milk to a baby.

In the first 1-2 days after birth, when the baby needs small amounts, a teaspoon can work well. You could express your own milk directly into the spoon and use it to feed the milk to your baby. On day 1 after birth, a full feed is about 7ml (1 ½ teaspoons), on average. On day 2 after birth, this doubles to about 15ml (3 teaspoons) per feed. Newborns need at least 8-12 feeds in 24 hours.

By day 3, something larger is needed. Cup-feeding can work well, with practice. You can use any clean cup - a small one, such as a shot glass, can work well. Trying to feed your partner or support person with a cup of water and having them feed you in return can help you quickly learn how far to tip the cup so that your baby can sip from it.

A nursing supplementer (also known as a lactation aid) is a tool that lets you feed extra milk (either expressed milk or formula milk) while your baby breastfeeds. It can be useful if you want to breastfeed but don't have enough milk. The extra flow of milk can encourage your baby to breastfeed. You can read more about supplementers here.

If bottles are used, it is important to know how to use them in a way that supports breastfeeding. It is easy to feed a baby too much, too fast by bottle, and this can be unhelpful for a baby who is finding breastfeeding difficult. You can find out how to do "paced" bottle feeding - at a good speed for your baby, letting him choose how much to take - here.

Extra milk - when to give it

It is often suggested that you breastfeed first, before giving the extra milk. This often means that the baby is at the breast when he is hungry and least happy, which can make breastfeeding stressful for both of you.

An alternative might be to try ending feeds with your baby at the breast. This may mean starting with some extra milk, to calm your hungry baby enough to help him breastfeed. Or you could start with one breast, give the extra milk in the middle, and finish on the second breast. It's much nicer for your baby to fall asleep at your breast than with a cup or bottle!

Even if your baby isn't breastfeeding much or even at all yet, spending happy time being at or near your breast will make it easier for him to breastfeed when he is ready. Carrying your baby in a sling, cuddling him skin-to-skin, taking a bath together and lying down together in a prepared bed ( if it is safe for you and your baby to do so) are all good ways for him to spend relaxed time at the breast. Babies who feel comfortable at the breast are more likely to try breastfeeding when they are ready. You might like to give the extra milk with your baby's cheek resting on your breast, letting him fall asleep on the breast as he finishes.

Extra milk - how much to give

Healthy, full-term babies are usually very good at knowing how much milk they need. If you are giving extra milk by cup or bottle, carefully watch your baby for signs that he wants more or has had enough. Your baby can show you how much they want.

Sometimes, though, a baby is so early, unwell or sleepy that they are not able to ask for as much as they need. A baby who has been getting less milk than he needs for a while may act as if he is not hungry, because he doesn't have much energy. He may look as if he is finished after a very short feed, but he will not be pooing or growing as expected.

When this happens, it is important to encourage the baby to take more milk. Keep your baby close, doing skin-to-skin as much as you can. This will encourage your baby's interest in feeding, and help you to notice the first signs that he is waking up and getting ready to feed. Your baby may only be able to feed for a short time, so he needs to do it very often. Feeds don't have to be equally spaced, but they need to happen at least 8-12 times in 24 hours. It can be helpful to record the number of feeds, along with the number of wet and dirty nappies he has done each day.

When your baby is growing and pooing as expected, he is taking as much milk as he needs.

It is important to keep in close touch with your healthcare provider during this time. If your baby starts doing fewer wet nappies, or it is getting more difficult to wake him to feed, please contact your midwife or doctor straight away.

Once your baby starts to take more milk, his energy will increase. He will start to catch up with his growth, and he might want a lot more milk. Don't panic! Give him as much as he wants, making sure that you feed carefully if using a cup or bottle, so that he can stop when he has had enough. Once his growth has caught up with where it needs to be, his appetite will calm down.

Reducing the amount of extra milk

If your goal is to feed your baby only with your milk, you will be wondering how to reduce the amount of donor or formula milk your baby is getting. It is important to work with your healthcare provider and your local breastfeeding supporters to come up with a plan tailor-made for you and your baby.

Read our article on Weaning from Supplements here.

What if you need to keep using formula milk?

Sometimes, however hard you try to increase your milk, your baby might need to keep having some formula milk. This might be an important part of his diet, or even most of it, but remember that breastfeeding is about much more than just milk. If you ask mothers of older breastfeeding babies or toddlers what they and their babies value about breastfeeding, they usually forget to mention milk! They talk about how much their babies enjoy it, how useful it is for calming them down and getting them to sleep, and how restful it can be for the mother to sit or lie down to feed. Breastfeeding can still work really well in all these ways, whether or not the baby is also having some formula milk.

It is sometimes possible to stop using formula milk after the baby has started eating other foods, usually from around 6 months. As your baby eats more food, he will need less milk. It is often possible to reduce the amount of formula he takes while still breastfeeding as much as you like. After a year, babies can drink unmodified animal milk (such as cow's milk or goat's milk) and no longer need formula milk. You can continue to breastfeed for as long as you and your child want to. Many mothers who have needed to use formula milk in the early months of their child's life find that the later months and years of breastfeeding are much more enjoyable, because they no longer need to think about how much milk their child is getting.
Written by Jayne Joyce, LLL Oxfordshire, June 2018

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Using donor milk and formula to support breastfeeding - La Leche League GB

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Babies sometimes need more milk than they can take at the breast. This may be because they were born early or small, and don't yet have enough energy to do all the work of breastfeeding. Sometimes, mothers don't have as much milk as their baby needs.

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Information about drop-ins available

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Breastfeeding has lots of benefits for you and your baby. As well as the health benefits of breast milk for your baby, breastfeeding is a good way to have skin-to-skin contact with your baby, which can help you and your baby to get to know each other.

Your baby may not be ready to breastfeed as soon as they are born. They may not be well enough or strong enough to breastfeed. Some babies who are born at term and sick may find it more difficult to breastfeed because of surgery or difficulties swallowing. Some babies with breathing or heart problems may also have difficulties coordinating breathing and feeding.

If your baby is very premature or sick, they may have to be fed using parenteral nutrition (PN) and/or tube feeding before they are well enough to breastfeed. We have more information about the signs a baby being tube fed may show if they are ready for breast or bottle feeding.

You can still provide breast milk for your baby if they are unable to breastfeed by using a technique called expressing. We have more information about expressing.

Sometimes premature babies need more nutrients than you can provide in your breast milk. If this is the case, your baby's doctor may prescribe a breast milk fortifier (which is usually a powder made from cow's milk) which can be added to breast milk. This can help with growth and bone development.

Some parents may feed their baby through a combination of breastfeeding and bottle feeding. This is often known as mixed or combination feeding. It is recommended that your baby, if possible, establishes breastfeeding before introducing another type of feeding. Combination feeding may be used if there are problems with breastfeeding, such as there not being enough breastmilk, or for other reasons. If you are thinking about mixed or combination feeding, talk to your neonatal team, feeding specialist, midwife, health visitor or GP.

Staff on the neonatal unit may recommend that your baby is fed your breast milk using cup feeding. They might suggest this if your baby is looking to feed but cannot latch onto the breast or is separated from the mother for any reason. If you are unsure, speak to the staff on the neonatal unit.

If you decide not to breastfeed your baby, it is very important that you are given information about the other options that are available. Your baby can still get many benefits of breastmilk if you express. Talk to your midwife, neonatal nurse or health visitor about how you are feeling and how they can support you.

The let-down reflex

Each time you breastfeed your baby, you may notice tingling or prickling in your breasts and nipples, or a feeling as if the milk is rushing in to fill them. This is called the let-down reflex (it is sometimes called the milk ejection reflex). During the let-down reflex, a hormone called oxytocin is released, which helps with milk flow. At first, this takes a few minutes to be released, but later it will happen within a few seconds.

The let-down reflex feels different to different women. Some women describe a slight pain and some have no sensations at all. Your body may respond to certain things you do, which can trigger your let-down reflex. For example, it is normal for the let-down reflex to happen in response to having a warm bath or shower, or to breast massage. It can also happen in response to being close to your baby, hearing your baby cry or having a picture or something close by that smells of them.

Staying as relaxed as possible and having skin-to-skin contact with your baby can all help to trigger the let-down reflex. Taking some deep breaths and concentrating on your breathing can also help.

How do I start to breastfeed my baby?

You may not know where to start with breastfeeding your baby, especially if your baby has previously been tube fed. A nurse, midwife or feeding specialist (such as an infant feeding coordinator) on the neonatal unit will be able to support you.

Both parents can be involved in breastfeeding, and other people close to you can also provide encouragement and support, such as grandparents. Having as much support as possible can help ensure that you continue to breastfeed when you go home from the neonatal unit. It might be helpful to talk about how you are going to approach breastfeeding with your partner, and how they can best support you. The NHS website has more information about how dads and partners can support breastfeeding, and signposts to more support that is available.

It is important to recognise the signs that your baby is hungry (feeding cues) before breastfeeding. Early feeding cues might include putting their fingers into their mouth, making sucking motions (rooting) and becoming restless.

What breastfeeding positions should I try?

When you are on the neonatal unit, a healthcare professional such as a neonatal nurse or midwife should support you to try to breastfeed your baby. They will help you to find feeding positions that are most comfortable for you. There are positions that may be more suitable for mothers who have had surgery, or whose baby was born premature or sick. Unit staff may recommend that you use pillows to support your arms or back.

If you have twins or multiples, you may also need more support with pillows when feeding, so that you are more comfortable and your babies are supported. Some mothers benefit from a hard pillow that ties at the back or a sling. It can be daunting at first to hold multiple babies at once, but staff in the neonatal unit will help with this. Twins Trust have some more information about breastfeeding multiples that you may find useful.

I am having difficulties getting my baby to breastfeed and latch on. Why is this?

As with all newborn babies, some find breastfeeding easier than others. This can depend on factors such as your baby's age, maturity and any medical conditions they have. It is normal for babies who are born premature or sick to take slightly longer to establish breastfeeding than babies born at term. Every baby is different, and it is important to ask for help and support, especially when you start.

There are some common problems that parents experience when starting breastfeeding. Some babies born premature can be too sleepy to feed effectively, and it can be difficult to get the right position for feeding when your baby is so small. We have a page that lists common problems you may have when breastfeeding or expressing milk for your baby and what can help.

For some mothers, it can take a while to gain confidence in breastfeeding. This is normal, even if you have breastfed before. Having a baby born premature or sick is a unique experience and it is okay to find things difficult at times. Having plenty of support around you can help you build up confidence. We have more information about support you can get with breastfeeding below.

Where can I get help and support with breastfeeding?

Many parents find breastfeeding a rewarding, empowering experience. But establishing breastfeeding can be challenging at times. It can be tiring, especially when you are travelling to and from the unit, and some mothers experience discomfort when they are starting to breastfeed. There are many places where you can get help and support.

Most parents find that having lots of support helps them to get started and to continue to breastfeed. Support can come from your partner, family and friends, and from medical professionals on the unit and at home.

Support on the unit could come from your unit's feeding specialist, a neonatal nurse, or your midwife. Some neonatal units also have a lactation consultant or feeding specialist, who are trained to help parents who are having problems with breastfeeding and expressing.

If you are at home, support with breastfeeding could come from your health visitor, a community neonatal nurse, if you have one, or your GP. You can talk to your health visitor for more information about any breastfeeding support groups in your area. It is always important to speak up and ask if you need more help and support, or if you have questions.

There are also helplines and organisations that can help:

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Breastfeeding has lots of benefits for you and your baby. As well as the health benefits of breast milk for your baby, breastfeeding is a good way to have skin-to-skin contact with your baby, which can help you and your baby to get to know each other.

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

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

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Vitamin D is not really a vitamin, it is a hormone produced by the body when skin is exposed to sunlight. A small amount of vitamin D comes from our food-sources include oily fish, cod liver oil, egg yolk, red meat, liver, and some artificially fortified foods-but the main source is from sunshine. This article looks at why we need vitamin D, why some people are deficient in vitamin D and how this might affect breast milk, and shares current recommendations for supplements for mother and baby.

Why do we need vitamin D?

Vitamin D is essential for healthy bones, teeth and muscles and is also said to protect against autoimmune disorders, cardiovascular disease, dementia and some cancers, it is important for mental health, supporting our immune systems and general well-being. Deficiency can lead to rickets, or osteomalacia (softening of the bones), and is linked to diabetes, seizures and tooth decay. Other symptoms of deficiency cited include frequent illness, feeling tired all the time, aches and pains in bones or muscles, impaired wound healing, depression and anxiety.

Why are some people deficient in vitamin D?

Our bodies make vitamin D when our skin is exposed to sunlight but because of changing lifestyles in some countries-such as limiting our time outdoors in the sun, or using a lot of sun protection-many of us are at risk of vitamin D deficiency. In the absence of enough sunlight, it's difficult to get enough vitamin D from diet alone because not many foods contain it. Those of us who are particularly at risk of low vitamin D levels include:

People who have little exposure to the sun or who cover their skin all the time with clothing or sun screen. Babies and toddlers often fall into this category due to concerns about sunburn from direct sun exposure on their skin.

People who live further north from the equator where day light hours are reduced for example in the UK between October and March

People with darker skin-more sun is needed to make the same vitamin D compared with that of a fair skinned person

People who have difficulty digesting fat in their diet (Nair and Maseeh, 2012)

People who are overweight with a body mass index (BMI) above 30.

Vitamin D and breast milk

If a woman has sufficient vitamin D levels before and during pregnancy, her baby will be born with good vitamin D stores. After birth, these stores, combined with regular sunlight on the baby's skin and the small amount of vitamin D in breast milk would historically provide enough of this vitamin for the breastfed baby. In recent years however, there has been a growing realisation that many women (and men) are deficient in vitamin D which can reduce both the baby's body stores (via pregnancy) and the levels available in breast milk.

Vitamin D levels in pregnancy

If a mother has low vitamin D levels throughout her pregnancy, her baby will also be born with low stores of this vitamin and could be at risk of deficiency. Correcting low levels during pregnancy will ensure babies are born with good stores. The UK's National Health Service recommends supplementing vitamin D in pregnancy between September and March and suggest 10 micrograms (400 IU) daily or no more than 100 micrograms (4,000 IU) daily. This ten fold difference between 400 IU and 4,000 IU is explained by the Vitamin D Council as follows:

How much vitamin D you need when you're pregnant is a complicated subject and one which doctors and scientists have yet to agree on. Not all organizations recommend the same amount of supplement each day.

Vitamin D levels during lactation

Breast milk has relatively low levels of vitamin D and if the mother is deficient herself, her breast milk will have even lower levels. Where babies are not getting vitamin D stores at birth, or any sun exposure on their skin for fear of sunburn, insufficient levels in breast milk can increase the risk of deficiency. Ideas to raise vitamin D levels in breast milk via supplements, sunshine exposure and diet are discussed below.

Raising vitamin D levels in breast milk

#1 Supplements

Research suggests that when a breastfeeding mother has high enough doses of a vitamin D dietary supplement, her breast milk will have significantly higher levels. However health advice varies widely regarding the recommended levels of vitamin D to take as a supplement during lactation to achieve this. Balasubramanian (2011) says:

there is no consensus on the dosage of vitamin D that needs to be supplemented to pregnant women nor is there robust scientific evidence to support implementation of a vitamin D supplementation programme for pregnant and lactating mothers.

What des research say?

Research suggests that the amount of supplement required to maintain adequate levels of vitamin D in breast milk is much higher than the recommended intakes often suggested to maintain a mother's own levels (Vitamin D Council, 2019).

Studies in 2012 and 2013 advocated for maternal supplements of 4000 and 5000 IU/day, while one study in 2015 and one in 2019 both cited maternal supplements of around 6,000 IU/day to sufficiently enrich breast milk. These same levels are mirrored in the current recommendation from the Academy of Breastfeeding Medicine (Protocol #29) (6,400 IU daily) and the Vitamin D Council (6000 IU/day)

Safety concerns

Some older papers caution that the safety of high-dose vitamin D supplementation in lactating women has not been proven, and some health organisations prefer to recommend babies be given vitamin D supplements directly.

In 2020 Tan et al reviewed 19 studies looking at the effect of vitamin D supplementation of mother and/or baby on the bone density and growth of healthy breastfed babies and found the quality of evidence around supplementation to be low or very low in all outcomes. They state:

There is currently insufficient evidence to recommend routine supplementation of vitamin D for breastfeeding mothers or their infants in populations at lower risk of vitamin D deficiency. In populations at high risk of vitamin D deficiency, vitamin D 400 IU per day given to the infant, or higher doses given to the breastfeeding mother, may prevent vitamin D deficiency, although effects on bone health are unclear.

#2 Sunlight

How much sunlight is needed for an adult to make sufficient vitamin D?

Amounts of sunshine needed to ensure healthy levels of vitamin D vary due to many factors such as the amount of skin exposed, skin tone and climate. In certain latitudes there is very little sunshine for much of the year and skin tones with darker pigmentation need more exposure to reach sufficient levels. The UK based Breastfeeding Network (a breastfeeding charity) suggests:

Sunlight exposure needed is 2 hours per day (if only the face exposed), 20-30 minutes a day if the face, arms and neck are exposed without sunscreen. Sun protection factor in excess of 8 prevents absorption of the UVB sufficient to make vitamin D. Need increases for those with darker skins. In all cases it is important to avoid sunburn, particularly in babies.

Heaney compares higher supplement amounts to sun exposure:

...while 5,000-6,000 IU may initially seem high, it is important to remember how much the sun produces for us. A single 15 minute whole body exposure to sun at mid-day in summer produces well over 10,000 IU.

Optimising vitamin D

Although not specific to breastfeeding mothers, author and dentist Dr Steven Lin discusses tips to optimise levels of vitamin D production in his article Vitamin D Through Sun: 9 Tips to Optimize Your Levels.

Babies and sunlight

Too much direct sunlight could burn a baby's sensitive skin so it is important to cover or protect a baby's skin before it goes red or burns.￼ UK's NHS recommends keeping babies under six months out of direct sunlight.

#3 Diet

Foods that contain vitamin D include cod liver oil, oily fish, fortified dairy products, some mushrooms and eggs

Vitamin drops for baby?

As with maternal supplementation, the recommendations for supplementing babies with vitamin D vary between authors. Many health recommendations currently advocate giving oral vitamin D drops to breastfed babies to ensure they are receiving enough of this vitamin. However, others such as Robert Heaney MD favour giving sufficient supplements to the breastfeeding mother so that mother and baby both have enough vitamin D in preference to giving vitamin drops to the baby.

The Breastfeeding Network (BFN) states that low vitamin D levels in a baby can't be reversed by breast milk alone even if the mother starts to replenish her own deficient vitamin D status and recommend giving vitamin D drops direct to baby. However this may depend on the dose of maternal supplementation since Dawodu et al found that maternal supplements of 6000 IU/day optimised vitamin D status for both mother and baby:

Maternal 6000 IU/day vitamin D3 supplementation alone safely optimizes maternal vitamin D status, improves milk vitamin D to maintain adequate infant serum 25(OH)D.

Recommendations for vitamin D and breastfeeding

Guidance from the United Kingdom

The Scientific Advisory Committee on Nutrition (SACN) produced a report in July 2016 upon which Public Health England (PHE) base their recommendations. They recommend 340 to 400 IU per day for all breastfed babies from birth to one year of age unless they have more than 500ml of fortified formula per day (formula is fortified with vitamin D) and 400 IU per day for a breastfeeding mother:

SACN is now recommending:

a reference nutrient intake (RNI) of 10 micrograms [400 IU] of vitamin D per day, throughout the year, for everyone in the general population aged 4 years and older

an RNI of 10 micrograms [400 IU] of vitamin D per day for pregnant and lactating women and population groups at increased risk of vitamin D deficiency

a 'safe intake' of 8.5 to 10 micrograms [340-400 IU] per day for all infants from birth to 1 year of age

a 'safe intake' of 10 micrograms [400 IU] per day for children aged 1 to 4 years.

Guidance from USA

The Academy of Breastfeeding Medicine recommends supplementing the breastfed baby or, if contraindicated, supplementing the mother 160 μg/day (6,400 IU/day)

The breastfeeding infant should receive vitamin D supplementation shortly after birth in doses of 10-20 μg/day (400-800 IU/day) (LOE IB). This supplement should be cholecalciferol, vitamin D3, because of superior absorption unless a vegetable source such as ergocaliferol vitamin D2, is desired (LOE IIA). Randomized trials demonstrate that safe vitamin D supplementation may be provided to a nursing mother to achieve healthy vitamin D status in her breastfeeding infant, when there is objection or contraindication to direct infant supplementation. A maternal dose of 160 μg/day (6,400 IU/day) is suggested.

The Vitamin D Council recommends supplementing the breastfeeding mother. They discuss their recommendations for pregnant and breastfeeding mothers and those of The Food and Nutrition Board and The Endocrine Society in their article Vitamin D During Pregnancy and Breastfeeding. The article discusses how to take sunshine exposure into account when deciding on supplementation for the nursing mother. The Vitamin D Council recommends that if a mother is taking 6,000 IU per day as a supplement, her breast milk will have sufficient levels and she won't need to supplement her baby. If she is not taking a supplement, or not getting good sun exposure or taking less than 5000 IU per day she should give her baby a vitamin D supplement.

if you take a supplement of 6,000 IU of vitamin D each day you shouldn't need to give your baby any vitamin D supplement. Your breast milk has enough vitamin D for your baby.
if you aren't taking a supplement or getting a good amount of sun exposure, or if you're taking less than 5,000 IU/day of vitamin D, you should give your baby a vitamin D supplement.

The American Academy of Pediatrics (AAP) recommends that all breastfed babies receive 400 IU of oral vitamin D drops until age one year, with 600 IU (15 mcg) per day for children over one year. and that nursing women should take at least 600 IU of vitamin D daily noting that many sources state 1500-2000 IU daily

Vitamin D and the newborn's gut

Vitamin D drops are widely recommended for babies (see above). How oral doses of vitamin drops in the early weeks of life could affect a newborn baby's gut is not clear but Talsness et al discuss how vitamin D can affect the baby's microbiome (balance of microorganisms living in the digestive system). A study by Hyppönen et al suggested babies supplemented with vitamin D during their first year of life had more allergies at age 31 years. while Katikaneni et al found babies who had vitamin D supplements had an increased risk of urinary tract infections .

In addition some brands of vitamin D drops may contain multiple ingredients. Wellbaby vit D drops contain olive oil and vitamin D3 (cholecalciferol) while Heathy Start vitamin D drops contain vitamin A, C and D, water, glycerol, polysorbate 80, banana flavour, alpha-tocopherol (a type of vitamin E), and medium chain triglycerides.

Summary-more research needed

Many people are deficient in vitamin D due to a general lack of sunlight in modern lifestyles. If a breastfeeding mother's vitamin D levels are low, the levels in her breast milk will also be low. Many health organisations recommend giving vitamin D supplements to both mothers and babies as a safety measure. Some studies have indicated that providing breastfeeding mothers with specific higher doses of vitamin D ensures breast milk has sufficient levels. However, some authors believe more research is needed to evaluate the long-term effects of giving high doses of supplement to the lactating mother. It is often recommended to give vitamin D drops by mouth direct to baby.
The need for vitamin D supplementation varies across the globe according to climate and lifestyle. The recommendations above may change as more research is revealed. Discuss the latest recommendations advised in your part of the world with your own health professionals to find the right advice for you and your baby.

Footnotes & References

Vitamin D Deficiency in Breastfed Infants & the Need for Routine Vitamin D Supplementation, Balasubramanian, 2011

Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents, Wagner & Greer, 2008

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A look at why we need vitamin D, why some people are deficient in vitamin D, how this might affect breast milk, and current recommendations for supplements

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BfN Supporterline in Bengali / Sylheti: 0300 456 2421

Breastfeeding support available for Bengali and Sylheti speakers. If a volunteer is not available to take your call, a message can be left and someone will get back to you. Lines are open 9:30 am to 9:30 pm, 7 days a week.

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

What is a blocked milk duct?

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

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

Causes of a blocked milk duct

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

Preventing a blocked milk duct

Ideas to prevent blocked milk ducts include:

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

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

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

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

Signs of a blocked milk duct

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

How to clear a blocked milk duct

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

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

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

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

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

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

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

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

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

Strategies over which some practitioners disagree include:

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

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

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

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

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

Massage techniques

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

Lymphatic breast drainage therapy

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

Therapeutic breast massage

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

Wide toothed comb

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

Cicular movements

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

Six step recanalization manual therapy (SSRMT)

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

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

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

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

Push and press the areola from different directions

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

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

Further ideas for persistent blocked milk ducts

Ultrasound and other therapies

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

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

Probiotics and vitamin C

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

Recurring blocked milk ducts

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

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

Oversupply of breast milk

Restricting breastfeeds to a schedule instead of on demand

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

Using a breastfeeding pillow if it is interfering with good positioning

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

A previous episode of mastitis that hasn't cleared properly

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

Stress , exhaustion or fatigue (Lawrence, 2016)

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

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

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

If your blocked milk duct is still there...

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

Summary

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

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

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How to Increase Milk Supply Whilst Pumping

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How to Increase Milk Supply Whilst Pumping

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How to Increase Milk Supply When Pumping

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How often should a mother pump to build up her milk supply and how long for? When is the best

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

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What colour is a breastfed baby's poop? How much poop should there be? Knowing the colour, consistency and amount of poop a breastfed baby produces in the early weeks can be very reassuring as it can provide clues about how breastfeeding is going and your baby's health. This article looks at what to expect in your exclusively breastfed baby's nappy during the first week of your baby's life, weeks one to six, and after the sixth week.

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Breastfed baby poop in the first week

Colour of poop in the first five days

The very first poop your baby passes on the first day of life is called meconium. Meconium is black, thick and sticky and will be passed in the first two days after birth. Over the next few days, breastfed baby poop tends to change through a predictable sequence of colours as the baby drinks more and more breast milk. The colour changes give a clue to how breastfeeding is going. When breastfeeding is going well, the colour of poop generally changes from black on the first day, to khaki green by the third day, then to brown and finally becomes yellow or mustard coloured poop by the fourth or fifth day. The stool consistency also becomes softer or more liquid and the number of poos per day gradually increases too.

Day one-black poo, thick and sticky

Day two-dark green/black poo

Day three-greeny-brown (khaki) poo, getting runnier

Day four-toffee brown poo

Day five-yellow/mustard poo: soft and plentiful, at least three or four poops per day.

If you are not seeing these colour changes on these days, asking for early support with breastfeeding will help to make sure your baby is getting enough breast milk.
Number of poos

Reference books vary slightly on the average number of dirty nappies to expect each day in the first week. Lactation consultant Marsha Walker says to expect one poop on day one, rising to three or four on day three, and around four large (or ten small) poops by day four or five . Authors Wambach and Spencer say to expect two to four dirty nappies each day in the first two days, two to five dirty nappies each day between days three and four and anything between two and six dirty nappies each day between days four and seven. If you are not seeing plenty of dirty nappies, asking for support with breastfeeding will help check if a baby is getting enough breast milk.

Plenty of milk = plenty of yellow poop

The colour changes towards yellow poop, along with plenty of dirty nappies are a guide that your breastfed baby is drinking plenty of colostrum (the first secretion from the breasts after giving birth) and breast milk. However the nappy output is only one factor in the assessment of a baby's calorie intake, health and well-being and it is important to have regular weight checks and be aware of all the ways to assess if a baby is getting enough milk (Wambach and Spencer, 2020).

Weight loss and poop

During the first five days some babies lose a little weight, newborns can lose up to 7% of their birth weight in the early days of life and this is considered "normal". When this happens, the daily colour changes in the nappy and the amount of poop can serve as reassurance that breast milk is being swallowed despite a little initial weight loss. However, if a baby continues to lose weight or is not gaining weight coupled with few or no poops, the most likely cause is they are not getting enough breast milk (Wambach and Spencer, 2020).

Breastfed baby not pooping?

If a baby is not pooping the most likely reason will be that he is not getting enough breast milk and this needs urgent attention. The idea that a breastfed baby has no waste and therefore doesn't poo very often in the first few days or weeks of life is not evidence-based. Wambach and Spencer recommend that if more than 24 hours pass without a stool in the first four to six weeks of life the baby should be seen by a health care provider and an assessment made of their milk intake (Wambach and Spencer, 2020).

Get breastfeeding help

Waiting around for poop without assessing how well a baby is breastfeeding can put a mother's milk supply and baby's health at risk. There are lots of reasons for a low milk supply and many ways to increase milk volume. If your baby isn't having any dirty nappies (or not many per day), and if the colour hasn't substantially changed by day four or five, check with your healthcare provider and call a breastfeeding specialist to check your baby's latch, position, how often you are feeding and whether you are using one breast or two per feed. Watch your baby feeding carefully. If he doesn't seem to be swallowing milk at the breast, expressing your milk will protect your milk supply and provide a supplement to feed your baby with until you can get help with breastfeeding.

Hold your baby

Kangaroo mother care and breastfeeding with skin to skin contact can help a baby breastfeed by optimising their feeding reflexes as well as encouraging frequent feeds. Keeping your newborn baby in your arms as much as possible may also help with more regular stooling. Nils and Jill Bergman explain that when separated from their mother, a baby's stress hormones are released with the effect of decreasing digestion (and therefore stooling) to prioritise heart rate and breathing in basic survival mode.

What about wet nappies?

When breastfeeding is going well you might expect to see at least one wet nappy on the first day of life followed by two to three on the second, three to four on the third, at least four to six wet nappies by the fourth day of life (Walker, 2017 p349) and at least five to six wet nappies per day by day five Plenty of wet nappies are important to show that a baby is well hydrated. Wet nappies, however, are not a substitute for dirty nappies which can help indicate whether a baby is getting enough milk to grow as well as to stay hydrated in the first few weeks of life.

How wet is a wet nappy?

It can be difficult to check for little wees in a disposable nappy as they are so absorbent. West and Marasco note clear urine usually means good hydration whereas more concentrated yellow urine may indicate dehydration.

Reddish marks in a dry nappy?

In the first couple of days after birth, before a mother's milk has come in, parents may spot orange or reddish "brick dust" marks in a baby's nappy. These are known as "urates" or urate crystals and may be mistaken for blood. Check with your midwife and breastfeeding specialist as they may be a sign your baby is not getting enough milk. A little blood in the nappy of a baby girl may also be "pseudomenstruation" due to hormonal changes. Jack Newman, a Canadian paediatrician and breastfeeding specialist, has a Facebook post with a photo and more information about urates.

Breastfed baby poop-weeks one to six

Colour and consistency of poop

There can be a wide range of normal when it comes to colour and consistency. Breast milk contains traces of the mother's diet. Therefore a mother's diet or any medications she (or her baby) are taking could affect the colour and form of her baby's poop.

Colour. The usual colour of a breastfed baby's poo by the end of the first week is yellow, mustard or light brown.

Consistency. A breastfed baby's stools are quite soft and unformed or runny and may contain small curds (Wambach and Spencer. 2021. p 263) that look like little lumps or seeds- see photo below. Authors Wilson-Clay and Hoover describe this as sometimes resembling mustard mixed with sesame seeds adding that occasionally stools may look watery.

Green poop

Green poo is also common, it could be normal for your baby or have one of a number of other explanations. A baby with green poo may have an intolerance to something in his mother's diet, be suffering from a lactose overload (green, frothy and foamy poop), not be getting enough milk or there may be another reason. See Why is My Breastfed Baby's Poo Green?, Lactose Intolerance in Babies and Milk Allergy in Babies for more information.

At least three or four poops per day

Expect frequent loose and copious bowel movements every day in the first four to six weeks (Wambach and Spencer, 2020) and five or six wet nappies per day. Frequency will vary between babies: The Womanly Art of Breastfeeding says to look for at least three poos each day in the first month the size of the circle made by touching the tip of your thumb and forefinger together. Shrago et al suggest that well-fed breastfed babies will have four or more poos a day by two weeks of age. Dr Jack Newman says to expect anything between three and ten dirty nappies per day. He explains:

Usually during the first few weeks, exclusively breastfed babies will have many bowel movements every day. Ten a day is not rare and if the baby is content, drinking well at the breast and gaining weight, there is no issue. Furthermore, the amounts of each bowel movement and the colour can be quite variable. One day a baby could have 3 bowel movements, the next day 10 and 5 the day after. What matters is whether the baby is content and drinking well at the breast, not the colour of the bowel movements. Of course, the very dark green, almost black, bowel movements that are meconium are not normal after three or four days of life.

Baby not pooing

As in the first week of life, if your baby is not pooping frequently and/or weight gain is poor it is important to check whether baby is getting enough milk: see Is My Baby Getting Enough Milk? and contact your breastfeeding helper for a breastfeeding assessment. If baby is getting plenty of milk and gaining weight normally, less frequent stools may just be your baby's rhythm-or see below for more possible reasons for infrequent stooling.

Breastfed baby poop-week six onwards

A breastfed baby's pattern of dirty nappies can change around six weeks of age and they may start having fewer dirty nappies or not pooping every single day. Wambach and Spencer explain that the ratio of whey to casein (milk proteins) in breast milk changes slightly around six weeks resulting in slightly thicker more formed stools that may be passed less often although many patterns of stooling are possible. Lactation consultant Robyn Noble says a breastfed baby over six weeks of age will typically have one copious mustard yellow poop per day with a consistency of toothpaste. Having fewer dirty nappies isn't usually a concern at this age as long as weight gain continues to be good with plenty of wet nappies as before.

Very infrequent poos

Some breastfed babies may only stool once every three to ten days or so and their poo may be light brown due to a longer time in the gut. The poop is usually soft and there's plenty of it when it comes, so doesn't fit the description of hard dry poop that may be described as constipation. However, although parents may be told that this interval between poops is normal in breastfed babies, it may not be ideal. A baby may be feeling uncomfortable after this period of time. Different authors have different explanations:

Author Linda Palmer proposes that a potential cause of infrequent stooling, despite a good breast milk intake and weight gain, could be a sensitivity to cows' milk products coming from the mother's diet-especially if accompanied with rashes and other symptoms of allergy. See below for more information on how allergy can influence poops and flatulence.

Lactation consultant Carol Smyth looks at a range of possible causes for infrequent stooling from medications to the microbiome in Should My Breastfed Baby Poo Every Day or is Breast Milk All Used Up?

Authors Wambach and Spencer point out that health issues such as Hirschsprung's disease, cystic fibrosis, infant botulism, cows' milk allergy and other bowel disorders can be associated with unusual patterns (Wambach and Spencer, 2020). Parents should check with a healthcare provider if they have any concerns over unusual stooling patterns.

Difficulty pooping?

Some babies who seem to be uncomfortable when due to open their bowels may be helped to poop by holding them in a more upright seated position e.g. over a toilet or potty. Baby can be held securely with their back supported against a parent's chest and with a thigh held in each hand in a supported squatting position. Gravity and freedom from a nappy can help a baby open his bowels.

Constipation?

An exclusively breastfed baby's poop is usually very soft and unformed. If stools are hard, dry and/or infrequent this may be diagnosed as constipation by your baby's doctor. Constipation is more likely with formula-fed or mixed-fed babies and a switch to infant formula could cause firmer stools (Palmer, 2015, p179). True constipation involves hard dry, infrequent stools and a baby's doctor will help to find the cause. Constipation can be associated with a food allergy or medical reasons such as a neurological disorder or even certain medication-reflux medication or iron supplements can cause constipation (Palmer, 2015; Smyth, 2016).

Food allergy and lots of poop

Situations that could be associated with food allergy described by author Robyn Noble in her book Breastfeeding Works! Even With Allergies include:

Very frequent poop. Beyond six weeks of age, an unexpectedly high number of copious runny poops per day could be an indication of a food allergy affecting the gut. Other symptoms might include reflux, mucus or blood in the stools, or poor weight gain despite lots of poop.

Smelly poop and/or flatulence (farts). Breastfed baby poop is usually described as inoffensive and has a characteristic sweet smell, sometimes described as yeasty or slightly cheesy (Wambach and Spencer, 2020). Unpleasant smelling poops, noisy bowel motions that are runny, frequent and gassy and/or excessive noisy flatulence (particularly after six weeks of age) can be associated with food allergy.

Nappy rash. Frequent nappy rash and perianal burns (despite regular nappy changes) may be seen alongside food allergy because runny, gassy stools are more acidic and can burn a baby's skin.

For more general information on food allergy see Milk Allergy in Babies.

The colour of poop

As with weeks one to six, the usual colour of breastfed baby poop before a baby starts solid food is yellow or mustard. Green coloured poop could be normal for an individual baby but there are also several other possible reasons, see Why is My Breastfed Baby's Poop Green? Any concerns about the colour of your baby's poop should be reported to your baby's doctor and especially in the following situations:

Black poop

Very dark or black poop (other than the first few days of black meconium) could be a result of digested blood due to bleeding somewhere in the gastrointestinal system and should be reported to your health professional urgently. If a baby drinks a lot of blood stained breast milk due to his mother's cracked nipples this may also cause very dark coloured poop, check with your health professional and see Blood in Breast Milk.

Red poop

If there is any bleeding lower down in your baby's gut it may show as red streaks in your baby's nappy as it won't have had time to be digested. Traces of blood may be seen if a baby has allergic proctocolitis but there are other possible medical causes of bleeding. Report all cases of blood in the nappy to your doctor.

Pale or white poop, greasy fatty poop

Very pale or chalky white stools or stools that appear "fatty" or "greasy" should always be reported to your health professional. See What are the Symptoms of Jaundice? for further information.

Mucous in poop

Small lumps or strings of clear mucous may be seen in your baby's nappy from time to time, mucous is produced in the bowel to lubricate the stool and is normal. But if there are frequent large amounts this may be due to some irritation in the intestines such as food allergy or sensitivity, an infection or it could be associated with other health issues-discuss with your doctor to rule out any concerns.

Unusual coloured poop

Unusual colours of an exclusively breastfed baby's poop can be due to artificial food colouring, natural food pigments or medications in his mother's diet.

After solids

Once solids are introduced, or formula, breastfed baby poop will change in appearance becoming browner, smellier and more like adult stools. Undigested food may sometimes be seen in the nappy (Wambach and Spencer, 2020). See Starting Solid Foods for more information.

Further reading

For a more in depth review of all the possible colours of baby poop and what they mean see Baby Poop: What Your Pediatrician May Not Tell You or visit the author's website here. For a review of the content of this book click here.

Summary

The contents of your baby's nappy can provide useful information about breast milk intake and your baby's health alongside other signs that your baby is receiving plenty of milk. See Is My Baby Getting Enough Milk? and Baby Not Gaining Weight if you have any worries about how much breast milk your baby is having and seek the help of an IBCLC lactation consultant or breastfeeding specialist. Always report unusual colours of poop or any other concerns to your health professionals.
*Excerpts reprinted by permission of Pinter and Martin

Footnotes & References

Walker. Breastfeeding Management for the Clinician, 2017, p 349

Wambach and Spencer. Breastfeeding and Human Lactation. 6e. 2020 p263

Mohrbacher. Breastfeeding Made Simple. 2010 p 36

Making More Milk 2e, Marasco and West, 2020 p30

Wilson-Clay and Hoover. The Breastfeeding Atlas. 6e. 2017. p29

Wambach and Spencer. Breastfeeding and Human Lactation. 6e. 2020 p263

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What colour is a breastfed baby's poop? How much poop should there be? Knowing the colour, consistency and amount of poop a breastfed baby produces in the early weeks can be very reassuring as it can provide clues about how breastfeeding is going and your baby's health.

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Antenatal Expression of Colostrum - La Leche League GB

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Being familiar with your breasts and how they work will give you confidence for after the birth.

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Antenatal Expression of Colostrum - La Leche League GB

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

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Baby Brasseries and breastfeeding cafes are breastfeeding support groups in various locations around Bedfordshire and Luton. These offer a welcoming environment for women to meet other breastfeeding mums and form a support network, as well as get help with breastfeeding issues. We welcome mums to attend with older siblings and encourage pregnant women to join us and talk about breastfeeding, meet the team and become familiar with the group. This may help new mums to feel more confident to attend once the baby has arrived.

Baby Brasseries can be found in the following places:

Baby Brasseries and breastfeeding cafes are social support groups for breastfeeding mums, where they can access support from each other and staff. For further information regarding Baby Brasserie venues or Luton Community Health Services speak to your health visitor (0300 555 0606) or visit: NHS Bedfordshire Children & Young People's Services Facebook Page (@BedsCYP)

We are proud to have a mother to mother peer support service - our volunteer Bedfordshire Breastfeeding Buddies (BBB). They attend Brasseries and Pop-ins alongside the 0-19 team (health visitors, community staff nurses & nursery nurses) to provide support to mums. Buddies have undergone training to help support breastfeeding mothers and keep up to date with the latest information on breastfeeding.
What is a Bedfordshire Breastfeeding Buddy (BBB)?
A Breastfeeding Buddy is a mum who has breastfed, usually for at least three months, and has volunteered to support other breastfeeding mums. This role is also known as a breastfeeding peer supporter. Buddies have undergone training to help support breastfeeding mothers and keep up to date with the latest information on breastfeeding.

BBB's offer mothers emotional and practical support with breastfeeding and model breastfeeding as an everyday part of life.

A BBB may be asked to volunteer at a Baby Brasserie, a Pop-in (Well Baby Clinic) or Antenatal group. They are there to provide valuable mother-to-mother support - they will always have a member of the 0-19 Team or Children's Centre staff at the group to support them. We expect that a BBB will be able to volunteer for us at least twice a month.
How do I become a Bedfordshire Breastfeeding Buddy (BBB)?
In the first instance speak to your Health Visitor or contact ccs.beds.childrens.babyfriendlyteam@nhs.net

You will meet with one of the Baby Friendly Team prior to attending the 2 ½ day training course and be given an application pack to complete, which includes a criminal record (DBS) check and a health questionnaire.

We will ask you to attend our 2 ½ day Breastfeeding Management and Relationship Building course and complete the required practical elements of the course.
What support will I receive as a Bedfordshire Breastfeeding Buddy (BBB)?
As a BBB, you will be linked to the 0-19 team which covers the area you volunteer in. You will have a Buddy Champion, who works within the 0-19 team and is your first contact point with any issues or queries.

The Baby Friendly Team will support you during your time as a BBB. As part of this, we expect you to attend Update & Reflection sessions. These take place once every half term and will be local to you. Update & Reflection sessions are a chance for you to talk about any issues you have come across, as well as learn about relevant topics to your role. You are welcome to bring your little ones along with you to these sessions.

These sessions take place roughly weekly at children's centres around Bedfordshire. Please ring your individual children's centre to find out when the next one is happening and to book a place.
Find children's centres in Bedford Borough here Find children's centres in Central Bedfordshire here Also see our introducing solids page here. For more information please contact the Baby Friendly Team:
ccs.beds.childrens.babyfriendlyteam@nhs.net
For help and support with breastfeeding outside of normal working hours the following contact details may be useful.

National helpline numbers which are charged at local rates
National Breastfeeding helpline number - 0300 100 0212 - 9.30-21.30
NCT Breastfeeding helpline number - 0300 330 0771 - 08.00 - 22.00
Breastfeeding Network supporter line - 0300 456 2421 - 09.30 - 21.30
(Bengali and Syleti)
La Leche League helpline number - 0345 120 2918 (8am to 11pm)

Information about breastfeeding can also be found here: https://www.bedfordshirehospitals.nhs.uk/our-services/maternity-obstetrics/maternity-services-luton-and-dunstable-university-hospital/breast-feeding-and-infant-formula/

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Baby Brasseries are café style breastfeeding support groups around Bedfordshire with a welcoming atmosphere where breastfeeding mums can meet and support each other, have a hot drink and also find help and support with breastfeeding issues. We welcome mums to attend with older siblings and encourage pregnant women to join us and talk about breastfeeding, meet the team and become familiar with the group.

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Wednesday

Stevenage Infant feeding drop in clinic at Hampson Park community centre (Hampson Park, Webb Rise, Stevenage SG1 5QU) 1145-1445. No need to book, just turn up for breastfeeding support and grab a coffee and cake in their lovely cafe. The drop in is located in the large hall to the left as you enter, but there are people on reception who can direct you.

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Breastfeeding Videos for Mothers: Global Health Media Project

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These 9 videos were created to help mothers see and learn about breastfeeding in ways they can easily understand and follow.

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Global Health - Breastfeeding in the First Hours

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Global Health - Breastfeeding in the First Hours

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

Join the Conversation

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

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

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding success and how to help mothers deeply attach the baby to the breast.

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Breastfeeding Attachment - Video - Global Health Media Project

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

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Association of Breastfeeding Mothers (ABM)

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Association of Breastfeeding Mothers (ABM)

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Trained breastfeeding counsellors are available at:National Breastfeeding Helpline, Find a local support group, Access web chat or email us.

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

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Team Baby: getting ready to breastfeed – ABM Training Support

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Spanish
French
Italian
German
Dutch
Turkish
Russian
Hebrew
Japanese
Chinese

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LLLGB resources

LLLGB breastfeeding information in Welsh is now available on our website.
Bwydo ar y fron
Hanfodion bwydo ar y fron
A yw fy mabi'n cael digon o laeth?

Our Leaders offer support to Mums in the following languages:
Afrikaans, Bemba, British sign language, Croatian, English, French, German, Gujarati, Hebrew, Hungarian, Italian, Polish, Portuguese, Spanish, Swahili, Welsh.

We are in contact with LLL Leaders around the world, and can access online support in many languages.
If you would like to access support in a language other than English, please contact our Administration Department and we will try to help you.

LLL Europe resources

You can also find articles, information and support on the LLL Europe website - it has contact details and links to LLL in 21 countries.

LLLI resources

LLLI's international online magazine Breastfeeding Today has translations of many articles in Spanish, German, French and Russian with articles in other languages coming soon.

For more information about LLLI click here.

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Support in languages other than English - La Leche League GB

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LLLGB resources LLLGB breastfeeding information in Welsh is now available on our website. Bwydo ar y fron Hanfodion bwydo ar y fron A yw fy mabi'n cael digon o laeth? Our Leaders offer support to Mums in the following languages: Afrikaans, Bemba, British sign language, Croatian, English, French, German, Gujarati, Hebrew, Hungarian, Italian, Polish, Portuguese, Spanish, Swahili, [...]

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Sometimes parents can worry that their milk supply is low, this article addresses some of these beliefs and should help to reassure you. If you are still concerned see the article on maximising milk in the practical help column

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Every day mothers panic and end breastfeeding or start using formula and there is not an underlying problem with their milk supply.

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Occasionally you may find that you are over producing milk, this can lead to a few issues including mastitis and fast flow, which can make things tricky for baby. This article will help address these issues and more

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

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

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

Symptoms of oversupply

The main symptoms of oversupply for a baby are:

Very fast weight gain, moving upwards through centile lines

Explosive green frothy poos

Struggling to control milk flow

Pain and excessive wind or 'gas'

You may also notice the following:

Choking, coughing, and pulling on and off the breast

Clamping down and biting to slow the flow of milk

Frequent spitting up

Always appearing hungry and unsatisfied despite large weight gain

Unwillingness to nurse to sleep

Breast refusal

Faltering weight gain due to breast refusal

Lots of wet and dirty nappies

General 'colicky' behaviour

A mother with oversupply may have the following symptoms:

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

How does oversupply happen?

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

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

How is your milk supply established?

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

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

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

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

Read more about how milk production works.

A note about foremilk and hindmilk

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

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

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

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

What can I do about the symptoms of oversupply?

To start with, you might like to:

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

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

use breast massage

avoid overpumping

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

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

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

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

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

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

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

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

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

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

Reducing your milk supply

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

If you still have problems

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

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

Breast compression

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

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

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

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

Adjusting to the new normal

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

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

Written by Charlotte Allam

Last updated May 2023

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

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

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

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

Copyright LLLGB 2023

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