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www.onespace.org.uk

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Same sex parents

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We are the LGBT Mummies organisation.

Our sole purpose is to support LGBT+ women & people globally on the path to motherhood or parenthood.
We provide guidance on the different family creation pathways through our website, social channels & support groups, whilst providing access to our global community to meet other like-minded families.

From providing guidance on fertility clinics & sperm banks, resources, connecting you to supporting organisations, brands, sharing studies, our private support groups, to celebrating & sharing your lived experiences & our annual events where families come together.

Whether you are thinking of starting a family or have children already
by home insemination, fertility treatment, surrogacy, adoption, fostering. Whether you're a single parent, couple,
co-parent, poly family or a stepparent, all families are welcome.

Our mission is to acquire true equity & equality for LGBT+ families to that of our heterosexual counterparts.

We passionately campaign for LGBT+ family equality & positive policy change. We do this through our ongoing recommendations, training & conversations with the Government, NHS, corporate & charitable organisations, to improve support for LGBT+ families across healthcare, law & society.

Through our educational arm, PROUD FOUNDATIONS, we provide education & training, consultancy services, speakers & project work to educate & enable organisations to better support our community by improving policies, guidelines & resources.

We work tirelessly to inspire people worldwide on their journey, whilst working to 'usualize' & celebrate our families in society, in turn creating a more inclusive future for our children.

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Support same sex families & LGBT women & people looking to start a family & providing a community space for lesbians, bisexuals, trans & non binary women & people

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Evidence based information on making up formula bottles using various preparation products

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Questions about infant milk safety Are powdered infant milks sterile? Powdered infant milks are not sterile and they may contain harmful bacteria. However, if milks are made up appropriately for infants, they should be safe. Salmonellaand Cronobacter sakazakii(previously known as Enterobacter sakazakii)are the organisms of greatest concern in infant formula and a range of Cronobacterspecies ...

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Expressing and storing breastmilk - The Breastfeeding Network

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This page gives you some tips on how to hand express and store your breastmilk. It also answers some frequently asked questions on this topic. You might be thinking of returning to work, or study, or planning a night out. It can also help relieve pressure from a blocked duct or mastitis. Expressing small amounts […]

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Thrush and breastfeeding with Dr Naomi Dow

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Podcast Episode · Makes Milk with Emma Pickett · 28/01/2025 · 1h 9m

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A nipple shield is a flexible silicone nipple that is worn over the mother's own nipple during breastfeeding.
When are they used?
Nipple shields can help establish breastfeeding with some babies who seem to have difficulty achieving and/or maintaining attachment to the breast. However, very few benefit from using a nipple shield. Please consult a breastfeeding counsellor or health professional for one-to-one support before you use a nipple shield. A nipple shield can be a temporary solution but not a permanent fix to an underlying problem. They may affect transfer of milk to the baby which may contribute to poor weight gain and health problems for both mother and baby.
What might cause my baby to have difficulty with attachment?

Events around labour and delivery.

Use of artificial nipples.

Baby's physiology.

Other reasons a shield could be used:

Flat or inverted i.e. non protractile nipples.

Breast refusal.

Sore, cracked, bleeding nipples.

Weaning a baby from bottle to breast.

Re-lactation or induced lactation (adoptive breastfeeding).

Before using a nipple shield, consider:

Accessing skilled breastfeeding support, ideally face-to-face.

Prolonged skin contact, and 'biological nurturing' i.e. laid-back breastfeeding techniques.

Hand expressing drops of milk onto the nipple to tempt the baby to attach.

Regular (2-3 hourly) hand expressing of colostrum to protect milk supply.

Regular (2-3 hourly) feeding of expressed breast milk (EBM) via syringe/cup.

Trying different positions/techniques e.g. cross cradle hold and exaggerated attachment, lying down feeding, underarm hold.

Applying cold to a soft nipple to firm it.

Use of nipple massage, gentle use of breast pump or other suction device to draw nipple out.

If milk is in, deal with any engorgement to soften areola to facilitate attachment.

When breastfeeding is uncomfortable, using a nipple shield can feel like a quick fix, but shields are not a substitute for finding qualified breastfeeding support. If there is an underlying latching problem, adding a shield on top can risk blocked ducts and mastitis, supply reduction, and a baby not getting enough milk. Feeds can end up being long and unsettled and baby may take in more air. When the shield is removed, the underlying problems remain, and may even be worse as the baby has become accustomed to using the shield. Always try and find qualified help if breastfeeding is uncomfortable or challenging.
Care
Wash the shield with hot soapy water, rinse with clean water, dry carefully and store in a clean container.
Choosing a shield
Nipple shields are sized according to the diameter of the base of the mother's nipple. A poorly fitting shield can cause problems including reduced milk transfer and pain.

In the U.K., the standard sizes are 16mm (small), 20mm (medium) and 24mm (large). A larger 28mm size is available online but can be difficult to find.

The size of shield you use is not the same size as the pump funnel you use. Shields are a closer fit. Many shops will only sell one size and you may have to shop online to get a wider selection.

A 'contact' nipple shield has a cut away piece that allows baby's nose or chin to remain close to the breast. This is preferable to a shield where the baby's nose is pressed against plastic.
How to use a nipple shield
It's often helpful to place your baby in skin to skin contact well before you attempt a feed. This will stimulate baby's instinctive feeding behaviours and make attachment to the breast more likely to be successful.

First, try latching the baby without the shield if you feel you can. How long you spend trying to latch effectively without the shield is a very personal decision and will depend on how long ago the baby fed, the support you have, and how breastfeeding has been going in the past.

A warm wet shield sticks to the breast better - run the shield under warm water prior to use.

Roll the wet, warm shield back about halfway down the shank of the shield.

It may adhere to the breast better if you apply a little water or breastmilk around the edge.

Roll the shield back onto the breast so the nipple is drawn into the teat of the shield.

There are some videos online that show you how to apply a shield with this 'slightly inside out' method.

Attachment
Attachment technique is still important with a shield. Don't just poke the shield teat centrally into baby's mouth. Baby should be held close, mouth wide open and chin in contact with the breast. Once attached, you should notice their chin moving deeply to show active swallowing and you will often hear some swallowing at the beginning of a feed.

Towards the end of the feed (when baby's swallowing slows) it is a good idea to use breast compression while baby suckles to increase the milk and fat transfer to the baby. Offering baby both breasts at each feed will mean baby gets more milk.

The nipple shield is a projection of the nipple so, when the baby unlatches, it should look well rounded, just as though baby had a good latch directly at the breast. You should see milk in the shield when baby comes off. As using a shield is often associated with reduced milk transfer, it can be recommended to express in addition, to help protect your supply. Your breastfeeding counsellor or health professional can support you to consider how often this is needed, depending on how things are going.

It's a good idea to keep an especially close eye on baby's bowel movements and urine output while you're using a nipple shield, as these give an indication of milk intake. Baby should have about three tablespoon-sized yellow, grainy stools in 24 hours (after the fifth day) and have at least six wet nappies.

If baby is discharged from hospital using nipple shields, their progress should be closely monitored by the community midwife or health visitor.
Weaning from a shield
Be sure not to make this a battle with your baby, or they will resist more. Don't obsess with weaning off the shield to the point that you are unhappy with breastfeeding. As long as your baby is gaining weight well, there is no need to rush into trying to wean them from the shield. Don't cut down a shield to wean a baby off it - this practice is no longer recommended.

You may be able to remove the shield part way through a feed and continue without. You may only use a shield on one breast, or for the first few minutes. Some babies need only one or two sessions with the nipple shields, while others may need more.

Keep trying as often as you can and give it some time. Your baby might be more receptive to feeding without the shield when they are less hungry or sleepy. Some continue to use a shield for the duration of their breastfeeding experience, but most are able to stop using the shield after only a short time if they wish to.

Be patient while you work through this time of transition. Breastfeeding with a shield is still breastfeeding.

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Using a nipple shield with a breastfed baby - ABM

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Nipple shields can help establish breast-feeding with some babies who seem to have difficulty achieving and/or maintaining attachment to the breast.

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I can be contacted via the National helpline for free. DM me and I’ll tell you what hours I am available that week or you can contact me privately via my website to arrange a home visit. My independent work is chargeable per hour.

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Start your birth and parenting journey with me today! 🌸I AM BACK IN PERSON🌸

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What bottles and teats do you need for babies? | Baby & toddler, Feeding articles & support | NCT

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Which bottle treats might be useful to consider? 

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Which bottle treats might be useful to consider? 

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How many bottles and teats do I need?

This will depend on how frequently you're planning to use bottles to feed your baby. Newborn babies generally feed between 10 and 14 times in 24 hours, with feeds becoming a little less frequent as they grow. If you are exclusively bottle feeding your baby, whether formula or expressed breastmilk, you might want around four to six bottles and teats to get you started. This allows for sterilising them between feeds.

If you plan to use bottles occasionally, or once a day, then it might make sense to buy just one bottle and teat.

If you're planning to breastfeed it isn't necessary to buy bottles 'just in case'. Over 90% of maternity units in the UK are now Baby Friendly Accredited, which means a midwife on the infant feeding team should be able to support you if you do have any difficulties with breastfeeding straight after birth (UNICEF 2017). They'll help you with hand-expressing your colostrum and feeding it to your baby using a spoon, syringe or feeding cup (Unicef 2017). Find out whether your maternity unit is accredited here.

If your maternity unit is not yet on this list, you can speak to their infant feeding lead or call the NCT infant feeding support line on 0300 330 0700.

What size bottle will my baby need?

Bottles come in two sizes, small ones which hold 150mls (5 fl oz) and large ones which hold 250ml (9 fl oz). For the first few weeks, newborns feed little and often because their stomachs are so small (Unicef, 2019). The smaller bottles are more suitable for this period. Babies who feed from larger bottles consume more milk, which may lead to overfeeding (Wood et al, 2016).

Parents who bottle feed find that they may need to move onto using larger bottles as their baby grows and milk consumption increases. Every baby is different so there isn't a set age for when this should happen (Unicef, 2019). It's important to follow your baby's feeding cues and signs that they need more milk, such as finishing each feed and seeming to want more (NHS, 2015; Unicef, 2016).

What type of feeding bottle is best?

Since 2011, the European Commission has banned the use of Bisphenol A (BPA) in baby bottles. This was due to concerns that the chemical could leach out of the plastic and be absorbed by babies. None of the bottles for sale in the UK should have BPA (NCT, 2011).

Many parents want to know 'which brand of baby bottle is best?' The fact is there is no independent research showing differences in feeding ability or pattern from different brands of bottles or teats (Which, 2021; Scheel, 2005). It's down to you and your baby to see what works for you. Here's an overview of the main types of bottles available on the market:

Basic bottles

These are the standard bottles, often narrow and cylindrical in shape. They'll usually come with their own teats and lids and are reasonably priced. They are widely available but it can be trickier to fill these narrow-necked bottles (Which? 2019).

Anti-colic bottles

These are pricier bottles and their design is supposed to reduce the likelihood of colic symptoms. These bottles usually have air vents, tubes or collapsible bags for the milk in order to reduce the amount of air swallowed. It's difficult to know if these really make a difference, because the only research comes from the manufacturers and is not independent.

You may hear that you should keep the teat full of milk to avoid swallowing air. However where the milk flow is too fast and not in your baby's control, it is more likely to cause indigestion or gas (Kellymom, 2020). Anecdotally, babies whose parents use paced feeding suffer less from gas (Herman, 2021).

Using these bottles isn't a guaranteed cure; some parents find them helpful but they don't work for all babies. On the other hand, they might be trickier to clean (Which? 2019).

Wide-necked bottles

These bottles are shorter and fatter than the basic ones but you can put the same amount of milk in them. They usually come with silicone rather than latex teats and have a self-sealing lid.

Some advantages of using these bottles are that they can be easy to fill and clean. On the other hand, they can take more space in a steriliser so you probably won't be able to clean as many bottles at once (Which? 2019).

Ready-to-feed bottles

Powdered formula is not sterile, so you need to use water at approximately 70 degrees to kill any bacteria that might be present (NHS, 2019a). If the water is too hot it can reduce the nutritional benefit of the powder, but if it is too cold it may not kill the bacteria in the powder. 'Ready-to-feed' bottles contain ready-made milk that has already been sterilised (NHS, 2018; Unicef, 2019).

Ready-to-feed bottles can be a convenient short-term solution if parents have been advised to give their baby formula on medical advice. They're more expensive and not great for the environment though (NHS, 2018; Unicef, 2019).

If you are planning to use formula from the start, your local hospital might ask you to bring these types of bottles in, as most do not have the room or facilities to sterilise bottles. Do check with your midwife (NHS 2018 and Unicef 2019).

What teat should I use?

Teats are made from silicone or latex. Silicone is less flexible but more durable than latex, which needs to be replaced regularly (Which? 2019).

Some parents are cautious about using latex teats due to the risk of developing a latex allergy, particularly if there is a family history of allergy to latex (Kimata, 2004).

There is a huge range of bottle teats on the market, which can be very confusing when it comes to choosing one for your baby. They vary in the width of the base and the length of the nipple. Some are marketed as being more breast-like, or as mimicking the breastfeeding experience, but there is no independent evidence to support this (Which? 2021).

Consider using a teat that is more suited to paced bottle feeding. This means it will hold enough milk when held in a horizontal position, rather than have to be tipped up so your baby can access the milk.

If you are mixed feeding (feeding from both bottle and breast) it may help to choose a teat that will encourage your baby to open their mouth wide and take in the whole teat rather than just the tip. Those with a medium wide base and a short to medium nipple length encourage babies to open their mouth wide and cup their tongue around the teat (Pearson-Glaze 2019, Bahr 2010). This article describes it well.

When should I change bottle teat size?

Flow rates of teats refer to the size or number of holes in the teat. This affects how quickly milk 'flows' from the teat into your baby's mouth. The categories are slow, medium and fast.

Slow flow is generally preferable for newborns, while you're both learning how to feed. If the flow rate is too fast it makes paced feeding more difficult. In which case babies would have very little control over how they feed: milk would flow into their mouth faster than they can swallow it. This might make your baby cough or splutter, or struggle to keep up with the flow of milk so it dribbles to the side of their mouth. This could also mean they feel upset, get indigestion and bring up lots of milk.

If they can't control the rate of feeding, they are more likely to over-feed. Non-responsive feeding has been associated with discomfort and fussiness in the short term (NHS 2021) and linked to obesity in the longer term (Hurley, 2011; Watchmaker 2020).

Once they're older and used to bottle-feeding, you could move to a medium flow. Just follow your baby's lead to see what teat is right for them. Some babies prefer to stay on the slow flow teats for many months. You can also buy variflow teats where the flow rate can be varied by changing the angle of the teat (Which? 2019).

Make sure you change the teats regularly and check them for damage. Once your baby's teeth start coming through, they can damage teats by chewing them which is a potential choking hazard (Which? 2019).

Why is it important to sterilise bottles and teats?

Sterilising bottles is recommended for babies under a year because bacteria can easily grow in any milk remaining on the bottle or teats (Unicef, 2019). Babies are more vulnerable to these bacteria.

Before sterilising, all bottles and teats need to be washed, either by hand or in the dishwasher (NHS, 2018). If washing by hand, you will need a separate brush for cleaning bottles and teats (NHS, 2019b).

When should I throw away my baby's bottle?

If you notice that your baby's bottle is damaged, scratched or cracked, it's a good idea to replace it.

It's also recommended that babies stop drinking from bottles with teats by the time they are one year old as drinking through a teat leaves the teeth coated in milk and can lead to tooth decay (NHS Choices, 2015; Oral Health Foundation, 2017). Read more about this here.
This page was last reviewed in December 2021
Further information

We support 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.

Our support line offers practical and emotional support in many areas of pregnancy, birth and early parenthood: 0300 330 0700.

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

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

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What bottles and teats do you need for babies? | Baby & toddler, Feeding articles & support | NCT

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There are so many different brands of bottles and teats, that choosing one can feel confusing. Here's a round-up so you can decide what's best for you and your baby.

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Unicef UK Baby Friendly Initiative | Hand expression

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Unicef UK Baby Friendly Initiative | Hand expression

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

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

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

Identifying tongue tie

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

How breastfeeding may be affected

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

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

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

Breastfeeding is important for every baby

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

Treatment

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

Keeping breastfeeding going

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

Soften your breast

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

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

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

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

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

Encourage tongue mobility

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

Maintain milk production

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

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

An unusual palate

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

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

Treating Tongue Tie

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

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

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

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

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

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

Painful nipples

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

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

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

Moist wound healing

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

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

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

Seek support

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

Further Reading

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

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

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

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

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

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

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

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

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

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

NICE Guideline s

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

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

Copyright LLLGB 2016

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Treating and coping with breastfeeding a baby with tongue tie

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Whether you are a parent or a health care provider, we hope you will find our website helpful in accessing all of the information you need about tongue-tie and the support available.

The Association of Tongue-tie Practitioners (ATP) was set up in 2012 by a group of tongue-tie practitioners from the NHS and independent sectors with the aims of:

Increasing awareness about the effects of tongue-tie on babies especially with regard to both breast and bottle feeding.

Supporting parents of tongue-tied babies to access safe and effective care.

Assisting tongue-tie practitioners to provide safe and effective care through training and sharing knowledge and experience.

Providing resources and education for healthcare providers who refer babies for tongue-tie division.

The Association of Tongue-tie Practitioners (ATP) is also actively working to redress inaccuracies in the reporting and documenting of the effects of tongue-tie on babies especially with regard to both breast and bottle feeding.

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Association of Tongue-tie Practitioners | For parents & health care providers, all of the information you need about tongue-tie and the support available.

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Whether you are a parent or a health care provider, we hope you will find our website helpful in accessing all of the information you need about tongue-tie and the support available.

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With the reduction in services including postnatal support, breastfeeding support groups and tongue-tie division services it is an extremely stressful time for new parents. If your baby is struggling to feed and has a suspected or confirmed tongue-tie you may feel the situation is somewhat hopeless.

However, it is important to understand that the impact of a tongue-tie (or restricted lingual frenulum) on breastfeeding will vary depending on how much the restriction is impairing tongue function. Not all tongue-ties will impact feeding. A study done in Southampton identified that 10.7% of babies within their sample had a tongue-tie but only 4.8% required division (Hogan et al, 2005). Other factors also contribute to the impact of tongue-tie on breastfeeding including positioning and attachment, milk supply, nipple shape and size, oral and facial anatomy (for example a high palate or a recessed lower jaw), tensions and strains in the neck, head and jaw area as a result of the birth (more common in babies who have been born with ventouse or forceps, being breech, born by caesarean section and so on).

Around a fifth of the babies that come to me for division under normal circumstances don't end up needing one because the feeding issues can be managed successfully with breastfeeding management and sometimes bodywork (osteopathy/chiropractic).

So, whilst some NHS and private tongue-tie services have closed and those that remain are working under restrictions and only seeing the more severe and urgent cases, it is important to keep in mind that there is lots that can be done to help improve and maintain breastfeeding whilst we wait for the pandemic to settle and restrictions to be lifted.

Tongue-ties can impact feeding in a variety of ways. Some babies cannot latch at all initially, especially if birth has been complicated with interventions. A significant percentage of these babies will latch given time and lots of skin to skin (information here). Many babies start to latch well when the milk starts to come in at around day 3-5 and the breast becomes firmer and there is more milk flow. Most babies with a tongue-tie will latch but the latch is shallow, and the nipples become sore and sometimes damaged. Some babies struggle to sustain the latch and slip off the breast. In this situation some babies will use their lower jaw to hang on to the breast and this clamping with the jaw can be very painful.

If a baby's latch is shallow this can impact on the baby's ability to drain the breast effectively and some babies with tongue-tie struggle to create sufficient vacuum to draw enough milk from the breast and will keep falling asleep at the breast. These babies will often be very frequent feeders or spend long periods at the breast without ever seeming to be satisfied. In these babies' weight gain can become a concern and an early warning sign is a lack of wet and dirty nappies. (See information on what to expect in terms of nappies here). Inadequate breast drainage is also a risk factor for engorgement, blocked ducts and mastitis.

Flow regulation can also be difficult for babies with tongue-tie and some babies will gulp and choke, whilst feeding, especially at the milk ejection reflex (the let-down) at the start of a feed. Their difficulty in managing flow is believed to contribute to wind and reflux.

So, if division is not available what can be done to sustain breastfeeding? The priority is to feed the baby. This can be extremely challenging if your baby can't latch, is struggling to latch well, your nipples are sore and damaged, and your baby is never settled and satisfied. Most babies with a tongue-tie will be able to latch and get at least some of the milk they require from the breast. Where supply is abundant and comes in early, as if often the case in mothers who have breastfed before, there may be no nipple pain or issues with weight gain in the early weeks because there is sufficient flow to compensate for the effects of the tongue restriction. However, in cases where nipple pain is severe then steps need to be taken to try to manage and minimise this. Accessing help with positioning and attachment is always the place to start. Your midwife can help you immediately after birth and you should be given information on how to access your local NHS infant feeding team. There are also lots of resources online to help guide you. This is just one of many. Many breastfeeding support groups are now offering free weekly group sessions online and some breastfeeding counsellors and International Board Certified Lactation Consultants (IBCLCs) can also offer support with positioning and attachment via one to one video consultations.

There are certain latching techniques that can help in tongue-tie situations. Two which I find most effective are:
* Laid back positioning
* Breast shaping

However, some more severely tongue-tied babies struggle to latch in the laid-back position.

If improving positioning and attachment does not make the nipple pain manageable, there is severe damage, or in cases where baby cannot latch or suckle effectively at the breast then a nipple shield can be helpful. But it needs to be the right size for your nipple, and you need to have a midwife, lactation consultant or breastfeeding counsellor observe baby feeding with the shield to ensure they can transfer the milk through it. Some tongue-tied babies cannot create enough suction to draw milk form the breast with a shield in place and this can be dangerous in terms of hydration and weight gain. However, used appropriately shields are a useful tool is helping a non-latching baby to latch and feed and can also act as protection from further nipple damage and reduce pain. More information on shield use can be found here.

There will be cases where neither improving positioning and attachment or using shields will be enough to address the nipple pain or latching difficulty and, in these situations, expressing milk and feeding baby by an alternative method is an option. Some mums find that the nipple pain can be managed if they combine some breastfeeding with giving baby expressed milk. Others find that resting the nipples completely and expressing for each feed is the better option for them.

Expressing may also be necessary for babies who cannot drain the breast effectively so are feeding frequently or constantly, are not satisfied after feeds or have issues with weight gain. In this situation, if mum is able to breastfeed comfortably, then she can express after first offering both breasts, using breast compression to maximise milk intake. This expressed milk can be given as top ups after feeds. Your infant feeing team, breastfeeding counsellor or lactation consultant can provide support with expressing and can help you ensure your baby is getting enough expressed milk. For more information on expressing see here.

Expressed milk can be given in a variety of ways. Most parents think just about bottles as that is what we are all familiar with. If bottles are to be used, then it is important this is done in a responsive way and that feeds as paced to avoid over feeding. Information here. The use of bottles, especially early on, is thought to potentially cause nipple confusion which can then cause further difficulty with feeding at the breast. So other options that can be used include:
* Cup feeding
* Finger feeding
* Lactation aid

Again, your NHS infant feeding team, a breastfeeding counsellor or IBCLC can help you decide how best to feed your baby when they are not going to the breast and give you guidance on how to use these methods safely.

Adequate breast drainage is not just important in terms of ensuring baby gets enough. It is important in preventing blocked ducts or mastitis. But effective and frequent drainage of the breast right from birth is also vital in terms of establishing a good milk supply and sustaining it long term. A real risk with babies who are tongue-tied is low milk supply due to their inability to effectively drain the breast. So, if a baby is not latching effectively, has weight issues, is not producing the
expected wet and dirty nappies and is not draining the breast well then expressing is crucial to protect your milk supply.

Protection of the milk supply is the single most important thing if you want to breastfeed long term. Most breastfeeding difficulties, whatever their cause, will be much easier to overcome if mum has established and maintained a good milk supply. For babies who are not going to the breast at all you will need to express at least 8 times per day for about 10-20 minutes, preferably with a double electric pump during the first 6 weeks to establish and secure a supply. A full supply on average will be around 700-800mls produced over a 24-hour period but it will take 2-4 weeks to get up to this level. This may sound like a lot of work so seeking advice from your infant feeding team, a breastfeeding counsellor or lactation consultant in this situation will be really helpful as they can help you develop a pumping plan that is sustainable for your situation. They will also have lots of handy hints and tips on what type of pump to use, flange fitting, pumping techniques to optimise milk production and cleaning your breast pump.

There will be situations where mums struggle with expressing and where formula will be suggested. It is important that any formula given is first and foremost prepared correctly. for information see here.

Secondly the formula needs to be given in amounts that are adequate to ensure baby's nutritional needs are met. However, often when there are worries about weight gain the amounts given can be far more than is needed and this is detrimental to breastmilk supply. So, formula supplements need to be given with care whilst maximising breast stimulation and drainage to preserve and optimise supply. This is a fine balance and again something your NHS infant feeding team or an IBCLC can provide help with.

Flow regulation difficulties (gulping and choking) associated with tongue-tie are some of the easier issues to address conservatively whilst you wait for a tongue-tie assessment and division. Laid back feeding positions utilise gravity to slow down flow and hand expressing or pumping off a small amount of milk before a feed can also reduce the force of the 'let-down'. Catching the 'let down' in a muslin can also be effective. These measures can also help reduce wind and reflux. Keeping babies upright after a feed for at least 20 minutes will also help a baby bring up any wind and reduce vomiting. There can be other causes of excessive wind and reflux, such as allergy or over supply, so talking this through with your NHS infant feeding team or an IBCLC can be helpful.

I hope what you have taken from this blog is that there is a lot that can be done to help you in your breastfeeding journey whilst you wait for tongue-tie assessment and division. Any delay in accessing division does not have to mean the end of breastfeeding. The strategies I have described here (and this is by no means an exhaustive list) I use every day when I am doing divisions because a division alone will rarely ensure successful breastfeeding. There are always other issues to address and accessing the right infant feeding expertise and having support from other mothers via groups is essential. This help and support is still available. It is just in an online or telephone format. So please don't give up. Contact your NHS infant feeding team who can provide you with help and support and sign post you to local breastfeeding support groups. You can find a breastfeeding counsellor, IBCLC or tongue-tie practitoner by contacting:

* La Leche League
* NCT
* Association of Breastfeeding Mothers
* Lactation Consultants of Great Britain
* Association of Tongue-tie Practitoners

The is also an excellent source of help and support National Breastfeeding Helpline

You can contact me via my website
My free breastfeeding groups (both available online) can be accessed via Facebook:
Ely Milks
Bury St Edmunds

Other useful information:
Covid 19 and implications for tongue-tie division in infants
A Parents Guide to Tongue-tie

References
Hogan M, Westcott C, Griffiths M (2005) A randomised, controlled trial of division of tongue-tie in infants with feeding problems. Journal of Paediatrics and Child Health; 2005 https://www.ncbi.nlm.nih.gov/pubmed/15953322

Sarah Oakley RN, HV, IBCLC Independent Nurse, Health Visitor, Lactation Consultant and Tongue-tie Practitioner. 5/4/2020.

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My baby has a suspected tongue-tie and I am struggling to access division due to the COVID 19 restrictions. What can I do? - Sarah Oakley Lactation

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With the reduction in services including postnatal support, breastfeeding support groups and tongue-tie division services it is an extremely stressful time for new parents. If your baby is struggling to feed and has a suspected or confirmed tongue-tie you may feel the situation is somewhat hopeless.

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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.

Optimal treatment choiceSwab mother's nipples and baby's mouth to confirm thrushEnsure breastfeeding and particularly latch are pain freeIf swabs positive:Topical treatmentMiconazole oral gel applied gently a small amount of time to baby's mouth four times a dayMiconazole cream applied sparingly to mother's nipples after every feedIf symptoms persistOngoing topical treatment plusOral fluconazole tablets 150-400mg as a start dose and 100-200mg daily

"I had been breastfeeding without problem for 5 months then suddenly developed terrible pains after every breastfeed. I hadn't changed anything and I was very confused. I noticed my baby's tongue was white. The doctor took swabs of my nipples and my daughter's mouth which confirmed we had thrush. It cleared up with treatment within a week" "I was told I had thrush when my baby was 4 weeks old but I could feel her clamping onto my nipple to slow my really fast flow. I went to see someone else who helped me to sort out my baby's attachment at the breast and the pain went without any medicines." "Who'd have thought such pain could stem from just an incorrect latch on. He fed for longer and it definitely didn't hurt as much afterwards. I'll keep on working to improve the attachment."
Signs of thrush in you

Thrush (Candida albicans) infection can affect a mother's breast while she is breastfeeding but it is being over-diagnosed at the moment. Symptoms of thrush are a sudden start of breast and/or nipple pain in BOTH breasts after some weeks of pain free breastfeeding - pain is severe and can last for an hour after EVERY breastfeed. It should be confirmed by a swab of your nipples.

Thrush should not be diagnosed if:

There is pain in only one breast/nipple

You have never had pain free breastfeeding

If your nipples are shaped oddly after breastfeeds

If your nipple is white at the tip after breastfeeds

If the pain is different at different times of the day

If your baby has a tongue tie which you are waiting to have snipped.

bfn.local/differential-diagnosis-of-breast-pain

Creamy white patches in your baby's mouth, on the tongue and may be far back or in the cheeks. Patches do not rub off.

Baby's tongue/lips may have a white gloss

It should be confirmed by a swab of the baby's mouth.

Before treating either you or your baby you should ask the person supporting you with breastfeeding to watch a full breastfeed from the moment the baby goes to the breast to the moment he/she comes away from the breast at the end of the feed. They need to look at your nipples at the end of the feed to look for change in colour and shape

If your baby has a white tongue but you are not experiencing pain, be aware of the risk of thrush but do not treat either of you immediately. Some babies have white tongues in the first few weeks after birth or this may be associated with tongue tie where the milk is not thrown to the back of the mouth.

Diagnosis should be confirmed by nipple swabs cultured for fungal and bacterial infection

BREASTFEEDING SHOULD BE PAIN-FREE from the point of attachment (the moment the baby goes to the breast) onwards. (Pain from thrush begins after a feed). There should be no change in the shape or colour of the nipple after a feed. Even good attachment can often be improved and help to relieve symptoms of pain.

attachment of the baby to the breast may need fine-tuning

eczema including reactions to breast pads or creams

tongue-tie in the baby

Reynaud's syndrome (associated with history of poor circulation and pain made worse when cold)

white spot which produces pin-point pain

bacterial infection which appears as a yellowy, thick discharge

vasospasm which is associated with less than perfect attachment of the baby at the breast and produces white nipples (particularly at the tip)after breastfeeds

Thrush can be passed between you and your baby - and also between you, your partner and other children

Anecdotally some mothers find acidophilus capsules can help to restore bacteria which can keep thrush under control (available from health food stores or chemists)

It is necessary to be very careful with hygiene in order to get rid of thrush completely - be sure to wash your hands well after each nappy change

Use a separate towel for each person in the family

Anecdotally some mothers find reducing the level of sugar and yeast in their diet helps

IMPORTANT - To make sure that you get rid of thrush infection, both you and your baby need treatment. Usually once treatment begins the pain and other symptoms will begin to improve within 2 or 3 days. It may take longer for full recovery.
If there is no improvement at all after 7 days, consult your breastfeeding helper again as the cause of the pain may not be thrush.

previous pain free breastfeeding

positive swabs for candida from maternal nipples and infant mouth

bilateral pain

pain which begins after a breastfeed has finished and continues for up to an hour afterwards

absence of red area on the breast

absence of pyrexia

If a mother reports sore nipples during breastfeeding the first action should ALWAYS be to re-examine and improve attachment. This needs to be carried out by a skilled practitioner.It is unethical to treat a mother and baby with medication inappropriately or unnecessarily, particularly if such use is outside of product licence.

The diagnosis of candidial infections on the breast is difficult. Swabs of the mother's nipples and the baby's mouth are useful to confirm the presence/absence of fungal or bacterial infection (commonly Staph. aureus).

Treatment of the surface of the nipple, the baby's mouth, and oral treatment for the mother (when necessary to treat deep breast pain), should be undertaken simultaneously to achieve relief from symptoms of confirmed candidial infection.

There is evidence that the use of miconazole oral gel is preferable to nystatin suspension with greater efficacy within a shorter period (Hoppe).

In a study the cure rates of nystatin suspension and miconazole gel were shown as:

The risk of using miconazole gel in babies under 4 months relates to the method application rather than the product bfn.local/miconazole

Use of miconazole gel in babies < 4 months is outside of licence application but is preferable due to the greater efficacy. https://pubmed.ncbi.nlm.nih.gov/9076817

Fluconazole oral suspension may be used to treat oral symptoms in the baby (Brent) but use is recommended for infections which do not respond to topical therapy (BNF).

Miconazole 2% cream applied SPARINGLY to the nipple & areola area after each feed. There is some anecdotally reported evidence that using 1% clotrimazole cream as an alternative is associated with allergic reactions and is less effective.

Miconazole gel and nystatin suspension have been reportedly applied to treat nipple candidiasis - they are not pharmacologically designed to penetrate the skin of the nipple and application is unlikely to be effective. Neither miconazole gel nor nystatin should be applied to the mother's nipples bfn.local/miconazole

For nipples which are very red and inflamed a mild steroid cream can be used to facilitate healing (Weiner). Miconazole 2% plus hydrocortisone cream 1% may be useful (Daktacort®)

S. aureus is significantly associated with nipple fissures and a topical antibiotic may be used concurrently with anti-fungal creams if swabs confirm both infections (Weiner).

If symptoms of pain do not improve or deep breast pain develops, oral treatment with fluconazole may be necessary in addition to topical treatment of mother and baby.

Treatment of thrush

Swabs

A swab should be taken using a sterile charcoal media swab and sent to the microbiology lab in a black swan tube requesting a culture for bacterial and fungal growth. The cost is under £5 (personal communication)

Ongoing care with attachment to the breast is vital if mothers and babies are to be treated effectively. Thrush is very frequently diagnosed when poor attachment is the cause of pain, resulting in inappropriate exposure to unlicensed drugs and delay in achieving pain free breastfeeding. Thrush can co-exist with poor attachment and it seems much harder to clear thrush when the nipple is continuing to be damaged at each feed. Attention to improving attachment will help thrush to clear.

Oral treatment for the mother if the pain is severe or deep within the breast after topical treatmentFluconazole is not licensed to be given to lactating women. Practitioners are required to take full liability for use. The amount that gets through in breastmilk is 0.6mg/kg/day. The amount which could be given to the baby within the license is 6mg/kg/day (Hale). Studies on the use in premature babies weighing under 1000g have demonstrated successful outcomes (Kaufman).The dose of fluconazole is 150-400mg as a loading dose followed by 100-200mg daily for at least ten days (Hale, Amir). The World Health Organisation recognises fluconazole as compatible with breastfeeding (WHO) but see below.

The amount of fluconazole passing into breastmilk is less than that given to treat babies with Candida. However in babies under 6 weeks the half-life is 88 hours. Daily treatment of the mother could theoretically lead to accumulation in the baby. (Babies under 6 weeks are not treated with fluconazole daily for this reason). The author has had reports of young babies vomiting or suffering extreme stomach cramps after maternal use of fluconazole, it has also anecdotally led to weight loss due to vomiting.

The experience of the BfN Drugs in Breastmilk Helpline is that many mothers with young babies are treated for thrush without having problems with attachment addressed first.

This is unethical and potentially dangerous to the health of the baby and cannot be supported by BfN or the pharmacist responsible for compiling this information.

A 2004 paper by Francis-Morrill on the Diagnostic Value of Signs and Symptoms of Mammary Candidiasis (J. Hum Lact. 2004;20:288-95) recommended use of a swab moistened in sterile saline, wiped over the area after cleaning the breast with sterile saline. This is not current UK practice (personal communication)Currently the CASTLE study (Amir 2011) is investigating the micro-organisms involved in the development of mastitis and "breast thrush" among breastfeeding women. This study is the first longitudinal study of the role of both staphylococcal and candidial colonisation in breast infections and will help to resolve the current controversy about which is the primary organism in the condition known as breast thrush. This study will also document transmission dynamics of S. aureus and Candida species between mother and infant. In addition, CASTLE will investigate the impact of common maternal physical health symptoms and the effect of breastfeeding problems on maternal psychological well-being.Bibliography

Amir L, Hoover K. 2002, Candidiasis and Breastfeeding, LLLI Schaumberg.

Amir L et al The role of micro-organisms (Staphylococcus aureus and Candida albicans) in the pathogenesis of breast pain and infection in lactating women: study protocol (the CASTLE study) BMC Pregnancy and Childbirth 2011, 11:54

Ainsworth and Jones It sticks in our throats too.BMJ;2009;337:a3178

Andrews JI et al, The yeast connection: Is candida linked to breastfeeding associated pain? Am.J.Obstet Gynec. 2007 197:424.e-1

Brent N., Thrush in the Breastfeeding Dyad: Results of a survey on diagnosis and treatment, Clin Paed. 2001; 40:503-506.

CKS Library Breastfeeding problems - Management. Scenario: Nipple soreness/pain - management.

Francis-Morrell J, Heinig MJ et al, Diagnostic value of signs and symptoms of mammary candidosis among lactating women. JHL 2004; 20:288-95

Fraser DM, Cullen L., Post-natal management and breastfeeding, Current Obstet & Gynecol 2003; 13:127-133.

Hale TW, Bateman TL, Finkelman MA, Berens PD. The absence of Candida albicans in milk samples of women with clinical symptoms of ductal candidiasis Breastfeed Med. 2009 Jun; 4(2):57-61.

Hale T. 2012, Medications and Mothers Milk

Hoppe JE, et al., Treatment of oropharyngeal candidiasis in immunocompetent infants: a randomised multicentre study of miconazole gel vs nystatin suspension, Paed Infec Dis. 1997; 16:288-93.

Jones W Breastfeeding and Medication. 2018 Routledge

Kaufman D, et al., Fluconazole prophylaxis against fungal colonisation and infection in preterm infants, N Eng J Med 2001; 345(23):1660-6.

Morrill JF et al. Risk factors for mammary candidosis among lactating women. J.Obstet.Gynecol. Neon.Nurse. 2005;34:37-45

Hoover, K. The Link Between Infants' Oral Thrush and Nipple/Breast Pain in Lactating Women. Morton, Pennsylvania, 2002

Weiner S., Diagnosis and Management of Candida of the Nipple and Breast. J.Midwif. Women Health2006; 51:125-128

2002, Breastfeeding and Maternal Medication, WHO.

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

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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.

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Breastfeeding Support - Breastfeeding tips, tricks & support

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Colic

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In this article

What is colic?

Colic is the term used when your otherwise healthy baby cries excessively and can't be soothed (NICE 2017).

All babies cry, of course. But crying is described as "excessive" if it totals three hours a day and happens more than three days a week for at least one week. This sort of crying is also sometimes called persistent crying, or part of the period of PURPLE crying® (NICE 2017, Purple Crying nd).

Whatever you call it, excessive crying is bound to be upsetting. Trying to comfort an inconsolable baby over many hours is hard work. At times you may feel helpless. It may be enough to drive you to tears of your own. But you're not doing anything wrong, and your baby usually won't be crying for any particular reason.

This phase of crying is very common and it will pass. It usually starts between two weeks and four weeks and will probably be over by the time your baby's about four months old (Purple Crying nd).

How can I tell if my baby has colic?

If your baby cries excessively, but is otherwise healthy and feeding well, it's likely that he has colic (NICE 2017). Your baby may be diagnosed with colic or persistent crying if:

he has frequent bouts of intense and inconsolable crying

he pulls his legs up to his tummy, clenches his fists and arches his back when crying

he cries most often in the late afternoon or evening

his face gets red and flushed when he cries

his tummy is rumbly or he has wind
(Newson 2015, NHS 2015, NICE 2017)

Should I take my baby to the doctor?

If your baby is crying excessively and nothing seems to be calming him down, take him to see your doctor. Try to keep a note of his bouts of crying and any other symptoms, and his feeds. Take this with you when you visit your doctor and whenever you see your health visitor, as it could help them work out if there could be a particular cause of his crying (NHS 2015, NHS 2016).

Your doctor will assess your baby's symptoms and check that nothing more serious is causing his crying (NICE 2017b). You should seek immediate advice from your GP if your baby:

has a weak, high-pitched, continuous or abnormal-sounding cry

is floppy when picked up

isn't feeding

has breathing problems, such as breathing very quickly or grunting while breathing

is less than three months old and has a fever of 38C, or is three to six months old, and has a fever of 39C

turns blue, goes very pale or blotchy

vomits green fluid

has blood in his poo

takes much less fluids than usual or is having fewer wet nappies than usual
(NHS 2015)

Read more about when to call your GP.
If your baby has any of these symptoms and your GP is unavailable, call 111 for advice (NHS 2015).

Even if your baby shows no obvious signs of illness apart from his excessive crying, it's still a good idea to see your doctor. She will examine your baby to make sure there is no underlying problem that's causing his crying (NHS 2015) such as:

An allergy or temporary intolerance to formula milk, or something you've eaten or drunk that's got into your breastmilk.

Reflux, which is when your baby brings up feeds or vomits after feeding.

Constipation.

Wind, which can be caused by your baby swallowing too much air when feeding.
(NHS 2015, NICE 2017d)

In these cases, your GP will advise the best course of action to help you ease your baby's symptoms.

Why does my baby cry so much?

We still don't know why some babies cry so much more than others. Experts have suggested that colic may just be at the extreme end of normal crying, which usually peaks in the first two months (St James-Roberts 2011, NICE 2017).

So while some babies only cry a little, your baby may just naturally cry a lot more in the early weeks of his life. This phase will pass. If you have a colicky baby, you'll be relieved to hear that his crying and fussing is likely to decrease by eight to nine weeks of age. By three to four months, his colic should have improved considerably, if not gone altogether (NICE 2017, Wolke et al 2017).

Colic is just as common in breastfed babies as in formula-fed babies.

You may have heard from family and friends that boys are more likely to suffer from colic than girls. This isn't the case. Colic is equally common among baby boys and baby girls (Newson 2015).

There are various theories about why colic happens. Some experts think that babies persistently cry because their tiny digestive systems are still maturing, making indigestion and wind more of an issue.

Research into colic is still ongoing and it's hoped that more will be understood about the causes in the future. Rest assured though that it's unlikely that your baby's in pain or you've done something wrong (NICE 2017). While it may be hard to cope with, he may just cry for no obvious reason at all.

How can I soothe my colicky baby?

The persistent nature of colic means there are likely to be times when your baby cries, no matter what you do. Be prepared for soothing methods to work well one day, but not the next. If your doctor has ruled out a treatable cause for your baby's crying, you're back to coping with the colic however you can. Although this can be hard, there are plenty of tips to test out:

Feed your baby whenever he seems hungry, rather than trying to time his feeds. This is called responsive feeding.

Allow yourself time to tune in to your baby's signals. This may help you to recognise his pre-cry cues. You can then offer a feed or sleep before his crying gets more intense. However, your baby may move straight into full-blown crying without giving any signals. If so, try calmly holding him or giving him skin-to-skin contact before he settles to feed (Douglas and Hill 2011, NICE 2017c).

Burp your baby after every feed. Hold him over your shoulder, sit him upright on your lap or place him face down on your lap. Then gently pat or rub his back to bring up wind (NICE 2017c).

Massage his tummy gently with clockwise movements to help move along trapped wind and poo (NHS 2015b).

Use a dummy. Your baby may be soothed by sucking. Some babies use their fingers or a thumb to suck on instead (NHS 2016).

Play white noise to him. Repetitive noise may recreate the whooshing sounds in your womb. The sound of a vacuum cleaner, your hair dryer, a ticking clock or a white-noise app may work (NICE 2017c).

Take him for a drive in the car or a walk in a pram. The vibrations from the road or pavement will soothe some babies (NICE 2017c).

Rock your baby. Recreate the swaying motion he enjoyed in your womb by babywearing or rocking him in a bouncy chair (NICE 2017c).

Quieten things down and dim the lights. Lots of activity or being passed from person to person could over-stimulate your baby.

Try a warm bath. Your baby spent months immersed in warm amniotic fluid and may find it comforting (NICE 2017c).

If your baby gets very windy, you could try these tips to reduce the chance of him getting indigestion after feeds:

If you're breastfeeding, try to keep your baby as upright as possible, or place him on your tummy and feed him in a laidback position. If your milk is flowing strongly, this will help to stop your baby taking big gulps and swallowing too fast (LLLGB 2016).

Try having short breaks during feeds, so he can burp if he needs to. When he's finished feeding, gently rub or pat his back to bring up any wind (NHS 2015c).

If he is bottle-fed, make sure he isn't swallowing air from the bottle. Try to sit him upright and tilt the bottle enough so that the milk covers the entrance to the teat. You could also try an anti-colic bottle (NHS 2015b).

A growing number of studies have found probiotic drops containing lactobacillus reuteri helpful in reducing colic in breastfed babies (Sung et al 2018, Johnson et al 2015, Chau et al 2015). However, there isn't enough evidence yet to say whether or not they're effective for formula-fed babies (Halpern et al 2016, NICE 2017c, Sung et al 2018), so your doctor is unlikely to recommend trying this until we know more.

Babies like routines, so always following the same pattern of care, such as the times of day you feed him or play with him, may also help. Then your baby will become used to what happens next and be more settled in general (Newson 2015).

Friends and family are bound to be concerned for you and your baby. You're likely to hear lots of theories and advice about what to do. Some suggestions can be hard to follow, such as excluding certain vegetables if you're breastfeeding. Others, such as cranial osteopathy, can be expensive. There's also very little evidence that cranial osteopathy actually works (Guillaud et al 2016).

No single soothing technique helps all babies, so it's often a case of trying different things to see what works for your baby. If you feel that nothing is helping and you're getting stressed, put your baby in his cot or Moses basket and take a break for a few minutes (NICE 2017c).

Set a timer on your phone if it helps you to be disciplined about giving yourself time out. Looking after your own wellbeing is a vital part of coping with colic.

Is colic harmful?

No. Colic won't harm your baby. It may actually be more painful for you and your partner to cope with your baby's constant crying. The best thing to do is to stay as calm as possible and remind yourself that he'll grow out of this phase (Newson 2015, Douglas & Hill 2011).

High-pressured situations caused by relentless crying can lead to frustration and anger or depression. In rare cases, some parents have been known to take actions that they regret, such as shaking their baby (Fujiwara et al 2016, Barr 2012).

If you're struggling to cope, don't be afraid to seek help from your GP or talk to your health visitor. Remind yourself that your baby's crying is not your fault, and that he won't hurt himself. This phase will pass. Just give it time.

You aren't alone. Talk to other mums coping with colic in our community and discover tried-and-tested ways of comforting your baby.

References

Anderson J. 2016. Lactose overload in babies. Australian Breastfeeding Association. www.breastfeeding.asn.au. [Accessed May 2018]

Barr RG. 2012. Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers. Proc Natl Acad Sci USA 109(Suppl 2): 17294-301 [Accessed May 2018]

Chau K, Lau E, Greenberg S et al. 2015. Probiotics for infantile colic: a randomised, double-blind, placebo-controlled trial investigating Lactobacillius reuteri DSM 17938. J Pediatr 166(1)74-8 [Accessed May 2018]

Douglas P, Hill P. 2011. Managing infants who cry excessively in the first few months of life. BMJ 343:d7772 [Accessed May 2018]

Fujiwara T, Yamaoka Y, Morisaki N. 2016. Self-reported prevalence and risk factors for shaking and smothering among mothers of four-month old infants in Japan. J Epidemiol 26(1):4-13 [Accessed May 2018]

Guillaud A, Darbois N, Monvoisin R, et al. 2016. Reliability of diagnosis and clinical efficacy of cranial osteopathy: a systematic review. PLoS One 11(12):e0167823 [Accessed May 2018]

Halpern R, Coelho R. 2016. Excessive crying in infants. J Pediatr (Rio J) 92(3 Suppl 1):S40-5 [Accessed May 2018]

Johnson JD, Cocker K, Chang E. 2015. Infantile colic: recognition and treatment. Am Fam Physician 92(7):577-82 [Accessed May 2018]

LLLGB. 2016. Too much milk and oversupply. La Leche League Great Britain. www.laleche.org.uk [Accessed May 2018]

Newson L. 2015. Baby colic. Patient, Paediatrics. www.patient.info. [Accessed May 2018]

NHS. 2015.Colic - overview. NHS Choices, Health A-Z. www.nhs.uk [Accessed May 2018]

NHS. 2015b.Colic - treatment. NHS Choices, Health A-Z. www.nhs.uk [Accessed May 2018]

NHS. 2015c.Bottle feeding advice. NHS Choices, Health A-Z. www.nhs.uk [Accessed May 2018]

NHS. 2016.Soothing a crying baby. NHS Choices, Health A-Z. www.nhs.uk [Accessed May 2018]

NICE. 2017.Colic - infantile: summary. Clinical Knowledge Summaries. cks.nice.org.uk [Accessed May 2018]

NICE. 2017b.Colic - infantile: diagnosis. Clinical Knowledge Summaries. cks.nice.org.uk [Accessed May 2018]

NICE. 2017c.Colic - infantile: management. Clinical Knowledge Summaries. cks.nice.org.uk [Accessed May 2018]

NICE. 2017d.Colic - infantile: differential diagnosis. Clinical Knowledge Summaries. cks.nice.org.uk [Accessed May 2018]

Nocerino R, Pezzela V, Cosenza L, et al. 2015. The controversial role of food allergy in infantile colic: evidence and clinical management.Nutrients 7(3):2015-25 [Accessed May 2018]

Purple crying. nd.What is the period of PURPLE crying? www.purplecrying.info [Accessed May 2018]

St James Roberts I, Peachey E. 2011. Distinguishing infant prolonged crying from sleep-waking problems.Arch Dis Child 96(4):340-4. doi: 10.1136/adc.2010.200204. Epub 2011 Jan 10 [Accessed May 2018]

Sung V, D'Amico F, Cabana MD, et al. 2018. Lactobacillus reuteri to treat infant colic: a meta-analysis.Pediatrics 141(1)pii:e20171811. doi: 10.1542/peds.2017-1811 [Accessed May 2018]

Wolke D, Bilgin A, Samara M. 2017. Systematic review and meta-analysis: fussing and crying durations and prevalence of colic in infants.J Pediatr 185:55-61.e4. doi: 10.1016/j.jpeds.2017.02.020. Epub 2017 Apr 3 [Accessed May 2018]

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In this article Colic is the term used when your otherwise healthy baby cries excessively and can't be soothed (NICE 2017). All babies cry, of course. But crying is described as "excessive" if it totals three hours a day and happens more than three days a week for at least one week.

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A little something to help baby digest milk more easily

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Finger feeding-a video clip for the early days

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Finger Feeding to Supplement a Breastfeeding Infant

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Paced bottle feeding and basic info for using formula

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For babies born premature or sick | Bliss

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Our vision is that every baby born premature or sick in the UK has the best chance of survival and quality of life.

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LLLGB Shop - comprehensive range of books, leaflets and information sheets for breastfeeding information and support.

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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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So you and your partner are considering to breastfeeding your baby. Well, don't fall into the trap of just assuming that because you don't have breasts, feeding will be just "mum's 'job"! You should know that your opinion, input and support throughout the process is fundamental, and it can really help to shape your baby's feeding journey in more ways that you can imagine! Studies show that mums whose partners are supportive of breastfeeding feel a lot more confident in their ability to feed their baby and also go on to breastfeed for longer, so it's really important that you know the basics, understand your role and know how you can support your partner.

Breastfeeding benefits:

When making the decision to breastfeed, it's important that neither of you feels pressured to do so. You should talk about how you both feel about breastfeeding your baby, and it might be good for you both to consider the nutritional and health benefits to both mum and baby.

For baby:

* Breast milk is the perfect food for baby - it changes composition and calories content throughout the day, and it meets baby's nutritional needs perfectly, in a way that cannot be replicated by formula milk.
* Antibodies are passed from mum to baby through breast milk, and this can help them fight infections a lot easier.
* A breastfed baby is less likely to have diarrhoea, constipation and vomiting.
* Breast milk also reduces the risk of chest and ear infections, eczema and obesity in later life.

But there are also health benefits for mum!

* Did you know that breastfeeding significantly lowers the risk of breast and ovarian cancer?
* Breastfeeding uses up approximately 500 calories per day, so it can also help some mums to re-gain their pre-pregnancy shape a lot quicker.

And let's be honest, breastfeeding can be quite a 'convenient' choice for your family as a whole - the milk is always there, ready when needed, and at the right temperature. You don't need any equipment, preparation and sterilisation time (and that can only be a bonus when baby wakes up for that 3am feed), and it doesn't cost you a penny either!

So if it's good all round, where's the catch?

Preparing and making it work:

As natural as it may seem, breastfeeding is a learned skill, for mum AND for baby! It takes some time (a few weeks) for mum to feel comfortable and confident in her newly learnt skill, and you will play a massive role in how she feels.

If you want to help and make it easier for your partner from the start, the best thing you can do is to prepare.

Make sure that, together with your partner, you learn how breastfeeding works. Yes, you read that right. Learn all about colostrum, foremilk and hindmilk; learn about feeding on demand and about latches and positions (or holds). If your partner is attending a class or course, make sure you go along, and if not, be ready to look for some inclusive classes in your local area.

You knowing your facts will pay dividends later as, whenever your partner is feeling unsure and not 100% confident, or if she experiences discomfort and pain, she'll know you'll be there to help her. And she'll trust that even if you don't have all the answers, you'll know how to get help.

So make sure that you use your midwives and health visitors whenever you can in those early days, and arm yourself with a list of helplines (listed below) which will give you access to organisations who can support you and your partner in your journey.

Top 10 breastfeeding tips for dads:

So, once your baby has arrived and mum has started breastfeeding, how do YOU fit in? How can YOU practically help?

1. First things first, remember that when it comes to pregnancy, birth and parenting, everyone has an opinion! Be prepared to be the one defending your family's feeding choices in front of not-so-understanding family and friends who either don't agree with your methods or decide to share well-meaning (but unsolicited) tips and advice.

2. Being positive about breastfeeding is crucial, so make sure that you compliment mum and tell her how proud you are of her and how well she's doing. You're doing this as a family, so try and fend off any negative comments coming from anyone else who doesn't appear as supportive as you are.

3. All that preparation that you did in advance will come in handy now - be prepared to know how important a good latch is, for both mum and baby, and help your partner to get herself comfortable and well supported whilst feeding so that she can achieve a latch that she feels happy with.

4. Remember that for most mums, breastfeeding can take some practice at first. Make sure that mum is comfortable and well supported wherever she decides to feed the baby. Babies are all different in the way they feed, and whilst some of the feeds will be really short, others can be quite long, so it's important that mum is comfortable in the position that she has chosen and that her back is well supported. If she's feeling self-conscious when feeding, help her to find privacy in the house by keeping visitors at the door when you know that baby needs a feed or by helping her to use a muslin, sling or breastfeeding scarf or cover, if she wants to feed and cover herself in front of visitors or when in public.

5. Also, breastfeeding is thirsty work, so make sure that once she's settled herself comfortably for a feed she has plenty of water to drink.

6. Breastfeeding mums need an extra 300-500 calories per day when breastfeeding, so make sure that she doesn't skip meals. If baby wants to feed when you're having lunch or dinner let them! Just make sure that you allow mum to eat as well, by helping cutting her food up so she can feed herself with one hand.

7. Give mum a break and a rest from time to time - resting is fundamental for a breastfeeding mum, especially in those very early days. You can take care of nappy changing, give the baby a bath, take the baby for a walk, or just enjoy some skin-to-skin time by taking your shirt off and holding your baby close to your chest (you can just hold the baby or place them in a sling or a carrier, even if it's just to walk around the house).

8. In the night, help mum by going to get the baby for her when they need a feed. Why not helping her to burp the baby and settle baby back to sleep after the feed? You may find that this is actually a lot easier for you to do, rather than your partner, as baby won't be able to smell the milk on you and may settle a lot quicker!

9. If you have other children, guests or visitors around the house make sure to keep them entertained whilst mum is feeding, so she can focus on feeding the baby in peace.

10. Try not to be jealous of that feeding bond that mum has with the baby, but rather celebrate it! You're doing this as a team, and your support IS crucial! Once the first few weeks have passed and the breastfeeding relationship feels strong and 'established', you can always give your baby a bottle of expressed milk, but hopefully you'll have seen how much more you can actually do for your breastfeeding partner and your baby!

Useful Helplines
UNICEF UK baby friendly Initiative
0844 801 2414, 020 7375 6052 or 020 7375 6144
NCT Breastfeeding helpline
0300 330 0771
The Breastfeeding Network and National Breastfeeding Helpline
0300 100 0212
La Leche League
0845 120 2918
Association of Breastfeeding Mothers
0300 330 5453

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So you and your partner are considering to breastfeeding your baby. Well, don't fall into the trap of just assuming that because you don't have breasts, feeding will be just "mum's 'job"! You should know that your opinion, input and support throughout the process is fundamental, and it can really help to shape your baby's feeding journey in more ways that you can imagine!

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Specialist breastfeeding support

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LCGB welcomes members and associate members from a wide variety of backgrounds. Find information about our membership offers, conference info, resources, up-coming education and training opportunities.

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Lactation Consultants of Great Britain - Charity

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LCGB welcomes members and associate members from a wide variety of backgrounds. Find information about our membership offers, conference info, resources, up-coming education and training opportunities.

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Screened and regulated service for milk donation

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UKAMB

Welcome to UKAMB

Donated breastmilk from the country's network of milk banks helps to save the lives of premature and sick babies.

UKAMB is a registered charity that supports human milk banking in the UK and was set up in 1997. Our motto is 'Every Drop Counts' and we believe that the provision of safe and screened donor breastmilk makes an important contribution to the care of the premature and sick infants who receive it. Our goal is to ensure access to donor milk to every child who would benefit from its use.

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UK Human Milk Bank - Breast Milk Donation, BreastMilk Storage, UKAMB

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UKAMB, a registered organization supports human milk banking to save the lives of premature and sick babies. Connect with our network today!

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The accreditation offers readers a guarantee that the material carrying the PIF tick is evidence-based, understandable, jargon-free, up-to-date and produced to the best possible standard.

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The accreditation offers readers a guarantee that the material carrying the PIF tick is evidence-based, understandable, jargon-free, up-to-date and produced to the best possible standard.

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First Steps Nutrition Trust is an independent public health nutrition charity. We endeavour to fill practical and policy-relevant information gaps and provide resources for health workers supporting eating well from pre-conception to five years.

Our Mission

To influence policies which enable the safe, appropriate and optimal feeding of infants and young children in the UK, and to protect them from commercial interest.

To ensure that the importance of good nutrition from pre-conception to age five remains on everyone's agenda.

To provide conflict of interest-free information on infant milks marketed in the UK, and to promote better regulation and marketing of breastmilk substitutes.

To provide resources for health workers to support them in their work with pregnant women and young families.

Our Resources:

Are put together by nutrition experts and are regularly updated.

Can be used in Unicef UK Baby Friendly Initiative accredited settings.

Are available as free pdf downloads for use by anyone promoting better public health on a not-for profit basis.

Everyone who works at First Steps Nutrition Trust feels passionately about the need for better information and support for good nutrition - and good food - from pre-conception to five years.

First Steps Nutrition Trust is supported by generous individual donations and conflict of interest free grants. First Steps Nutrition Trust does not work with organisations or individuals that work with, or take funding from, the breastmilk substitute industry and we reserve the right not to sell them our subsidised resources.

First Steps works with and supports a number of organisations including Unicef UK Baby Friendly Initiative, the Baby Feeding Law Group, the Obesity Health Alliance, the Children's Food Campaign and the APPG on Infant Feeding and Inequalities.

First Steps Nutrition Trust host and regularly update their partner site infantmilkinfo.org which contains comprehensive information about infant milks (for 0-12 month olds) available on the UK market.

To find out more about what First Steps Nutrition Trust achieved in its first 10 years and what we are seeking to do at present, you can read our summary report here.

To hear how First Steps Nutrition Trust's followers rate the relevance and accessibility of our resources and communications, you can read the results of our 2023 evaluation here.

Jamie Oliver MBE

Jamie Oliver is a chef and campaigner who has a particular interest in good food for children, and food education. He has been given awards from the Harvard School of Public Health and the RCGP for his work on tackling childhood obesity. Jamie also set up Food Revolution to make practical food education a compulsory part of every school curriculum across the world.

Patti Rundall OBE

Patti Rundall is the Policy Director at Baby Milk Action and co-chair of IBFAN's Global Council. She is an indefatigable campaigner for safe infant feeding and the protection of all infants from irresponsible marketing of breastmilk substitutes as well as a global campaigner for conflict of interest free public health policy making.

Dr Vicky Sibson

DIRECTOR

Vicky is a Public Health Nutritionist with a PhD from University College London. She started off her career in the humanitarian world and worked for several international NGOs both overseas and as a head office adviser for over a decade, during which time she gained a particular interest in infant and young child nutrition. Vicky joined First Steps Nutrition Trust shortly after having her first baby and keen to bring her international experience to bear in the UK. She is excited to take on the role of Director and passionate about protecting, promoting and supporting optimal feeding for all infants and young children.

vicky@firststepsnutrition.org

First Steps Nutrition Trust has four Trustees

Rob Percival

Rob Percival works as Head of Food Policy for the Soil Association, leading the organisation's advocacy and influencing in support of healthy and sustainable diets. For the past decade he has worked closely with the Soil Association's Food for Life programme, improving the food served in schools and hospitals, and he leads the organisation's policy and campaigns on ultra-processed foods. He is also the author of 'The Meat Paradox', a book published in 2022 which explores the complexity of the meat debate.

Dr Vicky Thomas

Dr Vicky Thomas is a consultant paediatrician at the Great North Children's Hospital in Newcastle upon Tyne. A generalist at heart, she has a portfolio of interests including childhood nutrition, infant sleep, child protection, and supporting parents with normal baby behaviour. She sits on the scientific committee of the Lullaby Trust, is a professional adviser to La Leche League and works with a number of other voluntary organisations supporting families.

Marjon Willers

Marjon Willers is the specialist dietitian for schools and early years in Islington, where she works as part of the health and wellbeing team supporting schools and early years to develop a health promoting environment and adopt healthy food provision. Marjon is also a co-director of the Health Education Trust, the charity which developed the School Nutrition Action Groups and is a national partner of Food for Life supporting the whole school approach, food policy, consultation and engagement.

Dr Marko Kerac

Dr Marko Kerac is a clinical associate professor and programme director for the 'Nutrition for Global Health' MSc at the London School of Hygiene & Tropical Medicine. Initially trained in paediatrics, he did his PhD based in Malawi before finishing specialty training in public health in London. His research focuses on severe malnutrition in infants and children. He particularly enjoys the challenges of GRIPP (Getting Research into Policy/Practice): working in multidisciplinary groups from the very start of a project to together identify high-priority problems and develop practical (and thus hopefully scalable!) solutions.

Dr Helen Crawley

Dr Helen Crawley founded First Steps Nutrition Trust in 2011 and was the charity's Director until 2021. A dietitian and public health nutritionist with over 30 years' experience in public health nutrition across government, academia, research and the charitable sector, she created First Steps with the purpose of providing clear, evidence-based and conflict of interest free information and resources on eating well in the early years.

Helen was previously the Science Director for Caroline Walker Trust, where she wrote national guidance for food in schools and early years settings. She also held an honorary research fellow post at City University London, sat on the WHO scientific and technical working group on inappropriate marketing of foods to infants and children, the CODEX e-working group on standards for follow-up formula, the NICE panel on maternal and child nutrition and the Unicef Baby Friendly UK designation committee. Helen also sat on the UK Food Poverty Alliance, the London Food Board, chaired the London Boroughs Food Group and sat on the Healthy Early Years London strategy group.

Having dedicated 10 years of her illustrious career to developing First Steps Nutrition Trust in to what it is today, Helen stepped down in 2021 to pursue other projects.

trustees

We are recruiting for two new trustees to augment our board; one to bring fundraising expertise and connections to the benefit of our small charity as we seek to diversify our income, and a second to bring fresh ideas from the perspective of a practicing health care professional familiar with current challenges facing young families trying to eat well. These are voluntary roles but will play an integral part in shaping the strategy and ongoing success of First Steps at an exciting time. For more information please click on the links below:

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First Steps Nutrition Trust is a charity which provides clear, evidence-based and independent information and support for good nutrition from pre-conception to five years of age.

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A useful information resources regarding allergies & intolerances

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Babies can be unsettled for many reasons and it can sometimes take time and effort to work out the cause. Our page The Unhappy Breastfed Baby can help you determine whether your baby's behaviour is due to something other than an allergy.

But when you have ruled out most of the obvious causes and your baby is still, unhappy, colicky, experiencing dry and itchy skin or passing mucousy stools you may wonder whether he could be reacting to something in his diet or environment, or something in your own diet.

Certain medical conditions can have symptoms similar to those of an allergic reaction. It may be wise to rule these out before deciding whether a baby's symptoms are due to an allergy or food intolerance.

A baby's immune system is immature at birth.

Colostrum, or early milk, is rich in antibodies, particularly secretory IgA (SIgA), which provide a protective coating inside a baby's intestines. Mature breastmilk continues to provide protection, helping to prevent potential allergens from reaching a baby's blood.

Exclusive breastfeeding generally helps to protect against allergy but it may still occur.

If any immediate family member ( siblings or parents) has an allergy eczema, hay fever or asthma, it makes it more likely that the baby could develop allergies.

Food intolerance

A food intolerance does not involve an allergic reaction but can cause similar symptoms. It occurs when a baby has difficulty digesting a particular food. You may not need to stop giving your baby a food to which he is intolerant-reducing the amount may be enough.

Food allergy

A food allergy occurs when a baby has an immune response to specific foods. There are two types of food allergy reactions; immediate and delayed. A baby can have either or both.

Immediate reactions are also called IgE-mediated alllergies. This is because the baby's immune system creates specific IgE antibodies to a certain food. If a baby is given the specific food he is allergic to, the IgE antibodies will recognise it and cause the rapid release of chemicals, including histamine, that trigger inflammation and allergic symptoms. Symptoms appear within minutes, or up to 2 hours after eating the food responsible.

Delayed reactions are called non-IgE mediated allergies because they are not controlled by IgE. Instead it is believed such reactions are regulated by immune cells. Symptoms appear 4-72 hours after eating the food.

It is wise to see your GP or health visitor if your baby is showing signs of allergy, but some symptoms are more worrying than others. Seek immediate medical help if your baby has signs of an anaphylactic reaction: sudden onset of breathing difficulties, swelling, or collapse, with or without a rash, after physical contact or eating a particular food.

Allergy symptoms

Food allergy symptoms occur in several different body systems; the tummy, airways and skin. An Allergic baby will usually have symptoms in more than one body system, but need not experience all the symptoms to indicate allergy. Many of the following allergy symptoms can also occur in normally developing children for other reasons.

Time

Immediate: within minutes or up to 2 hours

Delayed:
within 4-72 hours

When nursing

Baby hungry for the breast but pulls away after a minute or two, arching the back and screaming*

Skin

Itching
Inflammation**
Hives/nettle rash
Swelling, usually around the lips, face and eyes

Itching
Inflammation**
Eczema (dermatitis)

Tummy

Reflux
Loose or frequent poos
Blood or mucus in poo
Tummy pain
Infantile colic***
Food refusal or aversion
Constipation
Inflammation in the nappy area**

Airways

Cough, chest tightness, wheeze, noisy breathing, trouble breathing
Itchy nose, sneezing, runny nose, nasal congestion, conjunctivitis

Cough, chest tightness, wheeze, noisy breathing, trouble breathing

Other

Anaphylaxis: sudden onset of breathing difficulties, swelling, or collapse with or without a rash

Reduced growth, along with one
or more tummy symptoms above
Lethargy

*This may also be caused by a fast let-down. See Too Much Milk and Oversupply for
more information if you think that this may apply to you.
**Inflammation appears red on lighter skin, and darker brown, purple or grey on darker skin.
***Colic is defined as repeated episodes of excessive and inconsolable crying in an infant that
otherwise appears to be healthy and thriving.

Environmental triggers

An irritant is something that causes damage to the skin. Eczema (also known as dermatitis) and dry skin rashes can be caused by mild irritants such as bubble bath, baby wipes, skin cream, fabric conditioner or laundry detergent. Many mothers find avoiding unnecessary products or using a different product improves things. Reading packaging can help avoid problems with common irritants such as lanolin and perfumes. Use fragrance-free products whenever possible. Be aware that herbals can also be allergenic and irritant - being natural does not necessarily mean a product is any less irritating. Hay fever symptoms and other ear, nose and throat symptoms can be caused by spring and summer pollens and other airborne allergens such as dust.

Identifying the problem food

If your baby is having only your milk
Food allergens in the mother's diet can pass through into the breastmilk so a breastfed baby can have an allergic response or intolerance to something in the mother's diet.

Consider:

Are you taking any laxatives, medicines, vitamins, iron tablets or other supplements?

Do you drink lots of caffeinated drinks? Coffee, cola, tea and some pain relievers, cold remedies, weight control aids and diuretics contain caffeine. Chocolate contains a substance called theobromine that can have a similar effect to caffeine if you eat a lot.

Have you recently eaten a new food or any particular food in large amounts?

Are there any foods that you don't like but have decided to eat during pregnancy or breastfeeding because you think they will be good for you and your baby?

Are there foods that you crave? What foods do you snack on when you have a bad day?

Depending on how sensitive your baby is, removing or cutting down on the offending items in your diet may well solve the problem.

If your baby is also having infant formula or solids
The majority of babies don't need anything other than mother's milk before about six months - no infant formula, drinks or solids. Babies who have started solids can be sensitive to certain common foods until they are a little older.

Consider:

Could your baby be reacting to the drinks or solid foods he is having?

Is he on any medication or vitamin supplements?

Could he be receiving other drinks such as infant formula or juice, or solid food, from anyone else without your knowledge?

Infant formula or follow-on formula is usually cow's milk-based and a common, avoidable cause of allergy. Babies do not need follow-on formula at all.

Removing the offending food from your baby's diet for now should solve the problem; he may be able to tolerate it in a few months time. If you think your baby may be reacting to a prescribed medication that he has to take, speak to your doctor, who may be able to prescribe an alternative.
Common problem foods which may be eaten by a baby or a breastfeeding mother include:

Milk and other dairy products such as butter, yoghurt, cheese, whey, casein, caseinate, lactose

Egg

Peanut

Soy

Wheat

Fish

Sesame seeds (in tahini and hummus)

Lupin/lentils (including chickpeas which are in hummus)

Shellfish; crustaceans (e.g. crab, lobster, crayfish, shrimp, prawn), molluscs (e.g. mussels, oysters, squid)

Fenugreek is closely related to peanuts

Tree nuts (almonds, hazelnuts, walnuts, cashews, etc.)

Celery and celeriac

Mustard

Common foods that can be involved in intolerance or irritation but not usually allergy:

Sulphur dioxide and sulphites, benzoates, glutamate, salicylates, dietary amines

Citrus fruits, strawberries, tomatoes

Certain additives, artificial colourings, flavourings and preservatives

These can turn up in the most unexpected places so do check everything consumed including drinks and medicines. For example, some juice drinks contain milk, and wine can contain milk, egg or sulphites.

Cutting out suspected foods

If your baby is exclusively breastfed, you may need to follow an elimination - reintroduction diet. It can help to keep a food and symptom diary.
When eliminating major food groups take care to ensure you continue to eat a healthy and balanced diet. Your GP may be able to refer you to a dietician if you wish.
Only cut out one food at a time and allow 2-4 weeks to see if your baby's symptoms improve. If there is no improvement in this time, then the food is unlikely to be the culprit and can be reintroduced. Consider cutting out a different food.

If symptoms do improve, reintroduce the food slowly to confirm the food allergy. However, if your baby has previously experienced a severe or immediate reaction, ask your GP for specialist support before reintroducing the food.

Note: Usually a cow's milk protein allergy (CMPA) predicts an allergy to other animal milks (e.g. goat or sheep milk), and in some cases soya. If you plan to cut out dairy you may wish to cut out other animal milks and soya at the same time, then reintroduce them each individually.
Seek immediate medical help if your baby has shown anaphylactic signs, such as a rapidly developing rash, breathing difficulties, or swelling.
A note on eczema

Elimination - reintroduction diets should not be done due to the presence of eczema alone.
Some children who have a food allergy do have eczema, but most children who have eczema do not have a food allergy. If the only symptom is eczema it is unlikely to be caused by a food allergy. It is worth noting that frequently eating a particular food may mean a baby learns to tolerate it. If the food is stopped, for example during an elimination diet, there is a risk that tolerance may stop and an IgE mediated allergy (including possible anaphylaxis) can form. If you think your baby's eczema is due to a food allergy it is best to speak with your GP about allergy testing or to get referred to an allergy specialist.

Introducing solid foods

Human milk contains tiny traces of whatever foods a mother herself has been eating. This is the ideal way to prepare a baby gently for the eventual introduction of solids. The best foods for your baby are usually healthy foods selected from your diet. Solids can be introduced when your baby can sit up (with or without support) and starts reaching out for the food on your plate. For more information, see Starting Solid Food.

If your baby is under the care of a paediatrician for allergies, talk to your specialist team about how to introduce specific allergenic foods.

Body tolerance levels can change

Being allergic or intolerant to something means that your body is sensitised to it, but the symptoms you display may vary in each particular instance; sometimes you may not display any symptoms. Your body's allergen tolerance level changes based on many factors including stress and your general health, so it's ability to react to immune threats also varies. If your immune system is affected by more stressors than usual, you may show symptoms of an allergy/intolerance more readily.

Seek support

It can be quite an effort to be an allergy detective with a fussy baby on your hands, so seek information and support. The good news is that small changes to your diet could make a big difference to a baby with a food allergy or intolerance.

An LLL Leader can help you determine the most likely cause of your baby's symptoms. Local LLL groups are great for practical and moral support and you may find others there who have had similar experiences. Your GP or health visitor can help diagnose food allergy and refer you to specialist services for testing and advice.

Did you know?

If a baby reacts when his mother drinks milk or has dairy products, this is a sensitivity to cow's milk protein, not lactose intolerance.

Most infant formulas contain cow's milk, often referred to as whey based or casein based.

Soya, the basis of some infant formulas, is also a common allergen.

Infant formula may contain fish oils and vegetable oils (e.g. palm, rapeseed, coconut, sunflower).

Medicines and supplements can contain other ingredients that are potentially allergenic.

If you or a member of your immediate family has an allergy or intolerance, your baby is more likely to have one too.

FAQs

Q. Do I have to give up breastfeeding if my baby is allergic to something in my milk?
A. No; eliminating the offending food from your diet will remove the allergen from your breast milk enabling you to continue breastfeeding if you wish to. See section Cutting out suspected food.

Q. Will my baby outgrow his food allergy?
A. Possibly; some children do, some do not. Children are most likely to grow out of cows' milk, egg and soy allergies.

Q. I thought I was not meant to feed my baby egg/peanut/etc. until they were over 1 year old?
A. This was old advice. Recent research shows introducing allergenic foods from around 6 months old may help the baby to learn to tolerate the food. Introducing the food later can make it more likely that the baby will develop an allergy to the food.

Q. What's the difference between cow's milk protein allergy (CMPA) and lactose intolerance?
A. True lactose intolerance (reduced capacity to digest lactose) is very rare in babies and
is diagnosed within days of birth. Temporary lactose intolerance or lactose overload (too much lactose for the baby to digest) can cause tummy symptoms similar to an allergy. Lactose is produced in the breast, regardless of the mother's diet. Seek support if you suspect your baby has symptoms of lactose overload. CMPA is an immune reaction and can cause symptoms in many body systems. Breastfeeding mothers of children with CMPA generally need to exclude all cow's milk protein from their diet - including milk, cheese, yogurt etc. See section Cutting out suspected food.

Q. Should I avoid eating a food my baby is allergic to if I become pregnant again?
A. No; as long as you are not allergic to it and it is not one the foods you usually need to avoid in pregnancy (such as undercooked meat) eating a particular food in pregnancy has no effect on the development of allergy.

Q. Is my baby allergic to a food because I ate it whilst pregnant?
A. No; eating a particular food in pregnancy has no effect on the development of allergy.

Q. If I have another baby will it develop allergies too?
A. Possibly; if you have a sibling with allergies you are more likely to be genetically
predisposed to develop allergies. However, having an older sibling decreases the risk of
developing allergy.

Written by Sue Cardus, Robyn Halliday and mothers of La Leche League Great Britain
Endnotes

1. Andreas, N., Kampmann, B., Le-Doare, K. Human Breast Milk: A review on its composition and bioactivity. Early Human Development, 2015; 91 (11): 629-635.

2. Muraro, A et al. EACCI Food Allergy and Anaphylaxis Guidelines. Primary prevention of food allergy. Allergy, 2014;69(5):590-601.

3. NICE Guideline [CG116]. Food allergy in under 19s: assessment and diagnosis, 23rd February 2011, https://www.nice.org.uk/guidance/cg116 (accessed 26th Jul 2020).

4. NHS. Contact dermatitis, https://www.nhs.uk/conditions/contact-dermatitis/causes/ (accessed 26th Jul 2020).

5. Muraro, A et al. EAACI Food Allergy and Anaphylaxis Guidelines. Diagnosis and management of food allergy. Allergy, 2014; 69 (8): 1008-25.

6. Young, M. Editorial: Elimination Diets in Eczema-A Cautionary Tale. JACI: In Practice, 2016; https://www.jaci-inpractice.org/article/S2213-2198(15)00573-5/pdf

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
BREASTFEEDING ANSWERS - A GUIDE
FOR HELPING FAMILIES: SECOND EDITION.. Mohrbacher, N. Nancy Mohrbacher Solutions inc., 2020.
MILK MATTERS: INFANT FEEDING AND IMMUNE DISORDER. Minchin, M. Geelong: Alma Publications, 2015.
BREASTFEEDING WORKS! EVEN WITH ALLERGIES. Noble, R. Brisbane: Complete Publishing, 2017.

Online information:
LLLGB website
Unicef Research on Allergies
NICE Guideline [CG116]. Food allergy in under
19s: Assessment and Diagnosis
GP Infant Feeding Network: Cow's Milk Allergy
National Eczema Society
Anaphylaxis Campaign
CMPA Support

You can buy this information in printed form from our shop.

Copyright LLLGB 2020

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Allergies & Food Intolerances - La Leche League GB

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Babies can be unsettled for many reasons and it can sometimes take time and effort to work out the cause. Our page The Unhappy Breastfed Baby can help you determine whether your baby's behaviour is due to something other than an allergy.

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Article about parental expectations in the early days.

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Article about parental expectations in the early days.

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Very useful in helping to understand baby behaviour

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Impending parenthood provokes a different response in each of us, and often a combination of emotions: anxiety, sheer panic, confidence, uncertainty, excitement, happiness to name just a few. Our expectations of what's to come, and what is "best", are naturally based on what we experience around us. Those who already have babies such as family and friends, mixed with our own life experiences, memories of siblings or early life. For many, smaller families may mean fewer memories of siblings as young babies, and it can be rather like wandering into the dark unknown. Even those with lots of young baby practice, may not have lots of newborn 24/7 experience.

Instead as well as looking to those close to us, we often turn to books, magazines, websites and health professionals - who all seemingly have different opinions, but who nonetheless may plant new little seeds of expectation.

Before baby arrives it's common to believe your baby will be the happiest baby around; you will change their nappy when it's soiled, feed them when hungry, provide a nice bed for sleep times and so your baby wont need to cry, his needs will be met. You and perhaps a partner snuggled on the sofa, baby sleeping quietly in the basket next to you. Sure you know babies need feeding at night, but you will have him there right next to you so you can tend to him quickly, fill his little tum before slumber re-ensues.

And for some this may be true.

The reality? Many are not like this, especially in the early weeks - and even then it may require veering from "biological norms" (eg feeding method, sleep training, pacifiers etc) to achieve these expectations based on "society's current perception of the norm".

The one thing I hear over and over from new parents is they had no idea just how hard it would be, why didn't anyone spell out just how challenging being a new parent can be - so for all those parents this blog entry is for you.

Being a parent of a newborn baby can be really, really, insanity inducingly HARD.

No really, harder than that.

From the moment that precious new bundle is placed in your arms, life will never be the same again. It now, at least for a while, revolves around this dinky new being, who co-incidentally didn't read any books, nor pay heed at classes - so doesn't understand any related expectations.

You feed them, change their nappy, wind them, check they're not too hot or cold - yet still they may cry! The comfy bed you lovingly prepared might as well be covered in 9" nails, as they flail and wail every time you try and gently lower them in. Instead of snuggled on the sofa, you are taking it in turns to pace and jiggle the baby, before one of you tries to eat one handed so the other can have a powernap before shift change.

And the nights, who knew they could be so long? Even when you have everything "perfect" still baby squirms, grunts and wants to feed again; how can this be when it was only two hours since we just did all this?

"What do you want from me?" one mum confessed she had asked her baby at 3am after a rather rough night - desperate to sleep, yet desperately trying to stay awake whilst feeding. Whilst everyone had warned her not to bedshare, nobody had mentioned falling asleep upright or on a sofa was more risky, nor that baby naturally may want to feed quite frequently and having to sit up and do this every time was shattering, which made staying awake sitting up nearly impossible. Nobody had even asked if mum knew she could breastfeed laying down. I don't know what else she could want? What do I do?

One mum recently described the sleep deprivation as akin to mind altering drugs, that she dreamt (metaphorically) of a night of unbroken sleep, that she had never realised it would be so hard.

The only point I want to stress more than just how hard having a newborn can be (did I say that already?) is that it is nothing you as parents are doing wrong , let me repeat that a little louder: it is nothing you as parents are doing wrong.

It can be easy to feel that you are the only parent who has an unsettled baby. That given the books didn't describe this, it can't be common - because if you meet every need baby is settled, right? But that's simply not true. Some babies take a little longer than others to transition to life "Earth side" - even. If you've had a long birth, a long pushing stage, a speedy or difficult delivery - so did they. Some may be a little uncomfortable or windy, and don't forget nobody gave them the books. This piece talks about what a normal newborn expects, then compare that to what most parents in current society typically have in mind.. Whilst I don't feel long spells of crying should be just accepted as "colic", and it's always worth seeking help to explore why baby is crying if you're concerned - the point is that it isn't because you've held them too much/not put them in a routine early enough, not ignored their cries etc

The question also has to be - are your expectations realistic? If not adapting your expectations, can be a whole lot easier than trying to change those of a newborn - and given you have the cognitive ability to adapt, would also seem to be the fairer option. Expectations can play a part in how you perceive your baby's behaviour.

Example
expect their baby to wake and feed frequently day and night, understand their baby had no concept of time in the womb, and is used to receiving nourishment from an umbilical cord, rather than at spaced intervals via a breast or bottle. They know breastmilk changes composition so that at night it includes more "sleepy hormones" and helps to create circadian rhythms (sleep patterns).

"RESULTS: The tryptophan in the breast milk presented a circadian rhythm with acrophase at around 03:00. This affected the 6-sulfatoxymelatonin circadian rhythm with acrophase at 06:00 in the breast-fed infants, and also promoted nocturnal sleep. Assumed sleep, actual sleep, and sleep efficiency were significantly increased in the breast fed infants with respect the formula fed infants."

http://www.ncbi.nlm.nih.gov/pubmed/16380706

They heard that after a feed baby has a high level of something called CCK, and they know this tells him he's full; but also that the level drops again after another 10 or 20 minutes post feed, so he thinks he's hungry again - and that he may go through this loop several times, usually in the evening, commonly known as "cluster feeding," before dropping into a solid, longer sleep stretch.

They've been told how to check output and signs baby is transferring milk well - so they can identify normal from a "needs more help" situation - and they've been shown how to recognise baby's earliest cues of hunger, so there's time to work on getting baby to the breast and comfortable before she becomes really hungry and frantic!

In the evening dad/partner (if applicable) hops in the bath for some skin to skin time with baby, and mum builds a nest of pillows, snacks, books, drinks, music/TV remote as desired, ready to settle down for a longer feeding session.

A & B have also been told it's normal for a newborn to want lots of contact and cuddles from parents, when transitioning from a place with constant movement, sounds and security - familiar voices, smells, touch helps ease this. They've read about the theory of the fourth trimester, and it makes sense to them.

To make this work for all of them, they have a wrap which holds baby to them hands free, which they've found also helps if baby is a little windy or unsettled - on really tough days they head off out for a walk with it. They've discovered it's fab for holding the baby when they want to eat, even if at times this means eating whilst wiggling to settle baby, or taking turns wearing baby in the wrap whilst the other eats.

Baby sleeps next to mum, bedsharing safely or perhaps a cot attached to the bed. This means when baby wakes nobody has to sit up, get up or try and keep themselves awake - but can either just feed, or slide baby over (still without getting up) then feed laying down. They've realised the beauty of this is that there is no "lowering down" - which triggers a baby's startle reflex and wakes them up, and that with practice sometimes this can be done with all barely rousing.

Although baby wakes every few hours as expected, mum doesn't feel completely exhausted as when she does sleep she hits more restful sleep levels due to having her baby right next to her. If people offer to help the parents gladly accept offers of practical help, perhaps some meals cooked for them or an ironing pile tackled!

-----------

In contrast parents X&Y picked up a very different set of books when shopping. They expect that baby will slot around them, that they need to do so early to learn to settle themselves and become independent - quickly developing a reliable pattern.

They feed the baby and then place her in the crib, ready to sit and enjoy a meal together. No sooner is the food on the plate than baby wakes and also wants feeding, two hours earlier than expected. After a nappy change they gently place baby in her Moses basket - but she squirms and wakes, like a Jack in the Box every time she's placed back down. When baby wants to cluster feed from 7-10pm, the parents are tired and confused, why is she wanting to feed so frequently? On the one hand they reason, she can't be hungry as she only fed 45 minutes ago, so at first they try dancing, jiggling and rocking to help baby sleep. But when baby continues to cry for a feed, the doubts can start; she must be hungry? What if mum isn't producing enough milk, that must be the case because the book says she should only feed every 3-4 hours? Is it wind? Colic? How do we work out what's wrong? What if she isn't taking enough? You can't see with a breast to check...

During the night, baby sleeps in a separate crib - when she wakes frequently someone has to sit up, retrieve and feed her(staying awake) before putting her back in the basket. As mum tentatively gets back bed, baby cries again - trapped burp this time. After a few minutes wandering round the bedroom baby settles but as mum places her down she startles and cries again. More pacing ensues and dad takes over for a turn. He manages to get baby into the basket, by swaddling to mask her reflexes and gets back into bed, but by now everyone is wide awake. Just as the parents start to fall asleep - you guessed it baby wakes again. After another 20 minutes trying to get baby into the basket, she's used enough energy that she's ready for feeding again thank you.

The next evening events repeat, and then a few more after that - the parents become more dismayed that baby wakes every time food is served, and they feel resentful they've not managed to have a meal alone together since she arrived. They expected something very different.

They decide if they can get baby to wait four hours for her feed, this will stop the habit of frequent feeding, and encourage the routine of long sleeps with infrequent waking they read about - and so introduce a pacifier which at least gives them chance to eat that meal. Over the next few days baby becomes more unsettled, wants to feed more frequently - and mum becomes more convinced there is an issue with her milk supply. The forums mum goes on related to the books she bought, only compound her feelings - parents are congratulated with a "Great Parenting!!" when someone declares their baby has slept a 9-12 hour plus stretch; which of course infers you're clearly not a great parent if you're baby isn't doing the same.

Partner looks at the exhausted mum and says something has to give, they cannot continue as they are - they need sleep and "me time".

When help is offered, the parents encourage family to hold the baby whilst they complete household tasks, trying to keep the house tidy for visitors as though a baby hasn't landed and thrown chaos where there was previously order.
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OK so these are extremes, reality is more often various hues of grey - but you can see how mentally parents X & Y have a much harder time than the first set of parents when baby arrived. It can be at times hard to pick "instinct" apart from "social expectations" - ie is the instinct founded on something we already fundamentally believe to be true and thus expect or is there really an issue. It's always worth remembering that a baby simply does not have sufficient neurological pathways developed to manipulate, control, plan or "scheme" - meeting the needs of an infant leads to long term security compared to the potentially negative implications of trying to train behaviour to suit. Babies don't even develop mature sleep rhythms until the they're several months old, they're not developing habits at the newborn stage, they're purely focussed on survival!

Even with the most realistic expectation, some babies will still be much more intense than others - parents can still be exhausted and overwhelmed. Ditch anything non essential and go wit the flow. Some babies may just need time, others may have an underlying issue they need understanding to help resolve - either way, I hope knowing it is normal and you're not alone or at fault may help, even just a little bit.

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Impending parenthood provokes a different response in each of us, and often a combination of emotions: anxiety, sheer panic, confidence, uncertainty, excitement, happiness to name just a few. Our expectations of what's to come, and what is "best", are naturally based on what we experience around us.

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NCT website for a variety of information leaflets for breastfeeding, expressing and formula

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NCT website for a variety of information leaflets for breastfeeding, expressing and formula

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Lots of PDF documents to support informed decision making

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In these challenging times, as the UK's leading charity for parents, we want you to know that we're here for you in lots of ways.

Our antenatal support - we've moved the magic of our famously social antenatal courses online, so you can experience it all from the comfort of your own home.

Reliable information - we'll continue to give you up-to-date information, including how coronavirus might affect your pregnancy, birth and early days as a parent.

Networks and friendship - we'll bring you together online with other new parents in your area to make vital and lasting friendships.

We're here to make sure parents-to-be and new parents feel connected and supported.

Information for parents

If you're pregnant or a new parent, we know that you will have a number of questions and concerns about coronavirus. In our sections below, we've created a range of articles about how coronavirus might affect your pregnancy, birth and early days as a parent.

Courses and workshops

Interactive, engaging and social, our live online antenatal course is a fun and exciting way to grow your knowledge of birth and early parenthood, and make life-long friends.

Local activities and meet-ups

Our local activities and meet-ups can help you build up a supportive social network around you.

Find your local activities and meet-ups

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In these challenging times, as the UK's leading charity for parents, we want you to know that we're here for you in lots of ways. Our antenatal support - we've moved the magic of our famously social antenatal courses online, so you can experience it all from the comfort of your own home.

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Lots of useful evidence based information

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Friendly breastfeeding support from pregnancy onward.

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Very useful website on general information regarding how breastfeeding works

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Welcome! This website was developed to provide evidence-based information on breastfeeding and parenting.

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Making up formula safely

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https://gpifn.org.uk/cma/

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How can gravity, gaps & gaze simplify early breastfeeding?

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How can gravity, gaps & gaze simplify early breastfeeding?

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Clues to aid effective attachment document 

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Clues to aid effective attachment document 

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National sling wearing website to find the nearest sling consultant

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Sling Pages

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If baby struggles at breast, what can I do?

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Babies that struggle to latch

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If baby struggles at breast, what can I do?

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What most women find useful to buy

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Welcome!

I'm Gill Rapley, generally acknowledged to be the pioneer of baby-led weaning, or BLW. I first started talking about it in 2001 and it's since taken off around the world. In November 2015 I qualified as Dr. Rapley (a PhD, not a medical doctor). My own research, together with that of others such as Professor Amy Brown, means that BLW is now being taken seriously by academics and professionals, as well as by parents - as it should be!

Breaking News! The book, Your Baby Can Self-Feed, Too, is out! At the moment it's only available in the US but you can pre-order it in the UK, in paperback and Kindle editions. An Audible edition is on its way, too. The book describes how to adapt BLW for babies who face feeding challenges. I've written it with Jill Rabin, a fantastic speech and language therapist from Chicago, who has been using this approach with her clients for many years - with amazing results! It's been written for the American market, so refers to the US healthcare system, but the information is relevant for babies everywhere.

I'm featured in a number of podcasts in Katie Ferraro's series, including one with Jill Rabin that is all about Adapted BLW. Be sure to check it out!

This website sets out to be a point of contact, with suggestions for where you can learn more and a means for you to contact me direct, rather than being THE place to find out everything you ever wanted to know about parenting and BLW. (One of these days I'll get around to giving it a revamp, honest!) Having said that, the books and leaflets Tracey Murkett and I have written are a great place to start! The best source of information about what BLW is and why it makes sense is the original Baby-led Weaning. Then there's the Baby-led Weaning Cookbook, which will help you get started with cooking for a family. The follow-up to this, The Baby-led Weaning Quick & Easy Recipe Book has yet more easy recipes for babies, children and adults to share. Baby-led Breastfeeding explains how breastfeeding works and how to get it to work for you, while Baby-led Parenting, offers a practical guide to understanding your baby and being the parent he or she really needs.

Check out my choices on www.shepherd.com for five great books about society's obstacles to breastfeeding. Shepherd is like wandering around your favourite bookstore but online, accompanied by authors pointing out their favourite books. They launched in April 2021 and are just getting started. They have some exciting features planned to help readers find books in new and unique ways, with topic pages, a search facility and a much-improved homepage, to make it a great place to start wandering. Shepherd is also working to promote Bookshop.org, which is a new online bookstore competing against Amazon. Bookshop.org is a B corporation that supports local indie bookstores, with 75% of their profits going back to indie bookstores, authors, and Bookshop's partners.

Back to this site ...

The buttons on the left will take you to:

Information on all our books

Two simple 'how to' leaflets, on BLW and breastfeeding, which you are welcome to download, print and share, as well as some basic guidelines for implementing BLW with a brief explanation of the rationale behind them

Details of two textbooks to which I have contributed chapters on BLW

A useful info page, with my responses to common queries about BLW

Information about DVDs on BLW

Information about a few products that you may find useful when implementing BLW

A bit about me

Links to just a few of the many websites and blogs about BLW, which are jam-packed with tips and ideas

The email address for this site, where you can get in touch with me

Follow me on Twitter! Follow @gillrap

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I'm Gill Rapley, generally acknowledged to be the pioneer of baby-led weaning, or BLW. I first started talking about it in 2001 and it's since taken off around the world. In November 2015 I qualified as Dr. Rapley (a PhD, not a medical doctor).

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Collecting colostrum after 37 weeks before the birth (Video)
https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/hand-expression-video/

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Safer sleep and product information
Take a look at our product guide if you're unsure about what sleep products to buy for your baby:

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The Lullaby Trust raises awareness of sudden infant death syndrome (SIDS), provides expert advice on safer sleep for babies and offers emotional support for bereaved families

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Making little changes to make a difference

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Making little changes to make a difference

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Can a change in position help relieve nipple pain?

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has vomit that's green or yellow, or has blood in it

is projectile vomiting (being sick with more force than usual)

has blood in their poo

has a swollen or tender tummy

has a very high temperature or they feel hot or shivery

keeps being sick and cannot keep fluid down

has diarrhoea that lasts for over a week or has signs of dehydration

will not stop crying and is very distressed

is refusing to feed

Also call your GP or 111 if you have any other concerns about your baby.

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Find out about reflux, where a baby brings up milk during or soon after a feed.

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http://www.healthinmind.org.uk/

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Signs a baby is thriving

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How can I tell if my baby is feeding well?

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How can I tell if my baby is feeding well?

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Breastfeeding: how much milk does a baby need?

Breastfeeding is a skill that mother and baby learn together. It is normal for it to take some practice and for it to take a while for mothers to feel confident that babies are getting the milk they need (NHS, 2018a).

In the meantime, it can be reassuring to know that a breastfed baby who is fed on demand won't overfeed (NHS, 2020). And although you can't measure how much they are drinking, they will stop drinking when they've had enough, and feed again if they want to stimulate your supply (NHS, 2020).

Watch our video about how to know if you're feeding your baby in the right way.

You'll also be able tell if they're feeding well by checking the following...

Their poo

The first type of poo your baby will produce is called meconium. It is produced from birth for the first 2-3 days, and is sticky and green/black in colour. From day four you can expect breastfed baby poo to be soft and a yellow, mustard colour. Babies who are formula feeding might have more solid poo than those who breastfeed (NHS, 2018b). Babies do an average of four poos a day for the first week.

Their wet nappies

In their first 48 hours, most babies will only have two or three wet nappies.

If you have had IV fluids during labour or if your baby was born by caesarean, this will cause extra fluids in both you and your baby, so your baby will wee more in the first 24 hours (Noel-Weiss, 2011).

But from day five, you should get at least five or six heavy, wet nappies every 24 hours. Their wee should be pale and not dark brown (UNICEF and Start4Life, 2010; UNICEF UK Baby Friendly Initiative, 2010; NHS, 2018a).

Their behaviour

If your baby has a full tummy, they should seem healthy and alert when they're awake. They will also seem calm and relaxed while they're breastfeeding (UNICEF UK Baby Friendly Initiative, 2010; NHS, 2018a).

Weight gain

It's normal for babies to lose some weight during the first few days of life: 5-7% weight loss is considered normal. If baby loses 10% or more then this is an indicator they aren't getting enough milk. This weight loss usually stops after about 3-4 days. For most babies their weight has returned to what it was at birth by the time they are three weeks old (NICE, 2017). After that, they should be growing and putting on weight steadily (NHS, 2018a).

They will be weighed regularly (approximately once a month in the first six months) and their weight recorded in their personal child health record (PCHR) or red book (NHS, 2020).

Formula feeding or expressed milk: how much milk does a baby need?

If you're offering your baby milk from a bottle, whether formula or expressed milk, it is recommended to respond to your baby's signals about when they're hungry/thirsty and when they've had enough milk, unless there is a concern and your midwife or doctor has suggested otherwise (UNICEF, 2019).

Formula packaging suggests how much milk to offer, but use this as a rough guide while you're getting to know your baby because all babies are different.

Research into responsive or 'paced' bottle feeding suggests it can help reduce the risk of obesity. When your baby has had all the milk they want, remember to throw away any milk left in the bottle. Milk left in the bottle could become a source of infection. See more suggestions about how to bottle-feed responsively. (UNICEF, 2019).

How can I tell if breastfeeding is going well?

The following are seen as signs that breastfeeding is going well:

Your baby is well-attached if:

they have a wide mouth

they have a big mouthful of breast

their chin is touching your breast

their lower lip is rolled down (although you might not see this)

their nose is not usually squashed against your breast (unless the mother has quite large breasts)

your breasts or nipples are not painful when your baby's feeding, although their first few sucks might feel strong

more of the dark skin around your nipple (areola) is visible above your baby's lips than below them.

(UNICEF UK Baby Friendly Initiative, 2010; NICE, 2015; NHS, 2018a )

Your baby is getting enough milk if:

their feeding starts with a few quick sucks and after that their sucks and swallows are longer and rhythmical, with a few pauses

you see them swallow and you may hear them swallowing by around day three to four

their cheeks are rounded when they suck, rather than hollow

they're calm and relaxed when they're feeding

they finish a feed, either by coming off the breast or falling asleep after an active feed

they've got a moist mouth after they've fed

they look content and satisfied after most feeds

your breasts become softer after feeds

your nipple looks about the same after your baby's feeds, rather than white, flattened or pinched

you may feel relaxed and sleepy after you've breastfed.

(NICE, 2015; NHS, 2016)

How do I know that my baby is thriving?

How a baby looks and their behaviour are useful guides to whether they are 'thriving'. A thriving baby:

has a good skin colour

is alert when they're awake

asks for feeds

is usually satisfied after feeds.

(UNICEF UK Baby Friendly Initiative, 2010)

What should I do if I don't think I have enough milk?

Breastmilk is made on a supply and demand basis; the more milk your baby takes from your breast, the more milk you make. But the baby must be well latched on to do this. You can increase your milk supply by: (NHS 2018a)

Feed your baby as often and as long as your baby wants

Feed from both breasts at each feed

Keep your baby close and give lots of skin-to-skin, particularly in the early weeks, to maximise opportunities to breastfeed

Avoid giving your baby infant formula

Avoid dummies until your baby has learnt how to breastfeed well

If you're worried your baby isn't getting enough milk, speak to your health visitor, midwife or a breastfeeding counsellor. They can check how the baby is latched and may suggest changes you can make to help your baby get a deeper latch. Your health visitor or midwife can also rule out any underlying health problems or may refer you for a tongue tie assessment (NICE, 2015).

If you need breastfeeding support you can visit a local breastfeeding support group (some support groups are available online). In some situations it may be possible to have a home visit.

You can also speak to an NCT breastfeeding counsellor on our helpline (0300 330 0700) which is open every day, 8am to midnight. You could take a look at our article about breastfeeding support page to find out more.

Further information

NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk.

Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions.

You can also find more useful articles here.

National Breastfeeding Line (government funded): 0300 100 0212.

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Is my baby getting enough milk from breastfeeding or formula? | Baby & toddler, Feeding articles & support | NCT

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It's one of the most common worries in new parents: how do you know if your baby is well fed? Here are your questions answered.

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Check out stylish,
functional breast pump bags
and accessories from
our sponsor Sarah Wells Bags.

By Kelly Bonyata, IBCLC

Do I need to maintain a perfect diet while breastfeeding?

The short answer to this question is NO - you do not need to maintain a perfect diet in order to provide quality milk for your baby. In fact, research tells us that the quality of a mother's diet has little influence on her milk. Nature is very forgiving - mother's milk is designed to provide for and protect baby even in times of hardship and famine. A poor diet is more likely to affect the mother than her breastfed baby.

It's common to hear women say that they want to wean (or not breastfeed at all) because they miss drinking coffee, or want to have an occasional glass of wine, or don't like worrying constantly about everything they eat. Guess what? You can drink caffeinated beverages (in moderation), have an occasional drink, eat what you want and still provide your baby with the absolute best nutrition and immunological protection - mother's own milk.

According to Katherine A. Dettwyler, Ph.D., breastfeeding researcher and anthropologist, women throughout the world make ample amounts of quality milk while eating diets composed almost entirely of rice (or millet or sorghum) with a tiny amount of vegetables and occasional meat.

Are healthy eating habits recommended for mom? Absolutely! You will be healthier and feel better if you eat well. It is best for anyone to eat a variety of foods, in close to their naturally-occurring state, but this is not necessary for providing quality milk or for maintaining milk supply. Although it is certainly not recommended, a breastfeeding mother could live on a diet of junk food - mom would not thrive on that diet, but her milk would still meet her baby's needs.

What IS needed for maintaining an ample supply of milk?

The main thing needed to maintain an ample milk supply is simple -
The more often and effectively your baby nurses, the more milk you will have.

Occasionally, a mother's calorie or fluid intake can affect milk production:

Calories: In general, you should simply listen to your body and eat to appetite - this is usually all you need to do to get the calories you need. Counting calories is rarely necessary unless you are having problems maintaining a healthy weight. Excessive dieting can reduce milk supply, but sensible dieting is generally not a problem.

Liquids: It is not necessary to force fluids; drinking to satisfy thirst is sufficient for most mothers. Unless you are severely dehydrated, drinking extra fluids is not beneficial, may cause discomfort, and does not increase milk supply. It is not necessary to drink only water - our bodies can utilize the water from any fluid.

The main message on calories and fluids - Eat when hungry & drink when thirsty.

See Do nursing mothers need extra calories or fluids? and How does milk production work? for more information.

How does my nutrient intake affect breastfeeding?

Are there any foods that I should avoid while I'm breastfeeding?

There are NO foods that you should avoid simply because you are breastfeeding. It is generally recommended that a nursing mother eat whatever she likes, whenever she likes, in the amounts that she likes and continue to do this unless baby has an obvious reaction to a particular food.

It's suggested that everyone, particularly pregnant and nursing mothers, avoid eating certain types of fish that are typically high in mercury.

It is a good idea to restrict caffeine and alcohol to a certain extent, but it is rarely necessary to eliminate them.

Some food proteins (such as cow's milk protein or peanut protein) do pass into mother's milk. If there is a history of food allergies in your family, you may wish to limit or eliminate the allergens common in your family.

Any baby might react to a particular food (although this is not very common). If baby has an obvious reaction every time you eat a certain food, it may be helpful to eliminate that food from your diet. For more information, see Dairy and other Food Sensitivities in Breastfed Babies.

Making women think that they must maintain 'perfect' diets in order to have thriving breastfed babies is an unnecessary obstacle to breastfeeding.

Additional information

@

@ other websites

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How does a mother's diet affect her milk? * KellyMom.com

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The short answer to this question is NO - you do not need to maintain a perfect diet in order to provide quality milk for your baby. In fact, research tells us that the quality of a mother's diet has little influence on her milk.

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Herbs and things that may affect milk production 

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Herbs and things that may affect milk production 

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http://www.justbreastfeeding.com/low-milk-supply/peppermint-and-other-herbs-that-can-decrease-breast-milk-supply/

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Website with helpful information documents on sleep 

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Website with helpful information documents on sleep 

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Research-based information on baby sleep for parents and practitioners, covering normal infant sleep, sleep safety, where and how babies sleep, SIDS and SUDI, parental sleep and free resources.

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Tips for soothing and healing cracked nipples

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Tips for soothing and healing cracked nipples

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By Kelly Bonyata, BS, IBCLC

The following measures can be very helpful if the skin on the nipple is broken for any reason (cracked nipple due to shallow latch, tongue-tie/lip-tie or other anatomical variations, thrush, a bite, milk blister, etc.).

Keep in mind that one of the most important factors in healing is to correct the source of the problem.

Continue to work on correct latch and positioning, thrush treatment, etc. as you treat the symptoms, and talk to a La Leche League Leader and/or board certified lactation consultant (IBCLC) if what you're doing is not working.

During the nursing session | After nursing | Between nursings | Additional information

Breastfeed from the uninjured (or less injured) side first. Baby will tend to nurse more gently on the second side offered.

The initial latch-on tends to hurt the worst - a brief application of ice right before latching can help to numb the area.

Experiment with different breastfeeding positions to determine which is most comfortable.

If breastfeeding is too painful, it is very important to express milk from the injured side to reduce the risk of mastitis and to maintain supply. If pumping is too painful, try hand expression.

After nursing

Salt water rinse

This special type of salt water, called normal saline, has the same salt concentration as tears and should not be painful to use.
To make your own normal saline solution:
Mix 1/2 teaspoon of salt in one cup (8 oz) of warm water. Make a fresh supply each day to avoid bacterial contamination. You may also buy individual-use packets of sterile saline solution.

After breastfeeding, soak nipple(s) in a small bowl of warm saline solution for a minute or so-long enough for the saline to get onto all areas of the nipple. Alternately, put the saline solution into a squeeze bottle and squirt it on gently; use plenty of saline, making sure to get it on all areas of broken skin.

Avoid prolonged soaking (more than 5-10 minutes) that "super" hydrates the skin, as this can promote cracking and delay healing.

Pat dry very gently with a soft paper towel.

If baby objects to the taste of the residual salt from the saline rinse, rinse directly before nursing by dipping nipple(s) into a bowl of plain water. Pat dry gently.

After the salt water rinse

Apply expressed breastmilk to the nipples to promote healing-this can be done in addition to other treatments.

To promote "moist wound healing" (this refers to maintaining the internal moisture of the skin, not keeping the exterior of the skin wet) apply a medical grade lanolin ointment (e.g., Lansinoh, Purelan), soft paraffin/vaseline or a hydrogel dressing (e.g., ComfortGel, Soothies).

If you have thrush, follow the saline soak with an antifungal ointment or other thrush treatment.

If needed, apply an antibiotic ointment (e.g. Bactroban/mupirocin, Polysporin) or Dr. Jack Newman's All Purpose Nipple Ointment(APNO; an antibiotic/anti-inflammatory/anti-yeast combo) sparingly after each feeding.

Per Hale, Bactroban ointment (mupirocin; lactation risk category L1/safest), available only by prescription, may be the best choice for nursing mothers.

Of the over-the-counter treatments, Polysporin (Polymyxin B Sulfate and Bacitracin Zinc) may be preferred for topical use in the nipple area of nursing moms over antibiotic ointments containing neomycin (such as Neosporin or triple antibiotic ointment). Neomycin carries a small risk (1-2% of the general population) of contact dermatitis (see The Role of Topical Antibiotics in Dermatologic Practice by J.J. Leyden, MD).

It is not necessary to wash small amounts of antibiotic or APNO ointment from the nipple prior to nursing, even if baby nurses again within minutes (see Dr. Jack Newman's Sore Nipples info). If too much ointment was used and there is an obvious amount remaining when baby is ready to nurse again, gently wipe the excess off with a damp cloth.

Between nursings

Keep nipples exposed to air when possible. When wearing a bra, use fresh disposable pads (change when damp). Some mothers use breast shells to protect the nipple from the dampness and friction of the bra.

If there is a specific injury-like a bite-cold compresses (ice packs over a layer of cloth) may help: 20 minutes on, 20 minutes off; repeat as needed.

Ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) is compatible with breastfeeding.

Once a day, use a non-antibacterial, non-perfumed soap to gently clean the wounded area, then rinse well under running water. Using soap on the nipple area is not recommended unless the skin is broken.

Additional information

Treatment of Sore, Cracked, or Bleeding Nipples by Becky Flora, IBCLC

Sore Nipples by Jack Newman, MD, FRCPC

Nipple Pain by Paula Yount

Sore Nipples in the Breastfeeding Mother from Lactation Education Resources

Barton A. Oral Antibiotics and Positioning Are Effective in Decreasing Morbidity in Breastfeeding Mothers. Critically-Appraised Topic from University of Michigan Evidence-Based Pediatrics Web Site, February 14, 2000.

Buchanan P, Hands A, Jones W. Assessing the evidence: Cracked Nipples and Moist Wound Healing. Paisley, Scotland: The Breastfeeding Network, March 2002.

Livingstone V, Stringer LJ. The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study. J Hum Lact. 1999 Sep;15(3):241-6.

Martin J. Nipple Pain: Causes, Treatments, and Remedies. Leaven. February-March 2000;36(1):10-11.

Morland-Schultz K, Hill PD. Prevention of and therapies for nipple pain: a systematic review. J Obstet Gynecol Neonatal Nurs. 2005 Jul-Aug;34(4):428-37.

Cracked nipple Wikipedia

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Healing Tips for Nipple Cracks or Abrasions * KellyMom.com

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The following measures can be very helpful if the skin on the nipple is broken for any reason (cracked nipple due to improper latch or thrush, a bite, milk blister, etc.). Keep in mind that one of the most important factors in healing is to correct the source of the problem.

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Tips and techniques for the early days. 

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Tips and techniques for the early days. 