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At our trust, we have two hospitals with a team based at each location to support your feeding journey.

Here is how you can contact us:

Chelsea and Westminster Hospital

T: 020 3315 3017

E:  chelwest.infantfeeding@nhs.net

West Middlesex Hospital

T: 0208 321 5006

E: chelwest.infantfeedingteam.wmuh@nhs.net

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Responding to your baby's needs for physical and emotional comfort, as well as feeding, helps your baby's brain to grow and your baby to feel safe and secure

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Responding to your baby's needs for physical and emotional comfort, as well as feeding, helps your baby's brain to grow and your baby to feel safe and secure

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Your postnatal discharge support will be provided by your local hospital. You will be advised of who that is on discharge but below is a list of individual area support you can access.

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Chelsea and Westminster Hospital FACE-TO-FACE Antenatal Breastfeeding Workshops

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Chelsea and Westminster Hospital FACE-TO-FACE Antenatal Breastfeeding Workshops

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This is an interactive workshop run by the Chelsea and Westminster Infant Feeding Team.

The aim of this workshop is to help you make informed decisions on how to feed and nurture your baby and build close loving relationships, by exploring the health benefits of human milk, breast/chest feeding and responsive care.

The workshop also includes teaching practical skills using props.

This is a great time to ask any questions you have and to meet and chat with other expectant parents.

Due to limited spaces, we ask that only parents who are booked to have their baby at Chelsea & Westminster Hospital book onto the workshop.

NOTE: When booking on Eventbrite, 'Follow' the event to ensure you receive the pre-emails. You will receive information of the location 24hrs prior, or you can get this information at the main hospital entrance when you attend.

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chelsea and westminster face-to-face antenatal breastfeeding workshops

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chelsea and westminster face-to-face antenatal breastfeeding workshops tickets

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chelsea and westminster face-to-face antenatal breastfeeding workshops london

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chelsea and westminster face-to-face antenatal breastfeeding workshops london tickets

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Chelsea and Westminster face-to-face Antenatal Breastfeeding Workshops

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Eventbrite - Chelsea and Westminster Hospital presents Chelsea and Westminster face-to-face Antenatal Breastfeeding Workshops - Saturday, 25 February 2023 | Monday, 27 March 2023 at Chelsea and Westminster Hospital, London, England. Find event and ticket information.

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ONLINE Chelsea & Westminster and West Middlesex Antenatal Breastfeeding Workshops 

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ONLINE Chelsea & Westminster and West Middlesex Antenatal Breastfeeding Workshops 

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Antenatal breastfeeding workshops for families at Chelsea and Westminster Hospital and West Middlesex University Hospital.
Recommended from 34 weeks gestation.

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chelsea and westminster online antenatal breastfeeding workshop

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chelsea and westminster online antenatal breastfeeding workshop tickets

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Chelsea and Westminster online Antenatal Breastfeeding Workshop

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Eventbrite - Chelsea and Westminster Hospital presents Chelsea and Westminster online Antenatal Breastfeeding Workshop - Thursday, 23 April 2020 | Saturday, 25 March 2023 - Find event and registration information.

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Chelsea and Westminster FACE TO FACE Early Days Workshops

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Chelsea and Westminster FACE TO FACE Early Days Workshops

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These workshops focus on all the practicalities of having a new baby including meeting your baby and caring for them in hospital, normal newborn behaviour, feeding, nappies, bathing and skin care, sleep, car safety and more.

We run quarterly face-to-face early days workshops at Chelsea and Westminster hospital. Numbers are limited, so please book early by email chelwest.birth.preparation@nhs.net

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West Middlesex Hospital - FACE TO FACE Breastfeeding Workshops

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West Middlesex Hospital - FACE TO FACE Breastfeeding Workshops

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These workshops will be run by one of the members of our Infant Feeding Team. They will talk you through the benefits of breastfeeding and the practicalities of breastfeeding your new baby. The aim of this workshop is to help you feel more confident about breastfeeding and understand how to prevent and solve common breastfeeding difficulties, how to tell if your baby is getting enough milk and where to get help if you need it.

The session is fully interactive and you will be able to ask questions and have an opportunity to chat with other expectant parents.

Due to limited spaces, we ask that only those who are booked to have their baby at West Middlesex University Hospital or Chelsea & Westminster Hospital attend these sessions. We do encourage fathers, partners and any other family members to book on too – whoever may be supporting you when your baby is born.

Bookings via Eventbrite
West Middlesex Hospital Breastfeeding Workshops | Eventbrite

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West Middlesex Hospital Breastfeeding Workshops

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Book onto a FACE-TO-FACE Breastfeeding session on a day, location and time that suits you to learn about feeding your baby

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Breastfeeding can be a 98% reliable form of contraception in the first six months after birth - if a mother’s periods haven’t returned yet and her baby has nothing other than breast milk to eat or drink. Find out more in the article above.

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Can You Get Pregnant While Breastfeeding?

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Exclusive breastfeeding can work as a contraceptive preventing pregnancy for many women in the early months after birth. But when

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In the Early Days as you're getting to know your baby, feeding cues are your baby's only form of communication to say "I need something", respond to the cues as early as you can. However, your baby may want to come to your chest for many other reasons such as comfort and stimulation.

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Postnatal Infant Feeding Support Groups run by the Infant Feeding team of West Middlesex Hospital

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Postnatal Infant Feeding Support Groups run by the Infant Feeding team of West Middlesex Hospital

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Research on Close Loving Relationship building and brain development

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Hounslow residents can rent a breast pump for free from various family hubs in the borough

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Congratulations on the birth of your baby/babies!!

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Congratulations on the birth of your baby/babies!!

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Today you get to meet and welcome them to the world!

You get to hug them, smell them, gaze into their eyes and kiss them.

Building on your close and loving relationship.

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Information on feeding and nurturing your baby in alternative languages.

Please click on link below:

Infant Feeding Multi lingual (padlet.com)

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Chelsea and Westminster Postnatal Face to Face Drop-in clinic Tuesdays SW6

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Chelsea and Westminster Postnatal Face to Face Drop-in clinic Tuesdays SW6

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Chelsea and Westminster Postnatal Face to Face Drop-in clinic Thursdays W14

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Chelsea and Westminster Postnatal Face to Face Drop-in clinic Thursdays W14

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Feeding drop in groups in the Chelsea and Westminster area

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Feeding drop in groups in the Chelsea and Westminster area

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Support with feeding your baby- Ealing, Hounslow and Richmond

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Support with feeding your baby- Ealing, Hounslow and Richmond

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updated Jan 2026

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Support with Feeding – Ealing, Hounslow and Richmond

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As well as having lots of health benefits to both baby and the birthing parent, skin-to-skin helps boost Oxytocin for you and your baby- this helps get feeding off to a good start- this applies to all feeding methods. These positive brain connections continue building your baby's brain.

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Antenatal expression: bring expressed colostrum to the hospital

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Antenatal expression: bring expressed colostrum to the hospital

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Please ensure that any expressed colostrum/breastmilk is handed to your midwives on arrival to the hospital.

Frozen colostrum/breastmilk needs to be put into the hospital freezer to remain frozen (once thawed, any expressed milk needs to be used within 24 hours).

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Understanding the importance of building a close loving relationship

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Understanding the importance of building a close loving relationship

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Taking time to think about your growing baby and responding to their movements helps you bond with your unborn baby and promote positive brain development.

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

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Meeting baby for the first time video - Baby Friendly Initiative

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Baby Friendly’s video on skin-to-skin contact and how it can help mothers and babies get their relationship off to the best start.

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Use this table to know if your baby is getting enough milk. If anything in the red column applies to you or your baby, please seek breastfeeding support

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Breastfeeding in the first hours after birth

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Breastfeeding in the first hours after birth

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This video shows how a baby has newborn instincts to attach to the breast after birth.
It is recommended that you and your baby have uninterrupted skin-to-skin until after your baby has had their first feed.

Please watch the other Global Health Media Project videos on breastfeeding in the 'Supporting breastfeeding families'.

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Within the first few hours after birth, most healthy newborns will instinctively move to their mother's breast and attach on their own. This video shows early breastfeeding initiation through the journeys of 3 newborns and ways to ensure the success of this vital practice for any new mother and baby.

Join the Conversation

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Breastfeeding in the First Hours - Video - Global Health Media Project

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Within the first few hours after birth, most healthy newborns will instinctively move to their mother's breast and attach on their own. This video shows early breastfeeding initiation through the journeys of 3 newborns and ways to ensure the success of this vital practice for any new mother and baby.

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In this video, we look at the importance of developing close, loving relationships with babies in their early days and weeks.

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In this video, we look at the importance of developing close and loving relationships with babies in their early days and weeks.

Responding to babies' needs for comfort and food is hugely beneficial for brain development and makes for more confident toddlers. Parents should be supported in breastfeeding responsively and keeping their babies close to help them become happy, healthy and secure children and adults.

For more information:

Find more relationship building resources

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The Importance of relationship building video - Baby Friendly Initiative

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This video looks at the importance of developing close, loving relationships with babies in their early days and weeks.

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Congratulations on your new family journey!

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Congratulations on your new family journey!

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We embrace the beauty and joy of a growing family unit and we appreciate that everyone's journeys are unique.

If you feel you would like to explore all your feeding options and would like a one-to-one focused discussion, please refer to section 2 for our contact details.

We look forward to meeting you

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Expressing your milk by hand is a useful skill to have. It may take a bit of time and practice, but once you've mastered it, you'll find it's very helpful.

And the great thing is you only need your hands and a container - rather than a shop-bought breast pump.

Hand expression can be useful in various situations, for example if your baby isn't feeding or latching on well, if you want to stimulate your milk production, or if your breasts become engorged (this is a good way to relieve them).

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Expressing breast milk by hand - Start for Life

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Watch our video and read our step-by-step guide to expressing breast milk by hand.

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Chelsea & Westminster Hospital (C&W) and West Middlesex Hospital (WM) supplies sterile single-use bottles and teats for parents deciding to bottle feed. Please note: we do not have sterilising facilities/formula making capacity. If parents decide to use formula, please ensure premade/ready-made first stage (infant) milk is brought in. Formula is provided when medically indicated.

We have a milk freezer for frozen antenatal colostrum (please hand any frozen colostrum immediately to a Midwife). We have a fridge on the postnatal ward to store expressed breastmilk/formula.

At C&W, for parents using the hospital pump, a 24-hour pump set will be provided.

At WM, for parents using the hospital pump, a 72 hour pump set will be provided.

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Find answers about drugs in breastmilk plus other useful fact sheets.

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

Please use the below links for more information

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

What is the Drugs in Breastmilk Information Service?

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

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

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

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

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

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

Evaluation of the Drugs in Breastmilk Information Service

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

Become a Friend of Drugs in Breastmilk

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

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

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

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Infant feeding support in Wandsworth, Richmond, Merton

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Infant feeding support in Wandsworth, Richmond, Merton

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Sterilising Feeding Equipment - Before Feeding 

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Sterilising Feeding Equipment - Before Feeding 

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All equipment should be washed in warm soapy water before being sterilised before being used.

A range of sterilising methods can also be found in The Guide to bottle feeding' further along in this section. If you would like a paper copy this leaflet, just ask.

Our colleagues at Mid Cheshire made this useful resource that we would like to share with you. Naturally, should like any support with feeding your baby- discuss with our Maternity, Neonatal or Infant Feeding team here at Chelsea and Westminster NHS Foundation Trust. We are happy to help you with your feeding journey.

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Research on the links between breastfeeding and cognitive development
Human milk: From complex tailored nutrition to bioactive impact on child cognition and behaviour
This narrative review presents a complex picture of the current state of knowledge on the role of human milk and its components in the development of neurological processes and cognitive performance in infants. It offers practical and theoretical recommendations to advance research in this field, including innovative directions for future studies on cost implications and current support structures with the aim of inspiring social and political support for improvements in breastfeeding opportunities.
Weerth, C. et al. (2022). Human milk: From complex tailored nutrition to bioactive impact on child cognition and behaviour. https://doi.org/10.1080/10408398.2022.2053058. To what extent does confounding explain the association between breastfeeding duration and cognitive development up to age 14? Findings from the UK Millennium Cohort Study
This study evaluates whether the association between breastfeeding duration and improved childhood cognitive development can be explained by socioeconomic position (SEP) and maternal cognitive ability. The study uses multivariable linear mixed-effects models to compare verbal and spatial cognitive scores at ages 5, 7, 11, and 14 with reported breastfeeding durations. At all ages, longer breastfeeding durations were associated with higher cognitive scores after accounting for the child's own characteristics, however the effect was modest. Adjustment for SEP approximately halved the effect sizes.
Pereyra-Elias, R., Quigley, M., Carson, C. (2022). To what extent does confounding explain the association between breastfeeding duration and cognitive development up to age 14? Findings from the UK Millennium Cohort Study. https://doi.org/10.1371/journal.pone.0267326 Preterm nutrition and neurodevelopmental outcomes
Whilst survival of preterm infants has been steadily improving due to advances in perinatal and neonatal medicine, it does not reach the ideal target level of the normal fetus of the same gestational age. Postnatal weight gain is also often not achieved because extrauterine growth has higher energy requirements than intrauterine growth, due to the intensive care environment, illness and inadequate nutrition. This review focuses on the role of nutrition in preterm neurodevelopment, including the primordial importance of human milk and oligosaccharides and how these help to prevent neonatal complications and contribute to increased preterm survival.

Preterm infants are at increased risk of alterations in brain structure and connectivity and subsequent neurocognitive impairment. This study explores the extent to which breastmilk exposure is associated with improved markers of brain development and connectivity in preterm infants at term equivalent age. Findings from an analysis of data on 47 preterm infants' neonatal breastmilk exposure and brain MRI suggests that breastmilk feeding in the weeks after preterm birth is associated with improved structural connectivity of developing networks and greater fractional anisotropy in major white matter fasciculi.
Blesa M, Sullivan G, Anblagan D, Telford EJ, Quigley AJ, Sparrow SA, Serag A, Semple SI, Bastin ME, Boardman JP. Early breast milk exposure modifies brain connectivity in preterm infants. Neuroimage. 2019 Jan 1;184:431-439. doi: 10.1016/j.neuroimage.2018.09.045. Epub 2018 Sep 18. PMID: 30240903.

Impact of breastfeeding on intelligence, educational attainment and income at 30 years of age in Brazil
Victora et al (2015). Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet Glob Health, 3: e199-205 Horta, B. L. et al (2015). Breastfeeding and intelligence: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 14-19.

Impact of Baby Friendly accreditation on breastfeeding rates, cognitive outcomes and maternal mental health
Del Bono E, Rabe B. Breastfeeding and child cognitive outcomes: Evidence from a hospital-based breastfeeding support policy. ISER Working Paper Series: 2012-29

Breastfeeding and child development outcomes
Huang, J., Vaughn, M.G. & Kremer, K.P. (2015). Breastfeeding and child development outcomes: an investigation of the nurturing hypothesis. Maternal and Child Nutrition, DOI: 10.1111/mcn.12200

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Research on Brain and Cognitive Development - Baby Friendly Initiative

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The latest infant health studies that we have found to be most pertinent about brain and cognitive development.

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Research on Safer Sleep guidelines

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This website presents detailed, evidence-based information on sharing a bed with your baby and other infant sleep questions.

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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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Expressed Breast Milk Storage-Fridge and Freezer 

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Expressed Breast Milk Storage-Fridge and Freezer 

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Storing breast milk at the hospital is different to at home. Our team will guide you if you want/need to store your milk at the hospital. We can do this in both Maternity and the Neonatal units.

Here is a guide for at home

Please check your own fridge temperature to know how long you can keep your milk. It is suggested that you place breastmilk in the drawers or back of the fridge where there is less air flow so that the temperature is more stable

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Research and evidence on 'How breastfeeding works'

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To understand how to effectively increase (or decrease) milk supply, we need to look at how milk production works.
How does milk production work? • KellyMom.com

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A short video explaining how breastmilk is made.

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

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We encourage every mother to try laid-back breastfeeding which is about using positions that tap in to your baby's natural reflexes. It's sometimes called "biological nurturing". Your baby is born with the ability to move towards his food source - your breasts. You can play to this instinct by lying back and placing your baby, tummy down, on your chest.
Watch this video by Suzanne Colson who has done a lot of research on newborn instincts and breastfeeding.

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Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively. Read more on laid back positions and why they are useful in achieving a deep, effective latch.

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

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

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

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

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

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

Tips for getting started

If it hurts then make changes

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

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

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

Your baby needs to be calm

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

Your baby needs full body contact

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

Some babies need time

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

Laid-back breastfeeding

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

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

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

Sleepy babies

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

How laid back breastfeeding works

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

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

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

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

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

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

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

Latching on - getting a good attachment

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

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

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

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

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

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

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

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

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

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

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

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

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

Using different breastfeeding positions

The cradle hold

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

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

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

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

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

Laid back breastfeeding

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

The cross-cradle hold

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

Cross cradle

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

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

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

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

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

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

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

The underarm (clutch or rugby) hold

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

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

Your elbow keeps them tucked closely against your body.

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

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

Side lying

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

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

Standing up

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

As time goes by

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

Written by Sue Upstone, Karen Butler and mothers of LLLGB

Further Reading

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

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

LLLI Resources
Position to breastfeed

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

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

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

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

Copyright LLLGB 2016

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Positioning & Attachment - La Leche League GB

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

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See the infographic below which explains how a mother's breast storage capacity can affect whether baby takes one breast or two per feed.

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I decided to try my hand at one of the new innovations in communication, infographics. You have my permission to copy and use the infographic on breast storage capacity below, if you think it might be helpful. --Nancy

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Infographic on Breast Storage Capacity - Nancy Mohrbacher

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I decided to try my hand at one of the new innovations in communication, infographics. You have my permission to copy and use the infographic on breast storage capacity below, if you think it might be helpful. --Nancy

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Safe Preparation of First Milk Formula Feed 

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Safe Preparation of First Milk Formula Feed 

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Making first milk formula in this way is important for the health and wellbeing of your baby. Bacteria exists in water and formula powder, in order for the milk to be suitable for your baby to drink it is vital that this process is followed. Babies can become unwell both in short and longer term if not prepared safely.

Please ask the Maternity, Neonatal or Infant Feeding Team for any questions you might have after watching this short video

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Research Projects

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These reports describe past and current global trends of breastfeeding, its short and long-term health consequences for the mother and child, the impact of investment in breastfeeding, and the determinants of breastfeeding and the effectiveness of promotion interventions.

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With a substantial development of research and findings for breastfeeding over the past three decades, we are now able to expand on the health benefits for both women and children across the globe.

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Below you can access an overview of recent studies relevant to the infant feeding and parent-infant relationship building.
Research - Baby Friendly Initiative (unicef.org.uk)

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Research - Baby Friendly Initiative (unicef.org.uk)

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Further Advice

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Get more information on dummy use here.

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Can dummies affect breastfeeding?

Sucking is a powerful reflex that babies have in the weeks after they're born. Babies don't just get nutrition from their mother's milk when they breastfeed - breastfeeding also satisfies their sucking instinct.

Babies who are not able to breastfeed for whatever reason, might satisfy their sucking instincts by using dummies (Cinar, 2003). Yet any substitute for sucking the breast can put the relationship between the breast and the baby at risk. That's especially true for a baby who has not yet mastered breastfeeding (La Leche League GB, 2019).

When can dummies be used for babies?

Research suggests that it's best to avoid dummies in the first weeks after birth. That's because they're associated with shorter duration of exclusive breastfeeding (Adair, 2003; Kronborg and Vaeth, 2009). Some studies say this is caused by sucking confusion but other studies disagree with this idea (Newman, 1990; Howard et al, 1999).

After breastfeeding is established, dummies can be used. Evidence shows dummies used for healthy babies who are breastfed don't significantly affect the proportion of babies who exclusively breastfeed at three months (Jaafar et al, 2011). So the use of dummies should be limited to soothing babies after breastfeeding is well established (Adair, 2003; Horne et al, 2014).

Does a dummy reduce the risk of SIDS?

Many studies have suggested dummy use and breastfeeding are important factors for preventing cot death (also known as SIDS [sudden infant death syndrome]) (Hauck et al, 2005; Alm et al, 2016).

It's unclear how dummies might protect against SIDS or even if they do actually reduce the risk of SIDS at all (Horne et al, 2014; Blair et al, 2019).

Experts do not specifically recommend using dummies to protect babies from SIDS (Fleming et al, 1999). That's because even studies that reported a remarkable reduction of SIDS with dummy use still say that actually recommending dummies is open to debate (Mitchell et al, 2006). Any association between using dummies and reduced risk of SIDS could be down to lots of other factors, for example:

Dummies might prevent babies from rolling onto their front.

Sucking on a dummy may keep babies' tongues forward.

A baby that sucks on a dummy might be more still at night, so less likely to become covered by blankets.

Parents may check on their baby more frequently if their baby has a dummy (Grocock, 2018; Ball, 2019).

What are the advantages of a dummy?

The main advantage of babies having dummies is that they can satisfy their sucking instincts if they're not breastfed. Using dummies can calm babies and help them to fall asleep (Cinar, 2004). Dummies can also be used to sooth babies at other times, for example to help reduce pain during hospital procedures (Adair, 2003; Horne et al, 2014).

As discussed above, another advantage could be that dummies might protect against SIDS although more evidence is needed (Horne et al, 2014).

What are the disadvantages of using a dummy?

Using dummies can be helpful and convenient but there are some disadvantages. The most important concern is that use of dummies can decrease how often as well as how long babies are breastfed for (Adair 2003; Kronborg and Vaeth 2009; Horne et al 2014).

Another disadvantage of using dummies is that they might also transport bacteria and fungus, which can increase the rate of infections, particularly otitis media - middle ear infection (Uhari et al, 1996; Adair, 2003; Rovers et al, 2008). Mums whose babies used dummies reported more episodes of coughs, wheezing, earache, diarrhoea and gastroenteritis among babies up to six months old (North et al, 1999).

Dummies might also affect how baby teeth grow (Larsson, 1994).

Are dummies bad for baby teeth?

Some studies have found harmful effects on the way teeth grow if dummies are used for a long time (Larsson, 1994). Effects of dummies on baby teeth include overbite, malocclusion, cross bite and open bite (Poyak, 2006).

Using an orthodontic or flat dummy is much better for your baby's teeth, so that can help. These dummies are much better designed than dummies were in the past (Levrini et al, 2007).

It's also suggested that parents wean their children off dummies by two years old and discontinue using them before they turn three (Poyak, 2006).

One mum, Helen, says: "My little boy had started sucking his thumb and I thought an orthodontic dummy has got to be better than that because at least one day I can take it away."

Tips on how and when to stop your baby from using a dummy

If you think using a dummy is affecting breastfeeding (fewer daily feeds, weight gain affected, or difficulties in attaching to the breast) or if you want to wean a younger baby from a dummy, you could try the following:

1. If the dummy is being used as a sleep cue, then introducing a different sleep cue can help.

2. Give extra attention to your baby by cuddling or nursing instead.

3. Try different ways to soothe your baby, such as carrying them in your arms or a sling, or increasing skin-to-skin contact with them. This helps them to feel better.

4. You could restrict your baby's dummy use to certain times only, such as in the car.

5. Rewards might work better for an older child - your local children's centre or health visitor can offer support with this. Some areas even have 'dummy fairies' at Christmas.

6. Try picking a good time to stop using a dummy - when your child is feeling well, things are stable and they're happy.

7. Have a go at hiding the dummy away so your child doesn't see it.

(Cinhar, 2004; Huffington Post, 2015)
This page was last reviewed in July 2018.
Further information

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

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

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

Adair SM. (2003) Pacifier use in children: a review of recent literature. Pediatric Dentistry. 25(5):449-458.

Alm B, Wennergren G, Molborg P, Lagercrantz H. (2016) Breastfeeding and dummy use have a protective effect on sudden infant death syndrome. Acta Pardiatrica. 105: 31-38. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049485/ [Accessed 19th September 2019]

Ball, H. (2019) Dummies, baby sleep info source. University of Durham. Available at: https://www.basisonline.org.uk/hcp-dummies/[Accessed 19 September 2019]

Cinar ND. (2004) The advantages and disadvantages of pacifier use. Contemporary Nurse. 17:1-2, 109-112. https://www.tandfonline.com/doi/abs/10.5172/conu.17.1-2.109 [Accessed 19th September 2019]

La Leche League GB. (2019) Dummies and breastfeeding. Available at: https://www.laleche.org.uk/dummies-and-breastfeeding/ [Accessed 19th September 2019]

Fleming PJ, Blair PS, Pollard K, Platt W, Leach C, Smith I, et al. (1999) Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study. Arch Dis Child. 81(2):112-116. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1718026/ [Accessed 19th September 2019]

Grocock R, Robertson C, Brown N. (2018) Dummies: a review of the evidence; Journal of Health Visiting. 6(4). Available at: https://www.magonlinelibrary.com/doi/full/10.12968/johv.2018.6.4.182 [Accessed 19th September 2019]

Hauck FR, Omojokun OO, Siadaty Ms. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Paediatrics. 116(5):e716-e723. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16216900 [Accessed 19th September 2019]

Howard CR, Howard FM, Lanphear B, deBlieck EA, Eberly S, Lawrence RA. (1999) The effects of early pacifier use on breastfeeding duration. Pediatrics. 103(3):e33. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10049989 [Accessed 19th September 2019]

Horne RSC, Hauck FR, Moon RY, L'Hoir MP, blair PS. (2014) Dummy (pacifier) use and sudden infant death syndrome: Potential advantages and disadvantages. J Paediatrics Child Health. 50:170-174.

Huffington Post. (2015) 9 Ways to wean your baby off the dummy. Available at: https://www.huffingtonpost.co.uk/2014/08/14/9-ways-to-wean-your-baby-off-the-dummy_n_7336610.html [Accessed 19th September 2019]

Jaafar SH, Jahanfar S, Angolkar M, Ho JJ. (2011) Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database Syst Rev. (3):CD007202. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007202.pub2/full [Accessed 19th September 2019]

Kronborg H, Vaeth M. (2009) How are effective breastfeeding technique and pacifier use related to breastfeeding problems and breastfeeding duration. BIRTH. 36:1. Available at: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1523-536X.2008.00293.x [Accessed 19th September 2019]

Larsson E. (1994) Artificial sucking habits: etiology, prevalence and effect on occlusion. Int J Orofacial Myology. 20:10-21. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9055659 [Accessed 19th September 2019]

Levrini L, Merlo P, Paracchini L. (2007) Different geometric patterns of pacifiers compared on the basis of finite element analysis. European J Paediatric Dentistry. 8(4):173-178. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18163851 [Accessed 19th September 2019]

Mitchell EA, Blair PS, L'Hoir MP. (2006) Should pacifiers be recommended to prevent sudden infant death syndrome? Pediatrics. 117(5):1755-1758 Available at: https://www.ncbi.nlm.nih.gov/pubmed/16651334 [Accessed 19th September 2019]

Newman J. (1990) Breastfeeding problems associated with the early introduction of bottles and pacifiers. J Hum Lact. 6(2):59-63. Available at: https://www.ncbi.nlm.nih.gov/pubmed/2346601 [Accessed 19th September 2019]

North K, Fleming P, Golding J. (1999) Pacifier use and morbidity in the first six months of life. Pediatrics. 103: E34. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10049990 [Accessed 19th September 2019]

Poyak J. (2006) Effects of pacifiers on early oral development. Int J Orthod Milwaukee. 17(4):13-6. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17256438 [Accessed 19th September 2019]

Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG. (1999) Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Fam Pract. 2008 Aug;25(4):233-6. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18562333 [Accessed 19th September 2019]

Uhari M, Mantysaari K, Niemela. (1996) A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis. 22(6): 1079-83. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8783714 [Accessed 19th September 2019]

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Dummies, pros and cons: your dummy questions answered | Baby & toddler, Your baby's health articles & support | NCT

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Whether it's to do with breastfeeding, teeth or SIDS, here are some things to consider when deciding whether to give your child a dummy.

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How to feed baby in a paced and responsive way

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How to feed baby in a paced and responsive way

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Eating is such an key time for babies. By learning how to understand your baby's communication cues before and during a feed is important for a relaxed and calm feed.

Our colleagues at Mid Cheshire made this useful resource that we would like to share with you. Naturally, should like any support with feeding your baby- discuss with our Maternity, Neonatal or Infant Feeding team here at Chelsea and Westminster NHS Foundation Trust. We are happy to help you with your feeding journey.

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Guide to bottle feeding- printable leaflet 

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Guide to bottle feeding- printable leaflet 

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If you prefer a leaflet to a video, this is a handy step by step guide with all the information you need information on sterilising and prepartion of first milk formula.

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Protecting your baby from low blood sugar

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Protecting your baby from low blood sugar

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If you're diabetic, taking medication for high blood pressure, or know you may have a premature or small baby, read this leaflet to find out what additional support your baby needs to avoid low blood sugar.
We would encourage you to consider expressing your colostrum during pregnancy (see next leaflet down).

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Is your baby getting enough milk? (Video) 

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Is your baby getting enough milk? (Video) 

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Video detailing suck:swallow pattern, nappy output, activity levels (level of alertness when awake).

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Is Your Baby Getting Enough Milk - Video - Global Health Media Project

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A common concern of a new mother is whether her baby is getting enough milk. This video shows signs to tell whether the baby is feeding well.

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Although Breast/Chestfeeding is natural it is a learned skill that takes time and practice.

If you notice any breast health issues or are concerned with your baby's feeding, seek support.

Below are some common challenges.

Things to try include:

- Skin-to-skin to encourage innate feeding reflexes

- Laid-back positions to encourage self attachment and deeper latching

- Unrestricted access to the breast and unlimited feeding at the breast.

- Hand expressing/pumping to protect supply

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How will I know when my baby is hungry or wants to come to the breast?

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Breastfeeding in the early days. Resources in English, Dari, Pashto, Russian and Ukrainian 

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Breastfeeding in the early days. Resources in English, Dari, Pashto, Russian and Ukrainian 

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Maternity information translations - Welcome (southeastclinicalnetworks.nhs.uk)

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If your baby is admitted to Special Care or another unit,we will do all we can to support you.

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If your baby is admitted to Special Care or another unit,we will do all we can to support you.

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The following are some tips on what you can do..

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Open 24 hours a day, every day of the year.

Breastfeeding support is also available for Welsh, Polish, Bengali and Sylheti speakers and for people who have a hearing and/or speech impairment. If a volunteer is not available to take your call, a message can be left and someone will get back to you.

Live online support also available via online chat.

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Now is the time to start exploring your local area and finding your Peer Support and Baby groups.

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Hear from mothers and professionals, giving tips and advice on what it can mean to have a close and loving relationship with your new baby.

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This video looks at both the theory and practice of relationship building and responsive breastfeeding, supporting families to get their relationship with their baby off to the best start.

Hear mothers and professionals give tips and advice on what it can mean to have a close and loving relationship with your new baby.

Find more relationship building resources

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Breastfeeding and relationships in the early days video - Baby Friendly Initiative

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Baby Friendly's video on breastfeeding and relationship building covers views and tips from both mothers and health professionals.

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Good attachment will help a baby get more milk and make breastfeeding more comfortable.

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding success and what a mother can do to deeply attach her baby to her breast.

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Attaching Your Baby at the Breast - Video - Global Health Media Project

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding success and what a mother can do to deeply attach her baby to her breast.

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Infant-formula-and-responsive-bottle-feeding.pdf

If you prefer a leaflet to video, this is a handy step by step guide to how to responsively paced bottle feed. Understanding their communication cues before and during a feed, knowing and responding to these will support a calm and relaxed feed. This builds bonds leading to close and loving relationships, supporting your baby's brain development.

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Which formula milk to choose?  If you are using a formula milk, it is advised to be a first stage formula for the first 12 months of your baby's life.     

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Which formula milk to choose?  If you are using a formula milk, it is advised to be a first stage formula for the first 12 months of your baby's life.     

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First Steps Nutrition Trust- Evidence based, Specialised Dietitian led, free from comercial bias.

The Healthcare professional and Parent go to resource for information on diet and nutrition from pre-conception until the 5 years old!

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INFANT MILK INFORMATION | Types of infant milks on the UK market

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we provide information about the types of infant milks on the UK market and for infant formula, follow-on formula and infant milks marketed

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This bottle feeding assessment tool helps mothers and midwives/health visitors to recognise if bottle feeding is going well.

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This bottle feeding assessment tool helps mothers and midwives/health visitors to recognise if bottle feeding is going well

Please note that if there are any unticked boxes on the form, consider watching a feed and developing a care plan. Refer for additional support if needed.

For further help on having compassionate and effective conversations with mothers, please see our guidance on antenatal and postnatal conversations.
This assessment tool is designed for use with healthy babies and may not be suitable for sick or preterm babies who are not displaying normal feeding cues.

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Bottle feeding assessment tool - Baby Friendly Initiative

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Please note that if there are any unticked boxes on the form, consider watching a feed and developing a care plan. Refer for additional support if needed. For further help on having compassionate and effective conversations with mothers, please see our guidance on antenatal and postnatal conversations.

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This is a interview with Dr. Nils Bergman; a Swedish specialist in perinatal neuroscience and one of the founders of the Kangaroo Mother Care movement and a promoter of skin-to-skin contact between a mother and newborn.
He also has other interesting videos on YouTube about the impact of the first few hours after birth that you may want to watch.

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Our son´s first hours outside the womb were spent on my chest surrounded by the loving presence of his dad. He was calm, awake, locking eyes with us, which left us in awe. Now, 3 years later, he still thrives on physical closeness, and my motherly instinct is to provide him with that communion. I feel that skin to skin contact forges healthy early development and science validates that this is the case.

In the video below, M.D. and researcher Nils Bergman discusses the effect of skin to skin contact between mothers and babies.

Raylene Phillips MD, IBCLC, FAAP states that "The manner in which a new baby is welcomed into the world during the first hours after birth may have short- and long-term consequences. There is good evidence that normal, term newborns who are placed skin to skin with their mothers immediately after birth make the transition from fetal to newborn life with greater respiratory, temperature, and glucose stability and significantly less crying indicating decreased stress."

The following is part of an abstract written by Dr. Phillips on Uninterrupted Skin-to-Skin Contact Immediately After Birth:

"Mothers who hold their newborns skin to skin after birth have increased maternal behaviors, show more confidence in caring for their babies and breastfeed for longer durations. Being skin to skin with mother protects the newborn from the well-documented negative effects of separation, supports optimal brain development and facilitates attachment, which promotes the infant's self-regulation over time. Normal babies are born with the instinctive skill and motivation to breastfeed and are able to find the breast and self-attach without assistance when skin-to-skin. When the newborn is placed skin to skin with the mother, nine observable behaviors can be seen that lead to the first breastfeeding, usually within the first hour after birth. Hospital protocols can be modified to support uninterrupted skin-to-skin contact immediately after birth for both vaginal and cesarean births. The first hour of life outside the womb is a special time when a baby meets his or her parents for the first time and a family is formed. This is a once-in-a-lifetime experience and should not be interrupted unless the baby or mother is unstable and requires medical resuscitation. It is a "sacred" time that should be honored, cherished and protected whenever possible."

To read the full publication, go here: http://www.medscape.com/viewarticle/806325

By Jana Allmrodt

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Dr. Nils Bergman: Skin to Skin Contact - Birthing Without Fear

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Our son´s first hours outside the womb were spent on my chest surrounded by the loving presence of his dad. He was calm, awake, locking eyes with us, which left us in awe. Now, 3 years later, he still thrives on physical closeness, and my motherly instinct is to provide him with that communion.

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Read about the 9 observable newborn stages that are innate and instinctive for the baby.

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Healthy Children Project
159 Long Pond Drive
Harwich, MA 02645
Ph: 508.888.8044
Fax: 508.888.8050

The First Hour After Birth: A Baby's 9 Instinctive Stages

The first hours after birth are a developmentally distinct time for a baby and there are well documented short and long term physical and psychological advantages when a baby is held skin to skin during this time.

When a baby is in skin to skin contact after birth there are nine observable newborn stages, happening in a specific order, that are innate and instinctive for the baby. Within each of these stages, there are a variety of actions the baby may demonstrate.

Stage 1: The Birth Cry
The first stage is the birth cry. This distinctive cry occurs immediately after birth as the baby's lungs expand.

Stage 2: Relaxation
The second stage is the relaxation stage. During the relaxation stage, the newborn exhibits no mouth movements and the hands are relaxed. This stage usually begins when the birth cry has stopped. The baby is skin to skin with the mother and covered with a warm, dry towel or blanket.
Stage 3: Awakening The third stage is the awakening stage. During this stage the newborn exhibits small thrusts of movement in the head and shoulders. This stage usually begins about 3 minutes after birth. The newborn in the awakening stage may exhibit head movements, open his eyes, show some mouth activity and might move his shoulders.

Stage 4: Activity
The fourth stage is the activity stage. During this stage, the newborn begins to make increased mouthing and sucking movements as the rooting reflex becomes more obvious. This stage usually begins about 8 minutes after birth.

Stage 5: Rest
At any point, the baby may rest. The baby may have periods of resting between periods of activity throughout the first hour or so after birth.

Stage 6: Crawling
The sixth stage is the crawling stage. The baby approaches the breast during this stage with short periods of action that result in reaching the breast and nipple. This stage usually begins about 35 minutes after birth.

Stage 7: Familiarization
The seventh stage is called familiarization. During this stage, the newborn becomes acquainted with the mother by licking the nipple and touching and massaging her breast. This stage usually begins around 45 minutes after birth and could last for 20 minutes or more.

Stage 8: Suckling
The eighth stage is suckling. During this stage, the newborn takes the nipple, self attaches and suckles. This early experience of learning to breastfeed usually begins about an hour after birth. If the mother has had analgesia/anesthesia during labor, it may take more time with skin to skin for the baby to complete the stages and begin suckling.

Stage 9: Sleep
The final stage is sleep. The baby and sometimes the mother fall into a restful sleep. Babies usually fall asleep about 1½ to 2 hours after birth.

Benefits for Babies:
Regardless of how you are feeding your baby, your baby can benefit from skin to skin contact.

Babies are warmer.

Babies are calmer.

Babies can hear their mother's heartbeat.

Heart and breathing rates are normalized.

Milk supply may be improved.

Other family members can hold and bond with babies through skin to skin holding too!

What To Do in the First Hour with Mother

You and your baby are covered with a blanket. The baby's head stays out. The baby is naked and not wrapped. You and your baby will rest skin to skin for an hour or two after birth. This is a special time for you and your baby. Necessary procedures and checks are done with the mother and baby skin to skin.

If there are medical reasons that keep you and your baby from skin to skin holding right after birth, start as soon as possible.

If you are on medications or anything that might impair your strength or ability to stay awake when holding the baby, be sure someone else can help you care for the baby and hold the baby skin to skin.

Kajsa Brimdyr, PhD, CLC
Healthy Children Project
159 Long Pond Drive
Harwich, MA 02645, (508) 888 8044

© Health Education Associates, Inc. Based on the research of Widström, et al.

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When a baby is in skin to skin contact after birth there are nine observable newborn stages, happening in a specific order, that are innate and instinctive for the baby. Within each of these stages, there are a variety of actions the baby may demonstrate.

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Video helping you understand your sleepy baby

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Video helping you understand your sleepy baby

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Breastfeeding sleepy and reluctant babies

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Selection of videos on breastfeeding including attachment, positions and breastfeeding challenges.
Available in various languages.
Video Archive - Global Health Media Project

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Breastfeeding resources in other languages

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Breastfeeding resources in other languages

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Please see link for sources of resources in various languages.

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Useful websites

Listed in alphabetical order:

Find an IBCLC

Search for a breastfeeding expert near you

Australian Breastfeeding Association

The Australian Breastfeeding Association has translated the following free booklets into multiple languages:

Breastfeeding Confidence. Translations available in English, Amharic, Arabic, Assyrian, Burmese, Chinese, Croatian, Dari, Dinka, Farsi, Hindi, Karen, Tamil and Vietnamese.Each language can be downloaded from their website here.

Breastfeeding and Childcare. Translations available in English, Amharic, Arabic, Assyrian, Burmese, Chinese, Croatian, Dinka, Farsi, Hindi, Tamil and Vietnamese. Each language can be downloaded from their website here.

Breastfeeding and Ramadan. Translations available in English, Arabic and Urdu, downloaded from their website here.

Best Start Resource Centre: Ontario's Maternal Newborn and Early Child Development Resource Centre

The Best Start Resource Centre has several breastfeeding resources available in French, Arabic, Bengali, Chinese, Farsi, Gujarati, Hindi, Korean, Punjabi, Russian, Serbian, Somali, Spanish, Tagalog, Tamil, Urdu and Vietnamese, as well as English:

Breastcrawl.org

Breastcrawl.org has a number of breastfeeding resources in several languages; the website itself can be translated into over 100 languages including Hindi, Punjabi, Urdu and Gujarati, Italian, Spanish, and French. Select the language you require from the drop down menus at the top of the page. A video of a breast crawl can be viewed in English, Italian, Marathi and Spanish with sub-titles available in Bengali, English, Gujarati, Hindi, Kannada, Malayalam, Marathi, Oriya, Punjabi, Tamil, Telugu and Urdu.

European Lactation Consultants Alliance (ELACTA)

ELACTA provides basic breastfeeding tips with simple line drawings in 24 translations (Albanian, Arabic, Serbian, Croatian, Danish, Dutch, English, Farsi, Finish, French, German, Greek, Hebrew, Italian, Lithuanian, Polish, Romanian, Russian, Slovak, Slovenian, Spanish, Turkish, Ukranian and Vietnamese). These can be dowloaded as pdfs from this page.

Global Health Media

Global Health Media has many excellent breastfeeding videos available in French, Spanish, Swahili, Bamanankan, Italian, Khmer, Kinyarwanda, Lao, Malay, Nepali, Slovak, Vietnamese and English. Select the language you require from the drop down menus at the top of the page.

La Leche League Great Britain

La Leche League Great Britain (LLLGB) has translations of three information sheets in Welsh:

Visit their Support in Languages Other Than English page for more language support services.

La Leche League International

La Leche League International (LLLI) is an international breastfeeding charity. Their breastfeeding resources can be translated on the website (via google translate) into 100 languages. Visit llli.org and select your preferred language from the drop down menu at the top of each page. Alternatively their Get Help page lists where to find a breastfeeding counsellor or breastfeeding support group by country.

UNICEF (United Nations International Children's Emergency Fund)

Unicef's UK Baby Friendly Initiative has some breastfeeding and bottle-feeding resources in Arabic, Bengali, Hindu, Lithuanian, Mandarin, Polish, Romanian, Slovak, Turkish and Urdu. See Foreign Language Resources on the UNICEF website to access the translations and to see an English version for comparison.

Telephone helplines

Summary

A number of reputable websites have translations of breastfeeding information. Breastfeeding videos and telephone helplines are also available in multiple languages.

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Listed in alphabetical order: Find an IBCLC Search for a breastfeeding expert near you Australian Breastfeeding Association The Australian Breastfeeding Association has translated the following free booklets into multiple languages: Breastfeeding Confidence. Translations available in English, Amharic, Arabic, Assyrian, Burmese, Chinese, Croatian, Dari, Dinka, Farsi, Hindi, Karen, Tamil and Vietnamese.Each language can be downloaded from their website here.

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Resources to promote the support and development of a baby’s emotional wellbeing.

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We’re currently building a new website

The UK’s leading membership group for IMH practitioners

If you are looking to become a member, please contact us here.
Already a member? Contact us here for support.
Follow us on LinkedIn, Facebook or Twitter for updates.
AiMH UK Events book here.

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AiMH - The Association for Infant Mental Health professionals in the UK

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If you are looking to become a member, please contact us here. Already a member?Contact us here for support. Follow us on , or for updates. AiMH UK Events .

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This leaflet offers helpful, practical advice to parents on looking after their baby at night.

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Updated in 2022 with important new messaging on sleep safety, this leaflet offers helpful, practical advice to parents on looking after their sleeping baby both during the day and at night.

Caring for Your Baby at Night and When Sleeping covers a range of topics, including getting some rest, night feeding, safe sleeping environments and helping baby to settle. It is endorsed by the Lullaby Trust, the Baby Sleep Info Source (BASIS), the Royal College of Midwives (RCM) and the Institute of Health Visiting (iHV).

Printed copies are available for £15 per pack (1-9 packs) or £11 per pack (10 or more packs). There are 50 leaflets per pack and this price includes P&P within UK. Order using the Baby Friendly Resources order form, which you can download from our Resources page.
Please note: Orders for UK delivery only, and include postage and packaging costs. Orders may take up to 7 working days to process. The Baby Friendly Initiative reserve the right to re-print items at any time. If you are looking to order audit tools or e-learning please use our digital resources order form.

Caring for your Baby at Night and when Sleeping

A Guide for Parents

Download now

Caring For Your Baby at Night and When Sleeping: A guide for health professionals

Our accompanying guide supports health professionals who will be using Caring for Your Baby at Night and When Sleeping with new parents. It looks at the evidence underpinning the recommendations in the leaflet and offers guidance on discussing these issues.
An updated version of the health professional's guide will be made available soon.

Further resources

The Baby Sleep Information Source (Basis) is an informational source for parents who wish to make informed choices about their infant's sleep and night time care, and is the result of a collaboration between the Durham University Parent-Infant Sleep Lab, La Leche League, NCT, and the UNICEF UK Baby Friendly Initiative.

We have also collaborated with The Lullaby Trust, Public Health England, and Basis to create a range of resources for parents and health professionals, with accessible guidance on safer sleep practices. The following are available to download and buy on The Lullaby Trust website.

Safer Sleep for Babies: A Guide for Parents

Safer Sleep for Babies: Saving Babies' Lives - A Guide for Professionals

Safer Sleep for Babies: Quick Reference Card

Public Health Wales have produced a version of the Caring for your baby at night leaflet in Welsh, which is free to download.

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Caring for your baby at night leaflet - Baby Friendly Initiative

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This leaflet, endorsed by BASIS, the RCM and The Lullaby Trust, offers practical advice for parents on caring for their sleeping baby.

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This safer sleep guidance gives simple steps for how you can sleep your baby to reduce the risk of sudden infant death syndrome (SIDS) which is commonly known as cot death. It can give you the peace of mind to enjoy this special time.

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The safest cot is a clear cot

The safest cot for a baby is a clear cot. That means removing anything that isn't essential. Babies need just two items in their cot:

It's important to remove anything that isn't essential because items such as toys, blankets and bumpers could cover their face and obstruct their breathing.

When preparing your baby's sleep space, remember:

No pillows or duvets

No cot bumpers

No soft toys or comforters

No weighted or bulky bedding

No products designed to keep your baby in one sleeping position, such as wedges or straps

No pods or nests, rolled up towels or anything soft placed on top of the mattress.

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Safer sleep overview - The Lullaby Trust

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

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Read this to answer any questions you have about getting your baby into a routine.

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Mothering is about building relationships and nurturing the love and trust that enables babies and children to thrive. And mothering through breastfeeding is a normal, natural and effective way of doing this. Breastfeeding helps you nurture your relationship with your baby and meet their individual needs. It's nature's way of satisfying a baby's need for food, love, comfort and connection.

It can take time to learn what a baby needs. Some childcare experts promote strict routines for babies and young children. They claim that if a mother follows their rulebook, her baby will be perfectly content. But every baby is different. While we may feel reassured if our day follows a predictable pattern, strict routines for feeding and sleeping often fail to meet the needs of individual babies.

Difficulties with routines
Full breasts slow down their rate of milk production, which may lead to:
Problems caused by expressing
Breastmilk: a balanced meal, a drink, a snack
Breastfeeding: comfort and connection too
Frequent breastfeeds: day and night
One breast or two
Breastfeeding patterns adjust
Finding your own rhythms: a sense of freedom
Think of breastfeeds as minor events
Expect the unexpected
Establishing helpful patterns
Babies are little for such a short time

Difficulties with routines

Some babies will object strongly to an imposed routine that doesn't meet their needs. Others are easy going, and give only subtle signals that a particular routine isn't right for them. Early feeding cues include hand sucking, lip smacking, turning their head towards you, or fussing. Don't wait until they are desperate-crying is a late sign of hunger. Trying to 'stretch' the gaps between feeds is hard work and stressful for you both and can reduce your baby's overall intake of milk.

A well-drained breast makes milk faster than a full one. Encourage your baby to nurse frequently enough to keep your breasts soft and comfortable.

Full breasts slow down their rate of milk production, which may lead to:

A baby gaining weight slowly or needing supplements to maintain adequate weight gain.

A sleepy baby who needs to be roused and encouraged to breastfeed actively to get the food they need.

Lengthy feeds.

A fussy baby.

Engorgement, blocked ducts or mastitis.

Expressing milk (pumping) can cause problems

Some childcare experts advise pumping to keep milk supply one step ahead of a baby's needs. However, expressing can interfere with the delicate balance that happens when your baby and body are in tune with each other. Making more milk than your baby needs increases your risk of mastitis. You may experience fast flow and/or oversupply causing your baby to gag, splutter or come on and off the breast. Your baby might also have colic or be fussy.

Breastmilk: a balanced meal, a drink, a snack

Just like adults, babies feed irregularly-none of us eats the same amount at every meal, nor do we always follow a set timetable for eating and drinking. With easy access to the breast, babies will balance their intake of fluids, calories, proteins, fats and other nutrients so they receive exactly what they need. All that is usually needed is the confidence to let your baby take the lead.

Breastfeeding: comfort and connection too

Breastfeeding isn't just food and drink. It also helps you and your baby maintain that connection and closeness with each other. So when your baby is tired or unhappy or upset, theyinstinctively ask to nurse because it helps them regain a sense of rightness with the world. Many breastfeeding mothers say that the ability to calm and comfort a baby just by nursing is one of the main reasons for carrying on. It makes life easier and more peaceful for everyone.

Frequent breastfeeds: day and night

Your baby needs to nurse frequently to establish and maintain your milk production, especially in the early weeks. While breastfeeds may be further apart in the morning, it's very common for babies to nurse frequently (or 'cluster feed') in the evening. Babies receive fattier milk when they nurse more often. Your baby is stocking up for the night and putting in their order for tomorrow! (See here for more on coping with Fussy evenings with a newborn.)

One breast or two

Sometimes your baby will want one breast, at other times both. Your baby knows what they need-let them nurse actively from the first breast until they come off looking satisfied or sleepy. Then offer the second breast. After the first few months babies often become really efficient feeders-so don't be surprised if they've finished in 10 minutes or so! Their nappy output and continuing weight gain will reassure you they are getting enough. ( Is my baby getting enough milk?)

Breastfeeding patterns adjust

A baby's growth rate and mother's breast storage capacity will affect their nursing pattern. Even the weather can make a difference-a thirsty baby will probably nurse more in hot weather. When babies have growth spurts and seem extra hungry, most mothers find there's no need to pump to keep up milk production-more frequent feeds will do the trick. Milk production quickly adapts to meet your baby's needs and feeding patterns settle down within a few days.

Finding your own rhythms: a sense of freedom

Combining some predictability with flexibility can give you a sense of freedom and stop you feeling tied down. At first, life with a new baby can seem quite chaotic, but if you relax and observe your baby you will find gentle patterns emerging. You can build on these patterns, creating a daily rhythm to suit you both.

Strict routines don't necessarily make life easier for you. Being tied to particular routines, nap-times and sleep places can make getting out and about, visiting friends or taking holidays more complicated.

Your needs and those of your baby will change with time and from day to day. Following your baby's rhythms will help you meet their needs when they have has growth spurts or are ill. It will also give you confidence to adapt when necessary, for example for a doctor's appointment or holiday travel arrangements. When your baby is attached to you, rather than their routine, problems are less likely and you may feel more relaxed about managing the day.

Think of breastfeeds as minor events

Just as with your own tea-breaks, try thinking of feeds as minor and flexible events that fit in with everyday life rather than major events which have to be planned for.

Expect the unexpected

Whatever your baby's usual pattern is, there will always be times when they surprise you. They might sleep at a different time, sleep longer, or not at all. They might go longer between feeds, or suddenly want to feed more frequently. But there's no need to panic-this is how babies are! We may never know the reason for such changes. Life will either settle back into the original pattern or a new one will establish itself. Your baby will continue to grow and surprise you over the coming years.

Establishing helpful patterns

Morning - Having a reasonably regular time and pattern for getting up and dressed can be a springboard for your day.
Going out - Going out can help structure your day, entertain your baby and give you a sense of purpose. You can develop a routine for getting everyone fed, ready, and out of the house. Prepare what you'll need the evening before if you need to get out early.
Afternoon - Babies are often ready to have a sleep somewhere around the middle of the day. Babies are all different and patterns change as they grow and develop. Try to tune in to your own baby's natural rhythms of feeding, alertness and sleep and adjust your activities to match them. A nap or a rest for yourself, too, can help boost your energy for the rest of the day.
Night-time - A gentle evening routine, eg bath, rocking, singing and nursing can help a tired baby wind down to sleep. Watch for fussing, yawning and rubbing of eyes and start your wind down pattern promptly. Some babies are natural 'night owls', taking a late afternoon nap and being alert during the evening.

Household tasks - Developing the ability to be 'interruptible' is a real help. Completing housework in small 'bites' while being prepared to pause and attend to children can be a successful way to meet everyone's needs. Seeing the world through your baby's eyes can help you slow down and enjoy the present rather than rushing to get things done. Mothering babies and young children is a full-time job-it's ambitious to expect to be a cleaner, cook and gardener at the same time. Concentrate on essentials. Do those things you can do with a baby around and save really tricky jobs for times when you have help. It's unlikely you'll look back in years to come and wish you had done more housework!

Babies are little for such a short time

You can't spoil a baby with love and attention. The easiest way to care for a baby is to accept and meet their need for closeness. Remember, you know your baby best; take the information, advice and the ideas that are helpful to you and ignore those suggestions that don't feel right. You can develop rhythms and routines that are in tune with your needs, and those of your baby and family.

For support in meeting your baby's needs contact an LLL Leader by calling our Helpline or visiting our website. It can be helpful to share experiences with others at your local LLL group where you can exchange practical tips.

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

Pages you might also be interested in:
Is My Baby Getting Enough Milk?
Adjusting to Motherhood
Breastfeeding Basics
The Unhappy Baby
Safe Sleep and the Breastfed Baby
Fussy evenings with a newborn

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
How Mothers Love and How Relationships Are Born. Stadlen, N. London: Piatkus Books, 2011.
What Mothers Do, Especially When It Looks Like Nothing. Stadlen, N. London: Piatkus Books, 2005.
Why Love Matters: How affection shapes a baby's brain. Gerhardt, S. London: Routledge, 2004.
Kiss me! How to raise your children with love. Carlos Gonzalez. London: Pinter & March 2020

The information sheet is available to buy in printed format from our shop.
Rhythms & Routines is dedicated to all LLL Leaders who have given their time generously to support breastfeeding mothers and families over the past sixty years and continue to do so.
Copyright LLLGB 2020

Updated June 2022

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Rhythms and Routines - La Leche League GB

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Mothering is about building relationships and nurturing the love and trust that enables babies and children to thrive. And mothering through breastfeeding is a normal, natural and effective way of doing this. Breastfeeding helps you nurture your relationship with your baby and meet their individual needs.

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When to be concerned:
Your baby is not having the expected wet and dirty nappies for their age.

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Watch our early days videos to help you understand the behavior of your baby; to know what is normal and to know when to contact a health care professional.
Additional videos and resources — Chelsea and Westminster Hospital NHS Foundation Trust (chelwest.nhs.uk)

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When to be concerned:
If your baby has lost more than 8% of their birth weight.
Your baby will be weighed around day 3-5. Your midwife will provide support you with feeding your baby if your baby has lost more than 8% since birth.

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Steady weight gain is one of the signs that your baby is healthy and feeding well.

It's normal for babies to lose some weight in the first few days after birth.

Your baby will be weighed during their first 2 weeks to make sure they're regaining their birthweight. Most babies are at, or above, their birthweight by 2 weeks.

A midwife or health visitor will support you if your baby loses a large amount of weight or does not regain their birthweight by 2 weeks.

They'll talk to you about how feeding is going, possibly ask to observe a feed if you're breastfeeding, and look at your baby's health in general.

How often should my baby be weighed?

After the first 2 weeks, your baby should be weighed:

no more than once a month up to 6 months of age

no more than once every 2 months from 6 to 12 months of age

no more than once every 3 months over the age of 1

Your baby will usually only be weighed more often than this if you ask for it or if there are concerns about their health or growth.

Your baby's length may also be measured at some of their developmental reviews.

Understanding your baby's weight chart

Your child's growth will be recorded on centile charts in their personal child health record (PCHR), or red book.

These charts show the pattern of growth healthy children usually follow, whether they're breastfed or formula fed, or having a mixture of both.

Visit the Royal College of Paediatrics and Child Health website to see some examples of baby weight charts.

Boys and girls have different charts because boys tend to be a little heavier and taller, and their growth pattern is slightly different.

What the centile lines mean

The curved lines on the charts are called centile lines. These show the average weight and height gain for babies of different ages.

Your baby's weight and height may not follow a centile line exactly. Their measurements may go up or down by 1 centile line, but it's less common for them to cross 2 centile lines. If this happens, talk to a health visitor, who can advise you.

It's normal for your baby to be on different centiles for weight and length, but the 2 are usually fairly similar.

All babies are different, and your baby's growth chart will not look exactly the same as another baby's, even their own brother or sister.

Your baby's weight gain

Usually your baby will gain weight most rapidly in the first 6 to 9 months. Their rate of growth will gradually slow down as they become a toddler and are more active.

If your baby or toddler is ill, their weight gain may slow down for a while. It will usually return to normal within 2 to 3 weeks.

Your toddler's weight and height

Your child's height after the age of 2 gives some indication of how tall they will be when they grow up. If you like, you can use the adult height predictor in your baby's red book to work it out.

Once your child gets to the age of 2, a health visitor may use their weight and height to calculate their body mass index (BMI) and plot it on a centile chart. This is a way of checking whether your child's weight is in the healthy range or not.

If they're overweight or underweight, a health visitor can give you advice about your child's diet and physical activity levels.

You can also use our BMI calculator to check your child's BMI (as long as they are 2 years old or over).

For more information about your baby or toddler's weight or height, talk to a health visitor or GP.

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Steady weight gain is one of the signs that your baby is healthy and feeding well. It's normal for babies to lose some weight in the first few days after birth. Your baby will be weighed during their first 2 weeks to make sure they're regaining their birthweight.

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When to be concerned:
If you notice your baby is jaundiced  (which is worsening or not improving); lethargic; not waking to feed; or your baby has poor tone (floppy) make sure you get help.
You may instinctively know how your baby is doing - ask yourself: Does he have good colour? Is he nursing vigorously? Is his skin firm? Does he look healthy and seem  active and alert? Is he meeting developmental milestones?
For more information on jaundice read this link:

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Find out more about jaundice, a common and usually harmless condition in newborn babies that causes yellowing of the skin and the whites of the eyes.

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When to be concerned:
Your baby is not actively removing milk from the breast.
Make sure that you can identify that your baby is feeding well - you should see Initial rapid sucks changing to slower sucks with pauses and swallowing (may be less audible until milk comes in).
This video shows a baby at the breast doing very little drinking.

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When to be concerned:
Your baby is sleepy and has had less than 8 feeds in 24 hours.
After your baby is 48 hours old, you need to ensure your baby is feeding at least 8-10 times in 24 hours.
This article talks about all that's normal in the early days of breastfeeding including frequency of feeding.

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By Kelly Bonyata, BS, IBCLC

The First Week

How often should baby be nursing?

Frequent nursing encourages good milk supply and reduces engorgement. Aim for nursing at least 10 - 12 times per day (24 hours). You CAN'T nurse too often-you CAN nurse too little.

Nurse at the first signs of hunger (stirring, rooting, hands in mouth)-don't wait until baby is crying. Allow baby unlimited time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy at first-wake baby to nurse if 2 hours (during the day) or 4 hours (at night) have passed without nursing.

Is baby getting enough milk?

Weight gain: Normal newborns may lose up to 7% of birth weight in the first few days. After mom's milk comes in, the average breastfed baby gains 6 oz/week (170 g/week). Take baby for a weight check at the end of the first week or beginning of the second week. Consult with baby's doctor and your lactation consultant if baby is not gaining as expected.

Dirty diapers: In the early days, baby typically has one dirty diaper for each day of life (1 on day one, 2 on day two...). After day 4, stools should be yellow and baby should have at least 3-4 stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often-this is normal, too. The normal stool of a breastfed baby is loose (soft to runny) and may be seedy or curdy.

Wet diapers: In the early days, baby typically has one wet diaper for each day of life (1 on day one, 2 on day two...). Once mom's milk comes in, expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet.

Breast changes

Your milk should start to " come in" (increase in quantity and change from colostrum to mature milk) between days 2 and 5. To minimize engorgement: nurse often, don't skip feedings (even at night), ensure good latch/positioning, and let baby finish the first breast before offering the other side. To decrease discomfort from engorgement, use cold and/or cabbage leaf compresses between feedings. If baby is having trouble latching due to engorgement, use reverse pressure softening or express milk until the nipple is soft, then try latching again.

Call your doctor, midwife and/or lactation consultant if:

Baby is having no wet or dirty diapers

Baby has dark colored urine after day 3(should be pale yellow to clear)

Baby has dark colored stools after day 4(should be mustard yellow, with no meconium)

Baby has fewer wet/soiled diapers or nurses less frequently than the goals listed here

Mom has symptoms of mastitis(sore breast with fever, chills, flu-like aching)

Weeks two through six

How often should baby be nursing?

Frequent nursing in the early weeks is important for establishing a good milk supply. Most newborns need to nurse 8 - 12+ times per day (24 hours). You CAN'T nurse too often-you CAN nurse too little.

Nurse at the first signs of hunger (stirring, rooting, hands in mouth)-don't wait until baby is crying. Allow baby unlimited time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy-wake baby to nurse if 2 hours (during the day) or 4 hours (at night) have passed without nursing. Once baby has established a good weight gain pattern, you can stop waking baby and nurse on baby's cues alone.

The following things are normal:

Frequent and/or long feedings.

Varying nursing pattern from day to day.

Cluster nursing (very frequent to constant nursing) for several hours-usually evenings-each day. This may coincide with the normal "fussy time" that most babies have in the early months.

Growth spurts, where baby nurses more often than usual for several days and may act very fussy. Common growth spurt times in the early weeks are the first few days at home, 7 - 10 days, 2 - 3 weeks and 4 - 6 weeks.

Is baby getting enough milk?

Weight gain: The average breastfed newborn gains 6 ounces/week (170 grams/week). Consult with baby's doctor and your lactation consultant if baby is not gaining as expected.

Dirty diapers: Expect 3-4+ stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often-this is normal, too. The normal stool of a breastfed baby is yellow and loose (soft to runny) and may be seedy or curdy. After 4 - 6 weeks, some babies stool less frequently, with stools as infrequent as one every 7-10 days. As long as baby is gaining well, this is normal.

Wet diapers: Expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet. After 6 weeks, wet diapers may drop to 4-5/day but amount of urine will increase to 4-6+ tablespoons (60-90+ mL) as baby's bladder capacity grows.

Milk supply?

Some moms worry about milk supply. As long as baby is gaining well on mom's milk alone, then milk supply is good. Between weight checks, a sufficient number of wet and dirty diapers will indicate that baby is getting enough milk.
This information is also found as part of the professional Breastfeeding Logs.
Additional information

@
Breastfeeding Logs Hunger Cues - When do I feed baby? Resources: Is Baby Getting Enough Milk? Normal Growth of Breastfed Babies Breastfeeding Basics
Information is Your Ally in preparing to breastfeed: 10 Tips for Success by Eva Lyford
Tips for juggling a newborn and toddler Frequent Nursing
Worried about milk supply?
How does milk production work? Is your milk supply really low? My breasts feel empty! Has my milk supply decreased? How can I find help for my breastfeeding problem?
@ other websites

The Importance of Colostrum by Paula Yount

Baby Explains- Normal Newborn Behavior by Diana Cassar-Uhl, IBCLC

It's Not Just About Breastfeeding by Danielle Rigg, JD CLC

What is Normal? by Paula Yount

Breastfeeding as Baby Grows by Becky Flora, IBCLC

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Breastfeeding your newborn - what to expect in the early weeks * KellyMom.com

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Frequent nursing encourages good milk supply and reduces engorgement. Aim for breastfeeding at least 10 - 12 times per day (24 hours). You CAN'T breastfeed too often--you CAN breastfeed too little. Nurse at the first signs of hunger (stirring, rooting, hands in mouth)--don't wait until baby is crying.

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When to be concerned:
Your baby consistently feeds for less than 5 minutes or for longer than 40 minutes at each feed.
Lengths of feeds will vary between 5 and 40 minutes. If a feed is consistently shorter than 5 minutes or longer than 40 please - please ask for additional support.
This blog discusses the dangers of promoting a strict feeding schedule.

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This guest blog from breastfeeding counsellor Emma Pickett discusses the dangers of promoting a strict feeding schedule at the expense of responsive, flexible infant feeding.
Add your voice to Unicef UK's Change the Conversation campaign, calling on UK governments to take urgent action to protect, promote and support breastfeeding.
Somehow, somewhere, new mothers got the message that the gap between when a baby stops a breastfeed and the time they start to need another one matters a very very great deal. 24 hours a day.

It seems to matter beyond all logic and reason. They see this magic number - 90 minutes, 2 hours, 3 hours - as a measure of something sacred.

And it's crap.

There are mums sitting at home, relaxing and nesting with their gorgeous new baby. There's a disk from a box set in the DVD player, a cup of tea on the go, a recent chat with a friend. Breastfeeding is going well. Weight gain is fine. Baby is content. But when baby shows hunger cues after only 40 minutes instead of the hoped for 1 hr 30 minutes, their heart sinks and they feel a sense something is fundamentally wrong. They aren't 'doing it right'. Their friend's baby 'goes longer'. Doubts creep in.

As adults, we grab a cup of tea, a glass of water, a sweet, a snack. We respond to our personal cues and we're flexible depending on time of day, the temperature, our mood, our energy levels. Many go to bed with a glass of water or sip from a bottle throughout the day. I don't know any adults that look at their watch and say, "Only 30 minutes till my next sip of water or mint! Not long now". But yet we expect teeny growing babies to be governed by this artificial notion of time.

Basic misconceptions

I spoke to a new mother last week who was perfectly happy with her feeding routine but wondered if she should start to stretch her baby's intervals because 'that's what you do'. When I explained that it wasn't necessarily, she said she was more than happy to go on as she was.

Where do these ideas come from? They don't come from anyone with any breastfeeding education, nor antenatal classes with breastfeeding professionals, nor books written by those trained to support breastfeeding.

They come from popular baby care books and relatives and peers.

They seem to come from a fundamental misunderstanding of the science of breastfeeding and breastmilk production. Often they come from mid-20th century ideas based around the norms of formula-feeding and pseudo-science. And that's all incredibly dangerous.

There are still people out there, surrounded by breastfeeding, who believe that a baby who feeds after 4 hours rather than 3 hours will 'take more milk'. There are people who believe that you need to wait and hold a baby off to let your breasts 'refill'. There are people who believe that when a baby does want to return to the breast after only an hour that must reflect a 'problem' and perhaps the mother even has a supply issue.

It's scary and extremely frustrating that basic messages about how milk production works don't reach the people who need them.

Searching for "normal"

So what is normal? Well, how long have you got? Because there's a lot of normal. A newborn should feed a minimum of 8-12 times in 24 hours. That means some might be going every 3 hours and others will be feeding more frequently than 2 hourly. Some babies may feed every 10 minutes every hour. Some may feed for 10 minutes every 2 hours. Some may feed for 40 minutes every 2 hours. For periods in the day, a younger baby will often cluster feed and not be happy away from the breast for any longer than a few minutes at a time. This natural cluster feeding may dominate an evening.

A very common call to the National Breastfeeding Helpline goes like this: "My baby used to sleep in the evenings and now he's awake for 3-4 hours. The only thing that seems to settle him is the breast. I feel like I must not have enough milk as he's on there for ages. Surely there can't be anything there." As the baby swaps from breast to breast, getting small quantities of very high fat content milk and decompressing at the end of a long day, they know exactly what they are doing.

And soon their patterns will change again. Some babies will start to longer intervals in the day as the months go by. But not all will.

One of the most popular babycare books (which I better not name) gives a strong direction that while frequent feeding might be occasionally acceptable during growth spurts, this holy cow of the interval between feeds matters greatly. A 3 month old baby might be going 3 hourly intervals but if this isn't increasing at 4 months, then oh dear. This same writer believes a woman can measure her milk supply by doing a yield test and using a pump to extract milk which apparently will be the equivalent amount to what her baby extracts during a feed using an entirely different process. What this woman doesn't know about breastfeeding could fill an encyclopaedia.

What I find particularly dangerous about her message that longer intervals are 'better' and 'correct', is that is means new mothers doubt their milk supply with absolutely no justification. And I know from having spent time on the message boards associated with this writer, many mothers will end up supplementing with formula to try and reach these magic numbers of minutes.

Why?

Babies are no longer being exclusively breastfed and parents are not following Department of Health recommendations because of incorrect information in a baby care book.

There are parents who choose to use formula for a whole host of complex reasons. Some do so happily and some do so miserably. But to do so, merely because you have read a lie in a book, seems tragic to me.

Our knowledge about breasts has been transformed over the last 20 years. Much of the pioneering work has been done in Australia by scientists like Professor Peter Hartmann and Dr Donna Geddes, Steven Daly and their teams.

We used to think most women had a pretty similar number of milk ducts but the ultrasound research revealed there were less than previously thought and the range was big. One woman had 4 ducts at the nipple. One had 18.

But it's the findings about breast storage capacity that we need to talk about here. When a baby feeds, some milk is manufactured during the feed itself and some is taken from milk that has been stored in the breasts between feeds.

Ultrasound revealed that a mother's storage capacity cannot be guessed from breast size. Breast size is obviously not just about glandular tissue. The range in breast storage capacity was huge.

One mother was able to store about 2.6oz per breast. Another woman stored more than 20oz. That's not a typo.

Women with a smaller breast storage capacity had a healthy milk production over a 24 hr period and their babies had good weight gain. But their babies might need to feed more frequently to access this healthy milk production.

Is this a mother with a supply problem?

No, it is not.

Her baby may continue to feed 2 hourly or even more frequently for a few months during the day, cluster feed at certain points and perhaps continue to wake a couple of times hungry at night. Her friend's baby may settle into a pattern of feeding less frequently over a 24 hour period. This friend's baby may not be receiving more milk overall.

When breasts are fuller, milk production slows. When breasts are emptier, we make more milk. When babies feed more frequently and from emptier breasts, they receive milk with a higher fat content. Frequent feeding has value. And as human milk has a fat content of around 3-5% compared to some mammals who have a fat content of 40% +, it seems pretty clear we're designed as a species to need feeding more frequently.

But let's imagine the mother with the smaller breast storage capacity has read this baby care book. She might become distressed that her baby still wants to feed 2 hourly. She might even try and stretch the interval between feeds in the mistaken belief this will increase her baby's intake. And in doing so, her breasts spend longer at full storage capacity and their milk production slows and her breasts receive the signal to decrease milk supply.

So in her attempt to stretch between feeds as the advice she is reading suggests she does, she may actually be decreasing her overall milk production in 24 hours and be doing some actual harm.

So what should we suggest to this mum who never seems to be able to stretch her baby to longer intervals in the ways that her friends seem able?

First off, we should congratulate her for responding to her baby's cues. Thankfully she knew not to try and impose some routine early on and therefore her milk supply is at its maximum capacity. Let's check breastfeeding is otherwise going well: that feeds are comfortable for her, baby does settle for periods of contentment after a feed (though it may only be an hour or even less, rather than 3), weight gain and nappies are fine and latching and positioning is at maximum efficiency. If all this is true, and never reaching a magic 'interval' is her only concern, then we need to make sure she knows as much as possible about how milk production works. It is possible she is one of the mothers who has a minimal breast storage capacity and she will need to feed more in 24 hours to maximise the volume of milk her baby receives. And there might be nothing she can do about that. What happens next is about acceptance and support and attitude.

She has to keep that up for ideally around 6 months if her baby is going to get the full benefits of exclusive breastfeeding. She might need greater support with feeding outside the home - perhaps learning how to feed in a sling or experiment with different positions for different environments. It's possible she may be woken at night more than her friend with the longer intervals - though we would expect night time intervals to be longer and for her to get a block of longer rest. She may benefit from support on safe bed-sharing practices.

And it is just a matter of months. After solids have been established, patterns will change. It's surprising what we can cope with for just a few months. We have jars of pickle in our fridge significantly older than that. We may even have toothbrushes that are around that long. In terms of an adult lifetime, it's a blink of an eye.

What won't help these mothers is the relentless message that they just need to stretch their baby a little more. That if they leave him to cry for 15 minutes, magically he will take more milk and life will change. That just isn't what science tells us is true for all women.

Responsive feeding: So much more than milk

Of course breastfeeding isn't just about milk anyway. Apparently there are people who think that a baby comes to a breast primarily to get milk but I've not met a parent of a baby who thinks that's true. Just as we don't measure our sips of water, sweets and snacks, we also don't measure every time our family smiles warmly at us, communicates with us, looks for comfort, hugs us, checks in, helps us to feel safe. No smart phone app can measure all the complexities of our relationship with our baby and all the things that responsive feeding can do. You are trying to count and measure love.

And I'm talking about myself here, by the way. My children under 6 months never went longer than 2 hours between feeds in the day and not much longer at night. My red record book records me feeding at 3 months every 90 minutes or so. So I learnt to feed while babywearing. I went to friendly groups and friendly places and met up with people at home. I read about safe co-sleeping practices which I know beyond a shadow of a doubt saved my bacon. And thankfully, I never felt anything was 'wrong'. I just trusted my body. I trusted my baby and we worked as a beautiful team. I sat at home on the sofa and fed relatively frequently, enjoyed my box sets and my healthy and not-so-healthy snacks and that was OK.

It really wasn't for long. But the benefits of exclusive breastfeeding will be.

Why should a watch or clock tell me how to be a mother? I'd rather pay attention to my baby.
Sources

Anatomy of the lactating human breast redefined with ultrasound imaging. DT Ramsay, JC Kent, RA Hartmann, and PE Hartman. 2005.

The magic number and long-term milk production. Nancy Mohrbacher IBCLC

Studies on Human Lactation: Development of the computerized breast measurement system. D.B Cox, R.A Owens, Peter E. Hartmann

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Guest blog: Breastfeeding: The dangerous obsession with the infant feeding interval - Baby Friendly Initiative

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Advice that babies must follow a strict three-hourly breastfeeding routine is causing mothers distress and guilt,and reducing breastfeeding rates.

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When to be concerned:
Your baby comes on and off the breast during the feed, or does not latch at all.
Read the following article for some tips if you baby is struggling to feed.

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By Kelly Bonyata, BS, IBCLC

Introduction

The following techniques have proven helpful for a wide range of problems with baby refusing the breast. Some of the babies who might benefit include:

a newborn (or older adopted baby) trying to figure out how to breastfeed

a previously-weaned baby whom you wish to breastfeed again

a baby who seriously resists nursing (or even being placed in a nursing position)

a baby with nipple confusion

a baby who is a fussy nurser (but does not completely refuse the breast)

a baby on a nursing strike

Even if you have a baby who adamantly resists nursing, getting your baby to breast is very possible but it will probably require time, patience, and kangaroo-style frequency. Expect "two steps forward and one step backward."

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If you have a newborn who is not latching on, do keep in mind that almost all reluctant nursers will start latching by four to eight weeks of life.

The Basics

Follow the Rules

The two primary rules when you have a baby who is having problems nursing are:

1. Feed the baby. A baby who is getting the right amount of calories and nutrition is best able to learn how to nurse. First choice for what to feed a non-nursing baby is mom's own milk, second choice is banked milk from another mom, third choice is infant formula.

2. Maintain milk supply. If mom's milk supply is being maintained with an appropriate frequncy and amount of milk expression, more time is available for baby to learn to nurse, and baby's efforts will be better rewarded (with more milk).

Suggestions for a typical nursing session

Very careful, supportive positioning can be very helpful when baby is having problems breastfeeding; for example, a cross-cradle hold or a modified football hold can be useful.

If your baby is tolerating it, then work on latching for up to 10 minutes or so. If baby is getting upset, then go with shorter sessions. It's not a good idea to keep trying for more than about 10 minutes - after this baby will be tired, latching will be harder, and there is a risk of baby developing an aversion to the breast if you persist too much.

Don't continue trying to get baby to take the breast after major frustration (either mom's or baby's) sets in; stop for a bit and calm baby (and/or give mom a break) before continuing - let baby suck on a finger, or snuggle baby high up between mom's breasts, or hand baby to dad.

Sometimes it can be helpful to offer a little supplement at the beginning of a feeding; this can take the edge off baby's hunger so he has more patience to work on the breastfeeding. If you've been working on latching and hunger is getting in baby's way, go quickly to whatever alternative feeding you're using. If you're both totally frustrated, give a whole feed, but if you think your baby is up for it (and you are too), only offer enough supplement to calm him and go back to working on breastfeeding.

If baby does not latch or does not suck effectively (or won't sustain a suck for more than 3 sucks even with breast compressions), then either try supplementing at the breast (see below) or stop and offer baby a little supplement (1/2 ounce or so of expressed milk or formula), and then have another try at nursing. If the second try is unsuccessful, then go ahead and finish up the feed with whatever method of supplementation you are using.

Any time that baby does not nurse at all, or nurses but does not soften the breast well, pump after feeding baby. This will help to maintain your milk supply, plus you will have some "liquid gold" available the next time baby needs a supplement. See Establishing and maintaining milk supply when baby is not nursing.

Feed the Baby!

Do not try to starve your baby into nursing. Your baby is not refusing to nurse just because he doesn't want to and is being stubborn, so ignore anyone who tells you that "baby will nurse when he gets hungry enough."

In general, a baby who won't nurse, can't nurse. Your goal is to (hopefully) identify why baby can't nurse and either remedy the problem, work around the problem, and/or preserve your milk supply until the problem remedies itself (sometimes necessary for ill, small or premature babies). A board-certified lactation consultant is a great partner to have in this process.

Keep baby as full and happy as possible, i.e. continue to offer expressed mother's milk, banked milk, formula or solids (if baby is old enough), but gradually get closer and closer to the nursing position, skin-to-skin, etc. Click here for tips for weaning from formula supplements.

Maintaining milk supply when baby is not nursing

It is important to express your milk to maintain milk supply while baby is transitioning to full breastfeeding. See Establishing and maintaining milk supply when baby is not nursing for more information.

Coaxing baby to the breast

General tips

Your goal is to coax baby to the breast. Do not attempt to force your baby to breastfeed. Forcing baby to the breast does not work, stresses baby, and can result in baby forming an aversion to the breast. As baby gets better at nursing and is able to get more milk via nursing, he will grow to trust that breastfeeding works and will have more patience when latching.

Wear clothing that allows very easy access to the breasts. Baby may get very impatient in the split-second it takes for mom to lift the blouse and undo the bra. Spend time, if possible, in a warm place that allows both mom and baby to be naked from the waist up.

Lots of skin-to-skin contact can help your baby nurse better and even gain weight faster. Keep your baby with you as much as possible, and give him lots of opportunities to nurse (even if you're not successful). Get skin-to-skin with him, first when he is sleepy, right after a bottle feed (or however you're supplementing). This way baby has the opportunity to sleep and wake up happily, skin to skin at mom's chest, and mom is right there to catch the earliest hunger cues. If baby moves toward the breast and then falls asleep before even mouthing the nipple, or after sucking twice, then these are positive baby steps, not failures. (Read more about kangaroo care or take a look at the book.)

Offer the breast often. Try breastfeeding in baby's favorite place, in his favorite position, in the bath, while walking around, while lying down, with baby upright, baby flat on his back, in his sleep, just as he is waking, any time baby looks as if he might be interested, or any other way you can think of, i.e. any time, anywhere.

Avoid pressuring baby to nurse. Offer in an ultra-casual way and pretend you don't mind if he refuses (easier said than done, but try not to show any frustration - your aim is to avoid pressuring baby to nurse). Don't hold the back of baby's head or push or hold baby to the breast. If baby pulls off the breast, then don't try to make him go back onto the breast at that time - simply try again later. If baby seems frustrated with your offering the breast, then turn the pressure down and simply make the breast available (lots of skin-to-skin!) without offering. It can be helpful to have lots of skin-to-skin time with baby where he is cuddled at the breast with no pressure to nurse - give control over to your baby, so that baby decides if and when to nurse and when to stop nursing.

Carry your baby close to you (a sling or other baby carrier can help with this). "Wear," carry, hold and cuddle your baby as much as possible; carry baby on your hip while doing other things, play with baby, and give baby lots of focused attention.

Sleep near your baby. If baby sleeps with you, you'll get more skin-to-skin contact, plus baby has more access to the breast (see this information on safe co-sleeping). If baby is not in the same bed, have baby's bed beside your bed or in the same room so that you can catch early feeding cues, breastfeed easier at night, and get more sleep.

Nipple shields can be helpful at times for transitioning baby to the breast. Talk to your lactation consultant about using this tool.

Comfort nursing is often the first to come, followed by nutritive nursing. Offer the breast for comfort any time you see a chance- at the end of a feeding when baby is not hungry, when baby is going to sleep or just waking up, when baby is asleep, and whenever he needs to comfort suck If your baby is actively resisting nursing, then try encouraging comfort nursing after baby is comfortable with skin-to-skin contact. After baby is willing to nurse for comfort, you can then proceed to working on nursing for "meals" as well.

You are working to seduce your baby back to breast. Again, coax, don't force!

"Instant Reward" techniques

For a newborn who is not latching or an older baby who does not want to wait for letdown, try these techniques that help to teach (or re-teach) your baby that nursing is a way to get milk:

Hand express or pump until let-down, just before trying to latch baby, so that baby gets an instant "reward" for latching on. Another way to elicit let-down is by doing reverse pressure softening.

If you are using a nipple shield to transition to nursing, try filling the tip of the shield with expressed milk prior to applying the shield and latching, so that baby gets some milk first thing as he latches.

Drip expressed breastmilk (if you have it) or formula onto the tip of the nipple as you're latching (use an eyedropper or a bottle). You can continue this while you're breastfeeding: Just drip milk toward the center of baby's upper lip; let the drop start on the breast and roll down toward the center of the upper lip (12 o'clock position if you're using the football/clutch hold), one drop at a time. A curved tip syringe can also be used to drip milk into baby's mouth.

Use a nursing supplementer to increase milk flow at the breast.

If baby starts breastfeeding but stops sucking as soon as the milk flow slows, breast compressions can speed the flow of milk. If this is not sufficient, the last two methods above can also be used.

Skin to Skin/Laid-Back Breastfeeding

Keeping baby skin to skin with mom and "laid-back" breastfeeding techniques can both be very helpful when encouraging baby to breastfeed. This video shows baby-led, mother-guided latching. One technique used to get babies to accept the breast has been called rebirthing, but this is essentially just laid-back breastfeeding in the bath. Mom gets into the bathtub, full of warm (not hot) water with baby. Place baby on mom's tummy, in the water. Stroke baby, talk to baby. This may take time, but baby may begin to work his way up to the breast, search it out, and begin to suckle. It's important to have a support person with mom when doing this, for the safety of the baby.

Working with a baby who is actively resisting nursing

Make sure that a physical problem is not causing baby to resist nursing. Could baby have a birth injury or other condition that makes positioning for nursing painful? Is baby having problems with breathing while nursing or coordinating sucking and swallowing? Does baby have an overactive gag reflex that makes nursing uncomfortable? Does baby have severe reflux that makes feeding painful? Does baby have a sore throat from suctioning or other medical interventions? These are just some of the things that might interfere with breastfeeding.

Sometimes a baby will aggressively refuse the breast for no discernable reason - this baby will often resist being held, and may also be easily overstimulated. These babies can be transitioned to breastfeeding, but it should be done very gently so that baby becomes comfortable with being at the breast.

La Leche League's Breastfeeding Answer Book lists the stages that these babies go through as they transition to breastfeeding:

The baby aggressively fights the breast.

The baby cries more while being held than when he's put down.

The baby is willing to be held in some positions, even if not in a cradle hold.

The baby tolerates being held in the cradle hold.

The baby will attempt to root.

The baby will lick at the milk on the nipple.

The baby will attempt to suck, using and in-and-out movement.

The baby will take milk at the breast.

The baby nurses well, even before the let-down occurs.Source: Mohrbacher N, Stock J. The Breastfeeding Answer Book, Third Revised Edition. Schaumburg, Illinois: La Leche League International, 2003, p. 136-137.

Some babies will become more resistant the more you press the issue of nursing. If you've been working hard to get baby to latch and baby is resisting nursing, it can be helpful to step back for a bit, take the pressure off both yourself and baby, and not try to latch baby at all for a few days. Then slowly and gently work on moving baby through the above stages.

Start out by bottle feeding (or using whatever form of alternative feeding you prefer) in the feeding position you usually use, without trying to nurse. If baby resists being held in the beginning, it might be helpful to feed baby in an infant carrier or perhaps while holding baby so he is facing away from you.

Work with baby until he becomes comfortable being held in any position, then being held in a nursing position.

Once baby is comfortable being held in a nursing position, start trying more skin-to-skin contact. Don't actively try to get baby to latch before he is comfortable with skin-to-skin. You want baby to be able to trust being at the breast and cuddling at the breast without the stress of trying to latch.

When baby is comfortable cuddling at the breast, try feeding (bottle, etc.) at the breast. You're working to get him comfortable with feeding in a breastfeeding position, skin-to-skin.

Next step, start offering the breast for comfort when he's really relaxed and sleepy, or even asleep. Nursing in the side lying position might be helpful, as this positioning allows for less body contact. Some babies will take the breast after bottle-feeding or partway through a bottle-feeding.

Once baby is willing to take the breast for comfort, begin to work toward full breastfeeding.

Bottles - yes or no?

Many experts suggest that baby not get bottles or pacifiers while he is learning to nurse correctly, with the idea that his need to suck will help the process along (nursing will satisfy the need to suck). Of course, if you're working with a baby who has nipple confusion, it's best to avoid bottles (when mom and baby are together, in particular) until nursing is going well again. If baby is not latching on at all, you do need to balance this with your baby's need to suck and comfort level.

Do consider giving your baby his feedings via an alternative feeding device other than a bottle, such as a nursing supplementer, feeding syringe, finger feeding setup, flexible cup, spoon, medicine/eye dropper, etc. A nursing supplementer can be a big help if baby is latching well: it will encourage your baby to continue nursing by giving him a constant flow of milk (expressed milk or formula) while he stimulates your body to produce more milk.

If you prefer to use a bottle for supplementing baby, it's not the end of the world (or your breastfeeding relationship). For some moms, using a bottle is easier and more familiar. If you feel that using a specialized feeding device (like a finger feeder or SNS) is simply too overwhelming and other methods (cup, dropper) are not working for you, using bottles may make it easier for you to continue working on the breastfeeding. Although bottles can certainly have their disadvantages, a good lactation consultant should be able to help you to transition to breastfeeding with or without the bottles.

When using a bottle, encourage baby to open wide prior to giving the bottle. Stroke baby's lips from nose to chin with the bottle nipple, and wait until baby opens wide like a yawn. Allow your baby to accept the bottle into his mouth rather than poking it in. This will teach your baby to open wide for feedings, which is a good start to getting on the breast effectively.

Nursing Strikes

When babies abruptly stop nursing, it's a nursing strike - not weaning. Babies rarely wean on their own before 18-24 months, and self-weaning is almost never abrupt.

Will baby nurse while asleep or just waking up? This is usually one of the best times to try. You also might try nursing lying down or while walking around. See also the tips at the top of this page for persuading baby to nurse.

As long as baby is not nursing as often as before, you'll want to express milk to maintain your supply, stay comfortable, and reduce the risk of plugged ducts and mastitis.

Additional information

General

Useful info @

Nursing Strikes

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Help -- My Baby Won't Nurse! * KellyMom.com

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The following techniques have proven helpful for a wide range of problems with baby refusing the breast. Some of the babies who might benefit include: a newborn (or older adopted baby) trying to figure out how to breastfeed...

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When to be concerned:
Your baby does not release the breast spontaneously/you end the feed by removing your baby from the breast.
Your baby should lets go of the breast spontaneously, or will do so when breast is gently lifted.
This article explains how fat content of milk works, and why it is recommended to allow your baby to finish the first breast before offering the second.

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KellyMom.com - Breastfeeding and Parenting

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Foremilk and hindmilk – what does this mean? - KellyMom.com

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The breast only makes one type of milk (which has a relatively high fat content). Because of the mechanics of milk release, the amount of fat in the milk available to baby gradually changes as a feed progresses. As milk is produced in the breast, the fat globules in the milk tend to stick to each other and to the walls of the alveoli (where the milk is made). Between feedings, milk collects in the breasts and gradually moves out toward the nipple, leaving more and more of the fat “stuck” further back in the milk ducts. The more time between milk removal (feeding or expression), the lower the fat content of the milk available to baby at the beginning of the feeding.

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When to be concerned:
Your baby is unsettled after feeds.
Your baby should generally be calm and relaxed whist feeding and content after most feeds.
Read here about cluster feeding which is normal for a breastfed baby.

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Rita Brhel, Hastings, Nebraska
After years of supporting mothers at all stages of breastfeeding, I've learned that there are four key areas to focus on to help mothers get breastfeeding off to a good start: milk supply, latch, frequent access to the breast, and skin-to-skin contact. In this post, let's explore access to the breast as it pertains to growth spurts and cluster feedings.

Cluster feeding usually occurs over the course of a few hours each day and can happen every day during the early newborn weeks, when baby wants to breastfeed-constantly. You may finish one nursing session, only to have baby cue you that she wants to latch again. This is normal and is a way for baby to build up your milk supply. It tended to happen with my babies in the evening when my-and many mothers'-milk supply was naturally lower. It also may happen overnight or any other time of the day.

Growth spurts are like cluster feedings, except that they may be a bit more predictable. Babies go through growth spurts at about seven to 10 days, three weeks, six weeks, three months, six months, and nine months. From experience, those three and six-week growth spurts really sneak up on mothers! All of a sudden, baby starts nursing again like a newborn, wanting to latch very frequently and often being fussy. Even experienced breastfeeding mothers may be tricked into thinking their milk supply is insufficient.

But your milk supply is fine. What's happening is normal. Cluster feedings during and outside of growth spurts signal to your breasts to make more milk-remember, how much milk you make depends on how much is removed-so when baby breastfeeds more frequently, this tells your body to make more milk, which is then able to sustain baby as she grows. It's a great system.

You also may notice more frequent nursing when baby is sick or overstimulated or otherwise not feeling centered. Breastfeeding isn't just nutrition, it also is comfort. The act of sucking is comforting, and so is being physically close to mother. Try not to worry about the idea of being used as a pacifier. Pacifiers were created to be a substitute for you: the mother. Babies need that closeness to you, that ability to suck, and to get breast milk at the same time, for healthy development.

The best way to make it through cluster feedings and growth spurts is to let baby breastfeed as much as he wants. This will help your milk supply be where it needs to be for baby and will ensure your baby is getting enough milk for his growth.

How do you know if baby is getting enough milk? A satisfied baby at the end of a feeding is a good indicator, but the gold standard-besides weight gain-is watching baby's diapers. After the fourth day until about six weeks, you want to see at least three to four mustard-yellow, loose, seedy stools each day that are at least the size of a quarter, as well as at least five to six wet diapers.

Some babies, such as those who were born premature or early term or small for gestational age, need to play catch-up with their weight and it may seem like they are constantly cluster feeding, every day and night. This is normal, and you may wish to contact a La Leche League Leader or a lactation support professional for reassurance and perhaps some ideas for when it gets tiresome.

You can read more about growth of a breastfed baby on the LLLI website at www.llli.org/breastfeeding-info/growth.

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Helping to Get Breastfeeding Off to a Good Start: Frequent Access - La Leche League USA

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La Leche League USA helps parents, families, and communities to breastfeed, chestfeed, and human milk feed their babies through parent-to-parent support.

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How do your nipples and breasts feel during and after a feed?

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How do your nipples and breasts feel during and after a feed?

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When to be concerned:
Can include misshapen nipples at the end of feeds; sore or damaged nipples; breasts are engorgement or mastitis.
Read here about causes of sore nipples and how to ease the pain.

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Sore nipples when breastfeeding | Baby & toddler, Feeding articles & support | NCT

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Sore nipples can be a problem in the early days of breastfeeding and beyond. This article discusses causes of sore nipples and how to ease the pain.

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Read here about giving your baby supplement milk including the effect these may have on your breastfeeding journey.

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

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

Get support from LLLGB here.

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

Why a baby might need extra milk

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

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

How to tell if your baby is getting enough milk

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

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

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

Normal growth

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

Why protecting milk supply is urgent

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

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

You can read more about expressing and storing milk here.

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

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

A history of infertility due to hormonal imbalances

Past breast surgery, especially breast reduction

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

PCOS (polycystic ovary syndrome)

Thyroid problems (over- or under-active)

Obesity (BMI over 30)

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

Giving extra milk - what kind of milk

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

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

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

Mothers' feelings about using formula milk

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

Extra milk - how to give it

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

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

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

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

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

Extra milk - when to give it

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

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

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

Extra milk - how much to give

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

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

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

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

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

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

Reducing the amount of extra milk

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

Read our article on Weaning from Supplements here.

What if you need to keep using formula milk?

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

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

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

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

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Cracked Nipples and Moist Wound Healing - The Breastfeeding Network

This link helps guide you through possible reasons for cracked nipples as well how to relieve any damage.

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This information is also available in a printer-friendly PDF format by clicking here.
Updated (2019) by Agnès Léger, BfN Supporter Reviewed by Phyll Buchanan, Anthea Tennant-Eyles, Sarah Turner, Wendy Jones. Registered BfN Supporters
The original version of this leaflet was produced in 2002 and can be found below. Although some further research has been conducted since, the conclusions mostly haven't changed. This is still an area in urgent need of further systematic reviews and independent research, especially distinguishing sore and damaged nipples. Nipple pain is usually poorly defined in the studies, without distinction between broken and unbroken skin (see Section "Sore or cracked?"). It could be the case that those different types of issues benefit from different treatments.

A review of most of the recent studies that assessed the efficacy of treatments for painful nipples was produced in 2014, and we recommend readers to refer to this document to help them understand the evidence supporting the use of various treatments. Note that it does not separate treatment of recent and established wounds. This Cochrane review is entitled " Interventions for treating painful nipples among breastfeeding women" and was conducted by C‐L Dennis, K Jackson and J Watson. It can be accessed at the following link:
https://doi.org/10.1002/14651858.CD007366.pub2

Most of the content of this leaflet is still as relevant today. The amendment highlights some of the main updates of the last 17 years throughout the text (in boxes). The BfN is investigating paths to either produce an updated leaflet or support further systematic reviews.

Summary of the key points

· Cause of soreness

Addressing the cause of the nipple soreness is the most effective way of solving it! Correcting positioning and attachment is paramount in allowing a damaged nipple to heal and enable pain free, effective breastfeeding. Positioning and attachment should always be investigated, including for older babies, because even a good latch can be improved. There are resources on the subject here:
bfn.local/positioning-attachment

· How to treat sore nipples

Nipples can be air dried or kept moist using a few drops of expressed milk. To this date, there isn't satisfactory evidence than any other treatment is as effective in helping nipples heal, including purified lanolin and vaseline ( Dennis et al., 2014). If using creams, apply after feeds. Most do not need to be washed off before the next feed, though if using creams/gauze containing antibiotics its worth wiping off any excess before a feed. You can also check our section "A few things to try".

· How long does healing take

The duration of the healing will vary. Superficial and recent soreness may clear in a matter of hours or days. However, long-established and profound wounds may require a up to 2 or 3 weeks to be entirely resolved even after the cause of the soreness has been eliminated. Long-established wounds usually close from the bottom to the top, so creams applied to the wound in order to prevent a scab forming is likely to aid healing, see section on "Two ways of wound healing".

· Continuing breastfeeding

If positioning and attachment is adjusted so that pain is minimised with no new damage visible after a feed, you can continue breastfeeding. The wound will continue to heal. See our section "Expressing versus continued breastfeeding".

· When to contact a medical professional

You should speak to your health visitor or GP if you have signs of infection (like abnormal swelling, inflammation, [pus - check description] discharge, fever and/or chills, or feeling ill), or if your wound doesn't heal after a few weeks, even after adjusting attachment to a pain free latch. You can also check our section on "Other medical considerations".

Supporting women with cracked nipples is such a large part of our work, it is surprising how little certainty there is on the best method of healing them. We know that adjusting positioning is crucial to avoid any further damage. An established wound that is slow to heal may be a sign of continued friction. So, start with watching a whole feed to see whether fresh injury is happening and if so, at what stage. Sometimes it's when latching on, other times during a feed, or maybe it's towards the end when the baby is getting sleepy and the mother's arm relaxes downwards. Watching for any changes in suckling and swallowing will give further clues. Usually a more comfortable position can be found, but the wound may have been established for some weeks before we become involved. In these circumstances we can offer support while working towards comfortable feeding. Part of the feeding assessment should include looking into the baby's mouth to check for a high palate or tongue-tie.

Many women with cracked nipples want to know if there is anything they can put on the wound to speed up healing. A typical response might have been to suggest air drying or expressed breastmilk (EBM). However, when looking at the research we have a dilemma. A few years ago the available information on treatments was clear: In the Royal College of Midwives handbook, Successful Breastfeeding (2nd edition,1991, page 58), the section on treatment of sore nipples states "No randomised trial has yet been done to assess the usefulness of any of the creams, sprays, lotions or ointments [in current use] .... there is no scientific basis for their use. Nor is there any scientific evidence to support the use of expressed breastmilk or colostrum on the nipples after feeding." The 3rd edition (2002) now agrees that there is a strong theoretical basis for moist wound healing techniques though they have yet to be evaluated in the context of RCT's. Murray Enkin's A Guide to Effective Care in Pregnancy and Childbirth ' (3rd edition 2000, p507), still relegates nipple creams and ointments to forms of care likely to be ineffective or harmful. However Renfrew, Woolridge, and Ross McGill (2000) consider new evidence that the presence of 'epidermal growth factor' in breastmilk has potential therapeutic benefit in promoting the growth and repair of skin cells. This growth factor appears to be passively transported from the circulation into breastmilk as levels measured are constant over weeks and throughout a day's feeds.

Mohrbacher and Stock (1997) retract information in the previous edition on keeping the skin dry when sore, cracked or bleeding and add that research into moist wound healing results in wounds healing 50% faster when the internal moisture of the skin is maintained.

All books agree that no product is a substitute for finding and correcting the cause of soreness. The aim of this article is to help women achieve pain free effective breastfeeding.

Sore or cracked?

There is a move towards using moist wound healing for cracked nipples. At this point it is worth distinguishing between sore (unbroken skin) or cracked (wounded, broken skin) nipples. Many of the text books discuss sore, rather than cracked nipples or include sore and cracked nipples together (see above). This is reflected in the design of many research studies into moist wound healing, so it is perhaps not surprising that results are often inconclusive.

Mohrbacher and Stock (1997) now say, 'keeping the skin dry is no longer recommended for nipple soreness' while reminding us that many creams and ointments sold for the treatment of sore nipples may actually contribute to the problem (page 394). Yet sore nipples should be able to heal without creams, providing help is given with positioning to prevent a crack developing. Renfrew, Woolridge, Ross McGill (2000) find it plausible that this process (of moist wound healing) may have contributed to the previously reported claims by women that oil-based formulations (eg lanolin, 'Calendula', 'Kamillosan') are beneficial with nipple soreness.

Any study which suggests that using a moisturiser would help women with sore nipples should compare subsequent rates of cracked nipples in each group, as well as levels of pain. There appears to be no such study. It seems probable that the main use of moisturisers (or other forms of skin care) should be when the skin is broken as a result of nipple trauma, especially when prevented from healing by repeated damage. Renfrew, Woolridge, Ross McGill (2000) agree that no controlled studies of adequate size have been published to date.

Compare this with general health care, where the principles of moist wound healing are well established. The importance of a moist environment for wound healing was identified by the work of George Winter ( Nature, 1962, 193, 293-294.). He compared the effect of leaving superficial wounds exposed to form a scab, with the effect of applying a vapour-permeable film dressing (on a pig). The wounds healed twice as quickly when kept humid. The dressing maintained humidity on the wound surface, allowing skin cells to slide across the surface of the wound. With a scab, the cells had to go deeper under all the dry crust and dead skin to find a moist layer (ref 6, p79).

Ideal skin care would allow moisture to be retained, without making the skin 'soggy' (or macerated) - like when a plaster has been on the skin too long, or feet go wrinkly in the bath. This moisture prevents a hard scab forming. When applying this to cracked nipples, a softer wound has an extra advantage. There is less risk of further damage happening during breastfeeding as there is no hard scab to pull off during a feed, taking the new skin cells lying underneath with it.

Keeping the wound moist also reduces pain by keeping air from drying out the exposed nerve endings (then more pain as it rehydrates) (ref 6, p80). Just as grazed knees are really nippy when going into the bath, but don't hurt so much once underwater, keeping a cracked nipple moist avoids it being re-wetted every time the baby latches on. We are, however, unaware of any study that has looked at this specifically.

Two ways of wound healing

Normally a new wound heals when the edges close together. An established wound heals from the base upwards, with the new skin growing over the edges, so they look smooth - often described as a rolled edge. As these wounds look like they are healing relatively slowly, women can feel disheartened. It helps to explain this and to look for the wound getting shallower. These wounds are most likely to benefit from moist wound healing, reducing any scab formation and allowing the skin cells to glide over each other.

Amendment - Sept 2019

This is sometimes referred to as secondary wound healing, as opposed to the primary wound healing that occurs for more recent and superficial wounds. Chronic wounds are more likely to heal "by secondary intention", which means that they heal bottom to top. This process takes longer, and the wound is more susceptible to infection and scab formation in the meantime.

Newly healed wounds are not as strong as normal skin, so can re-open if the baby slips when feeding. This is more likely to happen when the mother or baby is sleepy. Feeding lying side-on may help reduce the chance of this happening during night-time feeds.

While the wound is healing, it sometimes helps to talk about a pain scale - imagine a ruler numbered 0 to 10, with 10 being unbearable pain. Suggest trying to drop down the scale at each feed so the mother can see a progression towards no pain at all. Correcting the position should give her an instant drop someway down the scale but not necessarily to 0. Depending on the extent of the wound, it may take some time before she reaches 0. If pain stays the same, or increases, ask her to contact you again.

Expressing versus continued breastfeeding

Expressing is sometimes suggested as an option to 'rest' the nipple. Finding a comfortable feeding position however, is usually less trouble than expressing milk, which puts suction on the wound. Breastfeeding only involves suction at the very beginning of the feed, as the nipple and areola are drawn into the baby's mouth to form a teat. Once the milk begins to flow the negative pressure is relieved and the nipple should be well into the baby's mouth, safe from any further damage (ref 12, Chap 80, p1362).

Possible treatments

The table below reviews the different moist wound healing treatments available. Choosing a moisturiser is not easy. Perhaps the first suggestion for mothers would be either white soft paraffin (Vaseline) or purified lanolin (such as Lansinoh ®). Vaseline is widely used in wound care, either directly, or as a base for other creams. Lanolin is also used as a base but concerns over allergic responses and high levels of contaminants (ref 2 and 7) limit its use. Purified lanolin is a purified anhydrous version. The revised edition of the Breastfeeding Answer Book warns that Vaseline is unsuitable because it "keeps out air" (ref 2, page 163) and is "not safe for ingestion" (page 395). Unfortunately, these comments are not referenced and the standard reference book for drugs, Martindales Pharmacopoeia, makes no reference to this. Softened paraffin is likely to stay on the surface of the skin longer than purified lanolin but this is what makes it so useful in preventing hard scab formation. It is worth noting that white soft paraffin, or its unbleached version yellow soft paraffin, has been widely used over many years for lip care in special care baby units - if it was unsafe for ingestion why is it used directly on babies lips? White soft paraffin is widely available and cheap (a small tin currently costs 99p) while purified lanolin cost between £5-£10.

Sue Huml, Lactation Consultant for Lansinoh ®, believes "Petrolatum [Vaseline] is occlusive (prevents any air reaching the wound/skin). Lansinoh ® is semi-occlusive, allowing oxygen and water transpiration. Petrolatum remains on the surface of the skin. Lansinoh ® penetrates the stratum corneum and in a study was found to penetrate into the stratum granulosum, where in can hold moisture already in the skin ...... In lanolin sensitive patients researchers were unable to elicit a single allergic response."

Amendment - Sept 2019

A 2014 feasibility study ( https://doi.org/10.1891/2158-0782.5.1.28) investigated if breastfeeding women using purified lanolin may have a higher rate of infections than others - however the results weren't conclusive. Further research is required to answer this question.

A few things to try

Get a breastfeeding supporter to watch a whole feed, even good positioning may be made better.

Use only water when washing, because soap will dry the skin further.

Massage the breast gently and/or hand express a little milk to shorten the time between the baby latching on and the milk beginning to flow.

Feed when the baby at the first stirs rather than when really wide awake - so the baby feeds in a more relaxed way.

Feed from the least painful side first.

After a feed, try expressing some milk, and let it dry on the nipple.

You can try anaesthetising the nipple with ice wrapped in a cloth before a feed.

Consider pain relief, e.g. Paracetamol or Ibuprofen at least 30mins before a feed is expected, and at regular intervals.

Change breast pads at each feed.

Conclusion

Correcting positioning is paramount in allowing a damaged nipple to heal and enable pain free, effective breastfeeding. Sore nipples alone are unlikely to need further treatment, no evidence exists to support the use of creams, sprays or ointments to prevent or treat nipple soreness (11). Cracked nipples may benefit from applying a moisturiser such as white soft paraffin (Vaseline®) or purified lanolin. Some women may not like a particular choice of treatment. It may be useful to check whether they have any allergies to creams or cosmetics. Creams can be tested on their inner arm, but bear in mind that healthy skin is often less likely to react than damaged skin.

This is certainly an area in urgent need of systematic review and further, independent, research. We would like to hear from anyone with any experience of moist wound healing, with examples of what worked or not. We would like to collect this information. It's your experiences that will help us learn.

Moist Wound Healing Treatments: a review (November 1999, revised May 2001)

Amendment - Sept 2019

For an update on this table, please refer to the Cochrane review "Interventions for treating painful nipples among breastfeeding women", published in 2014 by C‐L Dennis, K Jackson and J Watson ( https://doi.org/10.1002/14651858.CD007366.pub2).

The authors of this review conclude that

"The results [...] suggested that applying nothing or just expressed breast milk may be equally or more beneficial in the short‐term experience of nipple pain than the application of an ointment such as lanolin."

"There was insufficient evidence that glycerine gel dressings, breast shells with lanolin, lanolin alone, or the all‐purpose nipple ointment significantly improved maternal perceptions of nipple pain."

Expressed breast milk has no risk of allergy, contains antibodies and 'epidermal growth factor' which potentially may promote the growth and repair of skin cells (1).

Using expressed breastmilk encourages hand expressing - may have benefits not considered in studies of nipple healing. Is used in many cultures on skin irritations (2).

USP-modified lanolin, warm compresses, and expressed breast milk with air drying were compared to a control group (177 women with sore nipples) (3).

Results No differences in pain or duration of breastfeeding. Exclusive breastfeeding rather than partial was a better predictor of breastfeeding beyond 6 weeks.

Conclusion Clinicians should discontinue recommending creams and ointments, since these have not been proved to be effective... and may only present an unnecessary nuisance and expense for the mother.

White soft paraffin (Vaseline®)
Use in tube form where possible.

Widely available.

Might try next after breast milk.

Good at preventing scab formation which may be pulled off during a feed causing further damage.

Compared white soft paraffin to antibiotic creams in general wound healing (884 women) (4).

Results No skin reaction to Vaseline® was found when confirmed by patch tests. Only 0.9% reacted in the antibiotic group.

Yellow soft paraffin
This is the unbleached form of Vaseline®.

Available in hospitals and pharmacies.

This is used in special care baby units as a moisturiser on babies' lips.

See above re scab formation

Not tested on nipple wounds although in common usage. Compared reactions to yellow and white soft paraffin on 3 people with known sensitivity to yellow soft paraffin (5).

Results Within each brand purification meant less sensitivity, may mean white soft paraffin is preferable to yellow.

Jelonet® Gauze square soaked in yellow soft paraffin. Comes in foil pack or tin

Available on prescription, or from pharmacies.

Useful on open, established cracks; should help stop the wound sticking to a breast pad. Use folded in double layer to stop drying out, if it still sticks try something else.

Change at each feed.

See illustration in (6)

Has been used as a wound dressing for many years.
One book claims it does not maintain a moist wound environment, not as popular in general wound care because it can stick to the surface of larger wounds
(7, p 85).

Purified lanolin (e.g. Lansinoh ®)
Claims to be a highly purified form of lanolin, although allergies may still be possible.

Substitutes are widely available in high street chemists and supermarkets and unlikely to be effective.

Claims to be absorbed more effectively than Vaseline® and that Vaseline® needs to be washed off - no evidence of this.
See text

Advertised in baby magazines.

Look out for various substitutes purporting to be pure lanolin - some are diluted by other compounds i.e. liquid paraffin

Several studies published but have design shortcomings. No study found which compared purified lanolin to the soft paraffin group. One unpublished thesis compared purified lanolin to expressed breast milk (8) and (9).

Results Cracked nipples took on average 1-2 days quicker to heal with purified lanolin. Delay in publication has been prolonged which must cast doubts on its methodology.

Creams
Kamillosan®, Calendula, and other similar brands.

Widely available

No scientific evidence exists for their use.

Look for ingredients that should not be ingested by babies - vitamins, peanut oil. Many stores have own brand versions. Kamillosan® no longer contains peanut oil.

Referred to in (1) (11) (12) and (13).

Hydrogel
A dressing of gel granules which can be applied to the cracked nipple. Large water content. May feel cold to touch.

Expensive. Available from pharmacies e.g. as NuGel®, market is still developing

Various papers warn of the risk of the baby choking if the mother is sleepy enough to forget to take it off. Seems remote given that it would be held in place by a bra and breast pad which would have to be removed. Will absorb some wound fluid/ milk. Good at moistening a dry wound. Used for open and established wounds (granulating wounds). New dressings designed and marketed specifically for breastfeeding are being marketed in some countries. Some advantages are claimed for dressings containing glycerine, as these residues are considered safer.

Compared hydrogel dressings with standard hospital care of lanolin plus breast shells. (10)

Results Stopped early because of increased infections in the hydrogel dressing group. Two groups each with
21 mothers. Worth checking whether there is an explanation for this, eg how often the pads were changed.

Sprays
Rotorsept® and other sprays

Sprays have an alcohol base which is drying to the skin, may be more likely to cause cracking. May alter the normal skin bacteria

Antibiotic creams
Such as fucidic acud (Fucidin® cream)

Only available from GP's.

Antibiotic dressings
Yellow soft paraffin squares impregnated with fucidic acid

Not in general use in the UK but is more common in America and through information found on internet sites.

Expensive, can cause skin reactions, increase the risk of bacterial resistance.

Wipe off excess cream before the next feed but don't wash off or it may further damage skin.

Tulle gauze used like Jelonet® - doubled over and kept under breast pad.

May be used instead of a Jelonet® type dressing if the wound is superficially infected (11).

Study A randomised trial with 922 patients divided into 440 having white petrolatum (wsp) and 444 Bacitracin® - an antibiotic cream(ac)

Results The rate of infection was similar in both groups (2%wsp v 0.9%ac, not sig). Antibiotic creams were associated with infections that were more serious and expensive to treat. No patient in the wsp group developed an allergic reaction but 4 did in the antibiotic group (4). In a study of treatments for infected sore nipples (confirmed by lab culture) better healing was achieved in the group taking antibiotic tablets rather than creams (14). Letter states study was too small to be conclusive (15).

If using any of the above creams, apply after feeds. They do not need to be washed off before the next feed, though if using creams/gauze containing antibiotics its worth wiping off any excess before a feed (see above). Phyll Buchanan, Anabel Hands and Wendy Jones, Breastfeeding Network Supporters (2019 amendment also by Agnès Léger, Anthea Tennant-Eyles and Sarah Turner.)

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Cracked Nipples and Moist Wound Healing - The Breastfeeding Network

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This information is also available in a printer-friendly PDF format by clicking here . Updated (2019) by Agnès Léger, BfN Supporter Reviewed by Phyll Buchanan, Anthea Tennant-Eyles, Sarah Turner, Wendy Jones. Registered BfN Supporters The original version of this leaflet was produced in 2002 and can be found below.

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Watch this video to see how to make adjustments to make to make breastfeeding comfortable especially if you have sore nipples.

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This video shows basic points important for any position and demonstrates several other common positions that have worked well for many mothers and babies.

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The way a mother holds her baby affects how easy it is for her baby to feed effectively. This video shows basic points important for any position and then demonstrates several common positions that have worked well for many mothers and babies. About the Breastfeeding Series " DOWNLOAD

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Engorged breasts are painful. They feel heavy, hard, warm and sensitive - as if they are ready to burst!
As well as being painful, engorgement can lead to other breastfeeding problems if not treated.
Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

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Engorged breasts are painful. They feel heavy, hard, warm and sensitive -as if they are ready to burst! As well as being painful, engorgement can lead to other breastfeeding problems if not treated. Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

Most mothers experience some engorgement in the first weeks after birth. With changing hormone levels, your breasts swell and enlarge as milk production increases. It may seem as though they are filling up with milk, but engorgement is more than milk storage. Your body directs extra blood and fluids to your breasts to boost milk production. This causes congestion and swelling which will decrease as your body adjusts.

Minimizing early engorgement
Treat engorgement to...
When to treat engorgement
After the first few weeks
Causes of engorgement
Treating engorgment
Be sure your baby is sucking effectively
Reverse pressure softening
Keep comfortable
Watch out for signs of mastitis

Minimizing early engorgement

New mothers vary in how engorged their breasts become in the weeks after birth; some experience little engorgement, others describe their breasts as feeling like watermelons!

Try these suggestions

Breastfeed your baby frequently from birth: at least 8-12 times in 24 hours. Keeping your baby close makes it easier to nurse every hour or two.

If your baby is sleepy, perhaps from a medicated birth, you may need to wake him and encourage him to nurse.

Aim to be comfortable while breastfeeding, and learn how to get your baby latched on well.

If your newborn is unable to breastfeed, electric hand express frequently until your milk 'comes in', then combine with using a hospital-grade help establish your milk production and relieve engorgement. Your milk breastpump to can be given to your baby until he is able to nurse.

Treat engorgement to...

Make breastfeeding easier
Even if you feel as though you have lots of milk, engorgement can make it harder for your baby to latch on to your breast and feed well. A poor latch-on can give you sore nipples. Your baby may also have trouble coping with the flow of milk from engorged breasts.

Protect milk production
When milk isn't removed from your breasts, you will produce less milk. Treating engorgement gives your baby more milk now and helps protect milk production for when your baby is older.

Avoid blocked ducts or mastitis
Engorgement can result in blocked ducts leading to mastitis.

When to treat

Take action to relieve engorgement if your breasts feel firm, hard, shiny or lumpy. When milk is removed, blood circulation improves and swelling reduces. Use the suggestions below to reduce swelling and keep your milk flowing. Many mothers have a slight temperature when their breasts are engorged. Temperatures under 38.4ºC are not usually associated with infection. Keep your baby close and continue breastfeeding.

Engorgement after the first weeks

Treat as outlined below while working out the cause so you can prevent it happening again.

Common causes of engorgement are:

A missed feed or expressing session.
This can easily happen during holidays and festivities or when visitors arrive. Encourage your baby to feed more often, or express more frequently if you're apart from your baby.

Feeding a baby on a schedule
Recent research has revealed that mothers vary in how much milk their breasts can store without becoming uncomfortable. Mothers following routines often suffer from engorgement, mastitis and low milk production because their breasts are not drained often enough.

Expressing milk.
Some books advise expressing to keep milk production one step ahead of a baby's needs. However, making more milk than your baby needs can increase your risk of engorgement and mastitis, especially if you go for several hours without feeding or expressing.

A baby who is unable or unwilling to nurse well for any reason
Expressing milk frequently until your baby can nurse well will help you maintain milk production and avoid blocked ducts or mastitis.

Weaning from the breast too quickly
If you experience engorgement duringweaning, you may need to slow down the process. This will give your breasts time to adjust to the reduced demand for milk. If breastfeeding more often is not an option, try expressing just enough milk to relieve the fullness by hand or pump.

Treating engorgement
Reduce swelling and keep milk flowing:

Aim to breastfeed every 1½ to 2 hours during the day, and at night every 2-3 hours from the start of one feed to the start of the next. Let your baby finish on the first breast before switching to the second

Avoid using bottles or dummies. If a supplement is needed try using a spoon, flexible feeding cup or syringe.

Between feeds, apply ice for 15-20 minutes at a time between feeds to reduce swelling. Use an ice pack, crushed ice in plastic bags or bags of frozen vegetables (that can be refrozen several times before being thrown away). Wrap them in a lightweight towel to protect your skin.

Just before feeding, apply moist warmth to your breasts for up to two minutes to help milk flow. Try a warm wet towel, warm shower or immersing breasts in a bowl of warm water. Then, express to comfort if your baby isn't ready to feed.

Use gentle massage from the chest wall toward thenipple area in a circular motion.

Be sure your baby is sucking effectively:

Position your baby with his chest and tummy in full contact with your body. With his cheek in close contact with your breast, your baby can easily tip back his head to latch on. This way he'll take a large mouthful of breast. Listen for swallowing as he feeds.

If your baby is finding it hard to latch on - when your baby bobs his head and licks the nipple, he naturally makes it easier to latch on.

For more information on getting your baby positioned and attached comfortably see here.

Reverse pressure softening

works by moving fluid away from the nipple area.

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 fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby's lips will be.

If this isn't enough, gently hand express a little milk before feeding to soften the areola. If you choose to use a breastpump, set it to minimum suction.

Keep comfortable:

Ask your midwife or GP to recommend an over-the-counter, anti-inflammatory medication suitable for breastfeeding mothers to relieve pain and swelling.

A well-fitting, supportive bra may help. Avoid bras (and underwires) that are tight or put pressure on specific areas of the breast.

Cold, raw cabbage leaves worn inside a bra can be soothing. Change when they become wilted or after about 2 hours. Use only until swelling goes down as long-term use may reduce milk supply. Stop use if a skin rash or other signs of allergy appear.

Watch out for symptoms of mastitis:

Inflamed, hot, red or darkened localised areas of your breast, depending on your skin tone. Changes in breast appearance may be harder to spot in darker skin. You may still have engorged breasts without a noticeable red or darkened area.

Temperature over 38.4ºC or flu-like symptoms.

Weaning can make a breast infection worse so continue to breastfeed frequently especially on the affected side and treat as for engorgement. Rest and drink fluids. If fever persists, continue breastfeeding and check with your GP as you may need antibiotics. More information on mastitis.

Engorgement should improve within a day or two. If not, contact an LLL Leader for further suggestions. You may need to improve your baby's breastfeeding technique or find ways to reduce your milk supply. These are not difficult problems to solve, especially if treated promptly.

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

Further Reading

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

Beginning Breastfeeding
Comfortable Breastfeeding
Dummies and Breastfeeding
Hand Expression of Breastmilk
Mastitis
My Baby Won't Breastfeed
Nipple Pain - why and what to do
Positioning and Attachment
Sleepy Baby - why and what to do

This information is available to buy in printed format from our shop

Copyright LLLGB 2016

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Engorged Breasts - avoiding and treating - La Leche League GB

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Engorged breasts are painful. They feel heavy, hard, warm and sensitive -as if they are ready to burst! As well as being painful, engorgement can lead to other breastfeeding problems if not treated. Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

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Watch this video on the technique for hand expressing your milk.

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Unicef UK Baby Friendly Initiative | Hand expression

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Mastitis means inflammation of the breast.
This leaflet gives important information on how to recognise the signs and how to treat it.

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Mastitis - quick reference guide for self-help measures

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Mastitis - quick reference guide for self-help measures

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Please reach out to your Community Midwives or Health Visiting Team if you experience signs of mastitis.

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Expressing breastmilk can relieve breast fullness, soften the breasts, and make it easier for the milk to flow.
It is also important to maintain a mother’s milk supply during separation and make milk available for someone else to feed the baby.

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In the first few days, some babies are sleepy or uninterested in feeding. Read the article below for some helpful tips on how to get them to feed.

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

What is normal?

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

Normal newborn feeding cues

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

Mouth movements, including smacking or licking his lips.

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

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

Fidgeting or squirming a lot.

Fussing.

Crying-a late sign of hunger.

Why is my baby sleepy?

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

Good attachment

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

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

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

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

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

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

Encourage cluster nursing whenever your baby is more alert.

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

Other ideas

Dimming the lights and keeping your surroundings quiet and peaceful.

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

Unwrapping any blankets.

Biological nurturing™

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

Breast compression

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

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

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

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

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

If your baby isn't responding

Express milk for your baby

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

Avoid bottles and dummies

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

When to offer expressed milk

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

Don't give up too soon

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

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

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

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

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

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

Copyright LLLGB 2016

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

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

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This video includes steps to improve milk supply.

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

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Maximizing milk production with hands-on pumping

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Maximizing milk production with hands-on pumping

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This video demonstrates some ways that pumping mothers can increase production.

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

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

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