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Centers for Disease Control and Prevention

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The healthy mealtime patterns you and your child start now will help promote healthy habits in the future. Learn more here.

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You can use the intuitive technique to guide your baby's bottle feeds. Pacing feeds in this way helps to prevent overfeeding and reduces the likelihood of your baby developing "nipple confusion" or refusing the breast. Ideally, bottle feeds last about 15-20 minutes—you can take breaks as shown to pace your feed accordingly! For breastfeeding and bottle feeding help, visit: https://newnorthbaby.com/

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Intuitive Bottle Feeding for Breastfed Babies

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Paced Bottle Feeding - 
Breastfeeding Education by IABLE

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By allowing the infant control over the bottle-feeding, paced bottle feeding helps prevent over- feeding, and may prevent the breastfeeding infant from developing a bottle preference. https://themilkmob.org/

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By Kelly Bonyata, BS, IBCLC

Is my baby distractible?

Latch on, suck a moment, pull off... latch on, suck a moment, pull off. Nurse a minute, pull away to smile at mom. Nurse a minute, pull away to see who just walked in the room. Nurse a minute, pull away to listen to the TV. Nurse a moment, pull away because the dog wagged his tail.

Sound familiar?? Baby starts to nurse and just as soon as your milk starts to let-down, baby pulls off and wiggles around in your lap. Babies aged two to six months are notorious for pulling off the breast at any distraction (real or imaginary) and tend to forget to let go before they turn around (ouch!).

This is a passing developmental stage that can be quite a nuisance - it's usually at it's worst between four and five months. At around 2 months, your baby will become able to see things clearly across the room. At around 3 months, he'll start to stay awake longer and take a greater interest in the world around him. Your baby is also beginning to recognize that he is separate from mom. All of these things can result in a distractible baby. When baby first becomes aware of the rest of the world, he will have a hard time concentrating on nursing. In effect, he will be unable to "walk and chew gum at the same time." Once he gets a little older, he'll find it easier to both nurse and take in the world around him at the same time.

Distractibility is also common around 8-10 months, and can lead mom to think that her baby is trying to wean. If your baby is younger than a year, it's highly unlikely that this temporary disinterest is self-weaning. It's very rare for a baby younger than 12 months to self-wean.

What can I do about it?

Many moms find it more and more difficult to nurse a distractible baby, and sometimes even interpret it personally ("I don't want mom any more" or "I don't want to nurse any more"). At the very least, it's frustrating to deal with a distractible baby. Less frequent/shorter nursing during this distractible stage can lead to a low milk supply, so do your best to get in a few decent feedings during the day.

Until this stage has passed, baby may need a quiet place to nurse and/or more night nursing until he's figured out how to deal with distraction. Do take advantage of night nursing during this time - it doesn't matter when baby takes in his calories during a 24-hour period. One study showed that older babies can consume as much as 25% of their total daily intake of mother's milk during the night, probably partly because of daytime distractibility.

Nursing in a quiet, darkened, boring room often helps. Talk in quiet, soothing tones (if you talk at all). Nurse while lying down; nap nurse. Cover baby with a shawl or put him in a sling to nurse. Nursing while in motion (walking, rocking) can also help baby to focus better on nursing. Try to catch your baby when he's more willing, such as when he's just waking up, already a little sleepy, or actually asleep. Baby's initial pulling off is probably not an indication that he is finished - just an indication that he saw/heard something interesting across the room. When he pulls off, try to coax him back to the breast a few more times before giving up.

If baby pulls away without letting go, keep a finger ready to break the suction as soon as he starts to pull away. You can also nurse baby in the football (clutch) hold so you have better control of his head, or nurse him in the cradle hold in a sling. This type of behavior sometimes leads to biting; if your baby bites, see When Baby Bites.

If baby is not nursing as much because of distractibility, offer the breast often (even when he doesn't "ask" to nurse). Make up for lost time by nursing more often during the night. Older babies may nurse better if you try different and novel nursing positions in which they have more control - baby standing up, sitting on your lap facing you, etc.

Additional information

Wakeful 4 Month Olds by Jan Barger, RN, MA, IBCLC @

Breastfeeding as Baby Grows. This article, by Becky Flora, IBCLC, talks about baby's different developmental stages during the first year and how they affect breastfeeding.

What is Normal? by Paula Yount discusses the variations of normal that you can expect throughout your breastfeeding experience.

My baby fusses or cries during nursing - what's the problem? This article discusses some possible reasons for fussy nursing behavior. If you're looking for the rest of the info that used to be on this page, it's in this article (with more added).

Is my older baby getting enough milk? If you feel that your baby is not nursing enough, this page may be helpful.

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Latch on, suck a moment, pull off... latch on, suck a moment, pull off. Nurse a minute, pull away to smile at mom. Nurse a minute, pull away to see who just walked in the room. Nurse a minute, pull away to listen to the TV.

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The Fourth Trimester - AKA Why Your Newborn Baby is Only Happy in Your Arms

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The Fourth Trimester - AKA Why Your Newborn Baby is Only Happy in Your Arms

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"He sleeps really well but only when he's laying on my chest, he hates his moses basket" "She cries every time we lay her on her play mat" "He hates going in his pram, he cries the second we put him in it".
If I had a pound every time I heard these from a new parent I'd be a very rich lady by now! What amazes me though is that society in general doesn't get it, they don't get why so many babies need to be held by us to settle and what perplexes me even more is that we do spend so long trying to put them down! We spend more than time though, the 'putting babies down' industry is worth millions, rocking cribs, battery swings, vibrating chairs, heartbeat teddies and the list goes on..................having been a first time parent who bought all four of the items listed above I am embarrased to admit now it honestly didn't enter into my head that perhaps the answer was to *not* put my baby down and I certainly didn't consider why these things might help. It took me a long time to understand and empathise with my baby, to see the world through his eyes so to speak.
"Empathy: the intellectual identification with thoughts, or attitudes of another." or vicarious experiencing of the feelings, "Birth suddenly disrupts this organization. During the month following birth, baby tries to regain his sense of organization and fit into life outside the womb. Birth and adaptation to postnatal life bring out the temperament of the baby, so for the first time he must do something to have his needs met. He is forced to act, to "behave." If hungry, cold, or startled, he cries. He must make an effort to get the things he needs from his caregiving environment. If his needs are simple and he can get what he wants easily, he's labeled an "easy baby"; if he does not adapt readily, he is labeled "difficult."" - Dr. William Sears.
To empathise with our newborns feelings we need to put ourselves in their place, to imagine experiencing their world - but which world? The world they have spent most of their life in, their 'womb world' or the world they are in now - our world. To fully understand we must appreciate the enormous transition they have made - a concept known to many as 'The Fourth Trimester' -some make the womb to world transition easily, others less so and it is this latter group in particular "the clingy babies" we can learn so much from through this concept.

So lets quickly compare the two different 'worlds' your baby has lived in:

Pretty different huh? On top of this the big thing to understand is that in utero the baby's world was constant, each day was the same, the stimulation didn't change, but now they are born each day is different - ever changing, ever stimulating!

The concept of the fourth trimester helps us to understand the transition a newborn must make over their first few weeks earthside and once we understand we find so many ways we can help - but to me the most important facet of the fourth trimester is parental understanding and empathy, once that exists everything else will flow naturally.
Movement
Here are some common newborn calming techniques that tend to work quite well, but remember each and every baby is different, if you don't already know, you will soon learn what your baby likes best and that's what matters, that it is unique to *your* baby. Prescriptive 'do this/don't do this' baby calming lists don't help anybody - because they forget they are dealing with individuals - both parents and babies! Some things on this list will be inappropriate for you and your baby, some simply won't work, some you won't like - and that's OK! because really it isn't about these tips it's about you and your baby getting to know each other!
Skin to Skin Contact
The womb is a constantly moving space, Braxton Hicks would squeeze your baby at the end of pregnancy and each time you moves your baby was wobbled around inside. Imagine how walking upstairs feels for a baby in utero! Babies tend to love movement but so often we put them down somewhere completely still. You could try dancing, swaying from side to side, going for an exaggerated quick walk or bumpy car ride.
Bed-Sharing
Such a brilliant baby calmer! Being in contact with your warm, naturally (un)scented, skin is heaven for a baby, it helps to stabilise their body temperature, heart rate and stress hormones and stimulates the release of oxytocin - the love and bonding hormone - in you both. Topless cuddles, shared baths, baby massage and bedsharing are all great skin to skin experiences for your baby and you.

Sharing a bed with your baby is an amazing way of getting more sleep for everyone, babies are generally much calmer and sleep more easily if they sleep with you in your bed, yet it is such a taboo topic and although 60% of parents will share a bed with their baby at some point it's a subject that makes society very uncomfortable, but...it is an *amazing* baby calmer! It's really important that you think about how bedsharing will work and follow some important safety guidelines HERE.
Swaddling
For more on bedsharing and other ways to improve your newborn's sleep, watch my free webinar here:

Imagine how snug your baby was at the very end of your pregnancy inside of you - now imagine how strange it must feel to them after they have been born and have so much space around them! The absolutely best thing you can do is to envelop your baby in your arms, but for times when you don't want to or indeed can't then swaddling is an option. Swaddling is becoming increasingly popular, however there are important safety guidelines to be followed if you choose to swaddle your baby, if you are breastfeeding please make sure feeding is established before swaddling and take care not to miss your baby's hunger cues if you are feeding on demand:
** The American Academy of Paediatrics recommends swaddling for babies 0-14wks. Babywearing

Never swaddle over your baby's head or near his face

Never swaddle your baby if he is ill or has a fever

Make sure your baby does not overheat and only swaddle with a breathable/thin fabric

Only swaddle your baby until he can roll over**

Always place your baby to sleep on his back

Do not swaddle tightly across your baby's chest

Do not swaddle tightly around your baby's hips and legs, his legs should be free to "froggy up" into a typical newborn position.

Lastly start to swaddle as soon as possible, do not swaddle a 3 month old baby if he has not been swaddled before.

Wearing your baby in a sling is one of the ultimate ways to keep them calm and happy. It increases the time a baby spends in a state of "quiet alertness" - a time of contentment when they learn the most. When a baby is in utero they spend 100% of their time in physical contact with us - yet the moment they are born this is estimated to drop to only 40%! Babywearing also means 2 free hands!

Choose your sling carefully. A good sling will be easy to use and will support both yours and your baby's spine whilst not placing any pressure on your baby's growing hips - newborns should always be carried facing inwards with a "frog leg" pose, not a crotch dangle pose so commonly used by commercial baby carriers. Also seek to carry in an 'in arms' position - i.e: how your baby would be held if you were holding them!

Babywearing is a great way for dads to bond with babies!
Position
It is quite common for a baby to cry once placed in a sling, this does not mean that they hate the sling - it just means that you need to move, so get dancing! As with swaddling,babywearing is becoming increasingly popular, however there are important safety guidelines to be followed, the TICKS acronym below neatly sums them all up:

The "tiger in the tree" position below, taken from baby yoga, is often magical, stopping a crying baby in an instant!
Feed
Noise
Babies love sound, but for many not the sound you might think. For many babies a hoover is much more calming to a baby than a lullaby. A special white noise recording, such as , can be played on loop whilst your baby sleeps to help keep them calm.
Deep Bathing
If your baby is hungry nothing will calm him, so watch for his hunger cues. Feeding is always better if it is baby led, not led by a routine - whether you are breast or bottle feeding. Remember as well that your baby may not always be hungry for a full feed, they may want a quick drink, a quick snack or just some comfort sucking. Babies also find sucking the ultimate relaxation and comfort tool. Sucking helps a baby's skull bones to return to their normal position after birth as well as providing them with comfort and security. If you are not breastfeeding you might find your baby will relax when given a dummy/pacifier.
Outside
The womb is a wet, warm place. The world as we know it is dry and cold! Sometimes a nice deep, warm bath can stop a baby's tears in seconds - even better if mummy or daddy goes in the big bath with baby too as skin to skin contact is a wonderful baby calmer.
What have you found calms your newborn? The NEWLY UPDATED Gentle Sleep Book - out now! If you would like to understand and learn how to improve your baby's sleep WITHOUT cry-based conventional sleep training, this is the book for you! p.s: Come and chat with me on Facebook, Twitter and Instagram Or watch my videos on YouTube You can also sign up for my free parenting newsletter HERE.
If all else fails many babies stop crying the minute they hit the open air - I'm not sure if this is because we are usually moving (e.g.: walking over cobbles with the buggy/ bouncing in a sling and the drone and movement of a car) or because of the change in air - but it works!

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The Fourth Trimester - AKA Why Your Newborn Baby is Only Happy in Your Arms

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"My baby is only happy in my arms, the minute I put her down she cries" "He sleeps really well but only when he's laying on my chest, he hates his moses basket" "She cries every time we lay her on ...

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Life with a Newborn: Why It’s so Hard to Take a Shower Video

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Life with a Newborn: Why It’s so Hard to Take a Shower Video

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Life with a Newborn: Why It’s so Hard to Take a Shower Video

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Womb to world: helping your newborn adapt to life outside the womb (photos)

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Find out how your baby develops in the fourth trimester and learn how you can give your newborn all the support and attention he needs to flourish in his…

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Baby not settling/Wants to be held all the time

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Baby not settling/Wants to be held all the time

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Kathryn Kelly, NCT antenatal teacher, explains: 'The Fourth Trimester is a way of describing the period after birth when both parents and baby are adjusting to their new lives.

'We think of other trimesters as being three months long, and we can think in terms of roughly another three months after the birth to make the adjustments to being a new family.'

What's the fourth trimester like for babies?

Having been in your warm womb for nine months, your baby has now got to get used to a sensory overload of sights, sounds and smells, as well as a frequently colder environment where they're not constantly supported by your protective amniotic fluid.

Kathryn says: 'Babies have been used to being fed continuously, sleeping when they want to, and being rocked in the cosy embrace of their mum's tummy. When babies are born we introduce gaps between feeds, and put them in a different place to sleep. It's no wonder that they can find this scary, and it's natural that they cry to express their fears.'

Understandably, babies are likely to cry more in this three-month period than any other time in their life. But however logical it might be, it doesn't make this period any easier for new parents. Knowing that other parents are going through the same experience, and thinking of this period as the fourth trimester, might help.

'Parents describe it as a very useful concept, which reminds them that it is OK to find the early days with a baby hard. It is a period of transition, where women become mums, men become dads, and babies adjust to life outside the womb,' Kathryn says.

What can you do to help your baby in the fourth trimester?

Fundamentally, the closer your baby feels to you, the happier they will be. According to Kathryn: 'Anything that mum, dad or other carers can do to replicate the womb-like world will help their baby feel safe. And when we feel safe, we thrive. For your baby, this means holding them close, perhaps in a sling, so they feel the warmth of your body, hear your heartbeat, and are gently rocked as you go about your day (or night).

'Feeding for babies, just like for adults, is about more than just nutrition, it's also social - a way of sharing and being with those we care for. Feeding your baby whenever they they want to will support their emotional development, as well as their physical and intellectual development.

'Your baby will sleep when they're tired, and you will both feel safer if they're close to you. Many parents tell me that in the early days their baby won't sleep in their Moses basket or crib, but only when they're held by a parent. This is perfectly normal and understandable when you think about the baby's point of view. It's important that parents find out about the safer sleep guidelines, and work out a way of sleeping that suits them as a family.'

Can you 'spoil' your baby in the fourth trimester?

No. Despite some people saying that babies need to 'learn' that you won't rush to pick them up every time they cry, in this crucial Fourth Trimester period you can't care for them too much. In fact, the more you look after them when they're upset, the more reassured and confident they'll be.

How might you be feeling?

Even if you're not an international tennis champion, parents who have gone from living busy, independent lives, can find the sudden change to around-the-clock care for a completely dependable infant hard.

Add to that the need to recover from a traumatic or difficult birth, and you can understandably feel like you're the one in need of a little TLC. Kathryn says: 'With the emotional changes in a woman's body, plus the realisation of the enormous responsibility of having a baby, new mums can feel overwhelmed and tearful at times.

'Partners can be dealing with their own response to the birth, their changing identity, and strong feelings about protecting and providing for the family. All of these feelings can also be affected by the way both mum and her partner were parented themselves.'

As with all stages of early parenthood, it's worth remembering that this stage will pass. In what seems no time at all, you might be looking back at the period with fondness at how tiny and attached to you your baby was when they were first born.

However, that is not to downplay how challenging the Fourth Trimester can be for parents. When you're in it, it's all-consuming. You can feel like you don't know what you're doing and you're constantly one step behind.

So, what should I do?

If you think in terms of the first three months of your baby's life being a Fourth Trimester, it can be easier to take the pressure off getting back to 'normal'. You wouldn't have been trying to rush around tidying the house and welcoming endless visitors when you were heavily pregnant, so don't put pressure on yourself to do it now.

'When women are discharged from healthcare some people might think that means they should be able to return to normal life, but there is a long period of adjustment and care needed at home,' says Kathryn. 'Friends and family can support new parents with food, help around the house, and reassurance that they are doing a great job of looking after their baby.'

This is especially important for mums who are raising their baby alone, in which case asking for help from friends and family in advance can help ensure you get the support you need.

Kathryn adds: 'Having very modest aims in the early days - getting outside most days (perhaps a short walk around the block), eating well, resting as much as possible - will change over time to meeting up with friends regularly, getting some exercise every day, and doing the most necessary housework.'

When will the crying settle down?

'As babies grow and change, things that seemed easy one day might feel very difficult another,' Kathryn says. 'A baby's crying tends to peak at around week six, which can mean that parents feel they must be doing something wrong, or that there is a problem with their baby. However, this is normal, and has usually reduced by three months.

'Parents report the excitement and happiness that comes when they see their baby is starting to interact with them, including smiling for the first time.'

Where can I get more help?

'Part of the challenge of this early period is the feeling that there is so much to learn, and to worry about,' explains Kathryn. 'Using safe sources when looking for information about caring for yourself or your baby will reduce anxiety.

'Reputable sources such as NCT practitioners and the website, or NHS health professionals and are a good place to start. Avoid sources of information (including people or media) who make you feel bad about your parenting, and stick with people who you trust and who support you.

'Although things can feel like they're getting harder in the early weeks, most people are feeling much better by around three months after the birth, and some will feel fine before that. If parents are still finding life a real struggle at that point they might consider talking to a health professional, or seeking more support from friends and family, to help them until they are feeling more in control.'

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.

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. To find out when an NCT nearly new sale is happening near you, search here.

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

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What is the fourth trimester? | Baby & toddler articles & support | NCT

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Everyone knows that pregnancies last three trimesters - so what exactly is the Fourth Trimester? We explain what this crucial stage is, and what it means for you and baby

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When a baby starts to suckle, a reflex involving nerves and hormones (a neurohormonal reflex) releases milk from the breast. This reflex is known as the milk ejection reflex (MER) and is commonly called the "let-down". If milk is released very forcefully it is sometimes called a fast let-down or an overactive let-down. With a fast let-down, milk might be seen spurting from the breast like water from a firefighter's hose when baby comes off the breast mid flow. Such a fast or forceful flow is not necessarily a problem for a baby-many babies love the faster pace-and it is quite normal for milk to spurt from the breast. However, some babies can seem to be overwhelmed and fussy by a very fast let-down, they may cough, choke or let go of the breast and cry. This article looks at signs that can indicate a baby is struggling with the flow of breast milk in a fast let-down and what to do about it.

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What does a let-down feel like?

Not all mothers feel anything at all when milk begins to flow from the breast with the let-down reflex-but they will notice their baby starts to swallow milk more rapidly a few minutes into the feed. Other mothers will feel a tingling or prickling sensation when milk is released from the breast. Some mothers describe it as a pins and needles type feeling. If the breast is very full the sensation can be stronger and may be briefly painful.

Signs of a fast or forceful let-down

Signs that a baby is struggling to cope with the flow of milk in a fast let-down might include:

Choking, gasping and coughing at the breast

Coming on and off the breast during breastfeeding

Pulling on the breast and nipples (babies can also do this when the flow of milk is too slow)

Rapid swallowing of milk with stress cues e.g. fussing, frowning, crying, finger splaying

Short feeds if baby gets a lot of breast milk in a short time

Clamping down on the nipples to slow the milk flow leading to sore nipples

Spitting up frequently after a feed (this can be quite normal)

Making a clicking sound during breastfeeding due to losing suction with the breast (babies with poor tongue function may also make a clicking sound)

Having trapped wind, needing to burp frequently

Fussing or crying at the breast, unable to fall asleep contentedly

Refusal to breastfeed

Fast let-down and oversupply

The symptoms of fast or forceful let-down listed above are often seen in babies whose mothers have too much breast milk or "oversupply" however this is not always the case-a baby may struggle with flow without oversupply. If you feel you have much more milk than your baby needs see Oversupply of Breast Milk alongside this article for management ideas. Where appropriate, reducing your supply a little can help resolve some of the difficulties. Remember that if you and your baby are coping well with the volume and flow of milk you won't need to make any changes.

Why does my baby struggle with the let-down?

How well a baby can handle a fast let-down or forceful milk flow can depend on their latch (the way baby is attached to the breast), their positioning (the way they are held) and how well they can coordinate suck, swallow and breathe. It can be normal for a newborn baby to cough or choke occasionally with the let-down while they are still learning how to breastfeed and to can be quite normal to spit up excess milk (have reflux) after a feed.

Attachment and positioning

An IBCLC lactation consultant can help to identify whether a baby's latch or positioning could be causing difficulties with managing the flow of milk. If baby has only the nipple in his mouth rather than a good mouthful of breast it is more difficult for him to control the flow of milk. Similarly certain positions can make breastfeeding more difficult for a baby.

Coordinating suck, swallow and breathe

A fast let-down is not always a mother related problem (i.e. the let-down is too fast); it may be a "baby problem" for example a baby may have difficulty managing normal flow as well as fast flow. When a baby breastfeeds they coordinate their breathing with sucking and swallowing in a carefully timed sequence so they do not swallow the wrong way causing milk to enter their airway instead of their oesophagus. If the timing of the swallow is not quite right, fluid could enter the lungs (aspiration).

Lactation consultant and breastfeeding author Cathy Watson Genna explains that problems with swallowing (dysphagia) are not common but may be seen with some premature babies, babies who have had heart surgery, babies with neurological or anatomic issues or severe reflux and some healthy term babies. She explains that breastfeeding does not protect against dysphagia or aspiration and not all babies will cough or choke-some babies may stop breathing temporarily to prevent more fluid going into their lungs. Breathing issues such as congestion or mucous can also be a cause of difficulty handling flow rate at breast or with a bottle. In Supporting Sucking Skills In Breastfeeding Infants, Cathy Watson Genna, 2017, p164 explains that if a fast flow overwhelms breathing, the baby may:

change their sucking pattern to short sucking bursts to give more time for catch up breathing

use prolonged compression to try to stem the flow again to give time for breathing

pull away from the breast to have a proper chance to breathe

if the flow is too stressful some babies may refuse to suck or suck with very little pressure as a way of coping

For further reading see Supporting Sucking Skills, 3e and contact the health professional in charge of your baby if you have any concerns about your baby's swallowing or breathing coordination.

Tips for helping your baby with a fast let-down

If your baby coughs, chokes, gulps and gasps or lets go of the breast just after you have a let-down:

Check positioning and attachment

The deeper the latch, the better a baby can control flow. See Latching Tips and Breastfeeding Positions for Newborns for more information.

Try leaning back in reclining positions

Breastfeeding positions with baby above the breast can help to slow the flow of milk because milk flowing uphill is working against gravity.

Try letting the fast flow subside

If the let-down is very fast, try taking baby off the breast for a moment or two until the flow slows a little. A container or towel can catch the milk and once the flow has slowed your baby may be better able to cope with the flow. Alternatively initiate the let-down before baby comes to the breast so that the fast flow has subsided. Some mothers express a little milk before baby comes to the breast so the flow is slower. Bear in mind that regularly expressing milk before breastfeeding could ultimately stimulate your breasts to make more milk which may worsen the situation if your fast flow is connected to oversupply.

Feed frequently on demand

Avoiding long time intervals between breastfeeds will help to reduce engorgement and faster flow due to increased pressure of milk within the breast.

Look for early feeding cues

It can be helpful to avoid a baby being overly hungry which can make him less coordinated and have a stronger more frantic suck. Look for early feeding cues (sucking fingers, searching with an open mouth) or try offering a breastfeed while baby is still sleepy and relaxed.

Never hold the back of baby's head to force him to the breast

If milk flow is fast a baby may need to let go of the breast occasionally to breathe. Avoid holding the back of a baby's head so that he feels forced onto the breast, he needs to be able to protect his airway by taking a break.

Burp baby regularly during and after a feed

Swallowing milk quickly may mean you baby needs to burp frequently.

Nipple shields?

A nipple shield can help some babies by reducing the rate of flow of milk. However, a nipple shield can cause other problems. See Nipple Shield Good or Bad? and contact your breastfeeding specialist if you're considering using a nipple shield for a fast let down.

Adjust your milk supply

If a fast let-down is associated with having too much breast milk, steps can be taken to reduce the milk supply a little, and this in turn can help to slow a fast let-down. See Oversupply of Breast Milk for more information and check with your IBCLC lactation consultant before reducing your milk supply.

Try a bottle or cup

If problems continue it may be necessary to offer expressed breast milk via a slow flow teat or open cup until more help can be sought.

Seek professional help

Occasionally some babies may benefit from a referral to the Speech and Language Team (SALT) to check whether there is an underlying reason why they cannot manage the flow of milk.

Summary

Milk is released from the breast in a neurohormonal reflex known as the "let-down" at the start of a breastfeed. Sometimes the flow of milk in this reflex can seem to be too fast for an individual baby and they gulp, cough and gasp and may come off the breast crying while milk spurts everywhere. A forceful flow is often associated with having "too much milk". How easily a baby can cope with a forceful flow of milk depends on how a baby is positioned and attached to the breast and how they can cope with coordinating sucking, swallowing and breathing through a fast flow. There are several ideas to try if a baby is struggling with a fast let-down.

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When a baby starts to suckle, a reflex involving nerves and hormones (a neurohormonal reflex) releases milk from the breast. This reflex is known as the milk ejection reflex (MER) and is commonly called the "let-down". If milk is released very forcefully it is sometimes called a fast let-down or an overactive let-down.

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Foremilk and hindmilk - what does this mean? 

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Foremilk and hindmilk - what does this mean? 

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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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LLLGB resources

LLLGB breastfeeding information in Welsh is now available on our website.
Bwydo ar y fron
Hanfodion bwydo ar y fron
A yw fy mabi'n cael digon o laeth?

Our Leaders offer support to Mums in the following languages:
Afrikaans, Bemba, British sign language, Croatian, English, French, German, Gujarati, Hebrew, Hungarian, Italian, Polish, Portuguese, Spanish, Swahili, Welsh.

We are in contact with LLL Leaders around the world, and can access online support in many languages.
If you would like to access support in a language other than English, please contact our Administration Department and we will try to help you.

LLL Europe resources

You can also find articles, information and support on the LLL Europe website - it has contact details and links to LLL in 21 countries.

LLLI resources

LLLI's international online magazine Breastfeeding Today has translations of many articles in Spanish, German, French and Russian with articles in other languages coming soon.

For more information about LLLI click here.

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Support in languages other than English - La Leche League GB

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LLLGB resources LLLGB breastfeeding information in Welsh is now available on our website. Bwydo ar y fron Hanfodion bwydo ar y fron A yw fy mabi'n cael digon o laeth? Our Leaders offer support to Mums in the following languages: Afrikaans, Bemba, British sign language, Croatian, English, French, German, Gujarati, Hebrew, Hungarian, Italian, Polish, Portuguese, Spanish, Swahili, [...]

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Using straightforward language and simple illustrations to aid understanding, these infosheets on breastfeeding and bottle feeding are available in multiple languages and can be used to support parents with the basics of feeding and responding to their baby.

The infosheets are free to download and print, and are currently available in:
Please note: Following feedback, these translations were updated in 2019 to ensure the language used was as straightforward as possible.
The English versions of these resources are available below for reference:

Breastfeeding guidance: English (for reference)

Bottle feeding guidance: English (for reference)

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Foreign language resources - Baby Friendly Initiative

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These infosheets are available in multiple languages and can be used to support parents with feeding and responding to their baby.

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By Kelly Bonyata, IBCLC, Becky Flora, IBCLC and Paula Yount

Child-led Weaning

Child-led weaning occurs when a child no longer has a need to nurse - nutritionally or emotionally. A baby who self-weans is usually well over a year old, is getting most of his nutrition from solids, is drinking well from a cup, and cuts down on nursing gradually. If children are truly allowed to self-wean in their own time, most will do so somewhere between the 2nd and 4th year. Obviously, some will wean before this time and some will wean after this time, too.

Additional Information

Mother-led Weaning

If you feel that you need to encourage weaning before your baby is truly ready, it is possible to gently and lovingly "help" your child along the way, while at the same time remaining as flexible and as respectful to his needs as possible. Some children, even though they're not truly ready, can be gently weaned without too much of a protest. It's important to always conduct mother-led weaning in a way that is gentle, gradual, flexible, patient, and as respectful to your child's needs as possible. Be aware of any signs that the weaning process is going too quickly for your child and be ready to slow things down some if necessary.

If you want to take an active approach to weaning before baby show signs on his own, you might consider waiting until at least the age of 18 months. At this age most children can be told "no" and asked to wait on nursing more easily than a younger child can.

Sudden Weaning

Stopping breastfeeding abruptly, or "cold turkey," can be very distressing for both mother and baby and can cause plugged ducts, breast infection, or even a breast abscess. Hormone levels are also more likely to take a drastic plunge, causing mood swings, depression, etc. It's very rare that sudden weaning is truly necessary. If someone suggests to you that this is required, get a second opinion. It would also be helpful to talk to a lactation consultant and/or a La Leche League Leader, who will be able to suggest alternatives and, if necessary, help you to wean with as little distress to mom and baby as possible.

Additional Information

Gradual Weaning

Gradual weaning allows you to gradually substitute other kinds of nutrition, affection and attention to compensate for the loss of nursing. Gradual weaning also allows the immunity levels in your breast milk to increase (as overall milk supply decreases) and thus give your child a last bit of extra protection against infection. Weaning should occur as slowly as your situation permits to make it easier on both you and your child.

How long weaning takes depends upon too many variables to predict. Be as patient and as flexible as you possibly can. Weaning will happen, but you may feel at times that you're taking one step forward and two steps back. When you're actively weaning, be sure to offer lots of cuddling and extra affection during the day. As your child grows older, nursing becomes much more than a way to satisfy hunger and thirst. It provides him with much comfort, security and closeness, so be as sensitive to his needs as you possibly can be throughout the process.

Additional information

Partial Weaning

Weaning is not an all-or-nothing process. You can always keep one (or more) feedings per day and eliminate the rest.

Additional Information

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Weaning: How does it happen? * KellyMom.com

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Child-led weaning occurs when a child no longer has a need to nurse - nutritionally or emotionally. A baby who self-weans is usually well over a year old, is getting most of his nutrition from solids, is drinking well from a cup, and cuts down on nursing gradually.

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Weaning is the process whereby a child learns to take nourishment other than his mother's milk. It starts when the child is introduced to foods and drinks in addition to breastmilk, and ends when he ﬁnally stops nursing.

Introducing a baby to the exciting world of food alongside breastfeeding is covered in Starting Solid Food. Here we concentrate on situations when mothers plan to cut down or stop breastfeeding their babies or toddlers and we will be using the word 'weaning' to refer to this process. A baby is usually ready to start tasting solid foods at around six months old, but it's often some time before he is ready to eat substantial amounts. Until then, milk remains his main source of nutrition and calories.

Gradual weaning

Breastmilk continues to be a valuable source of nutrition and immunity for as long as nursing continues. Nursing toddlers have fewer illnesses and breastfeeding promotes proper mouth development. Your own risk of developing breast cancer is lowered the longer you breastfeed. Nursing is a valuable mothering tool and many mothers ﬁnd that it gives them and their toddlers immense comfort and closeness.

The World Health Organisation recommends that breastfeeding should continue for up to two years of age and beyond, with appropriate complementary foods from six months. So alongside introducing solid foods and a cup from about six months you can continue to breastfeed avoiding any need to give bottles or infant formula.

Partial weaning

Partial weaning may be an option if you are feeling overwhelmed by your child's need to breastfeed round the clock. Shortening the length of feeds or reducing their frequency may be enough to make you feel less overwhelmed. Some families ﬁnd weaning their little one from night-feeds relieves the pressure-other families encourage their child to feed less during the day whilst meeting his need to nurse at night. You may have become used to thinking that nursing meets your baby's every need for attention. As a child grows he will crave your focused attention as well as your presence. Just joining in enthusiastically with his play may be enough to change the pattern.

Natural weaning

One thing is certain: all children eventually stop breastfeeding. They grow and change dramatically in the ﬁrst few years of life, and their interest in nursing changes too. Children want to nurse only as long as it fulﬁls a need for them. A need that is satisﬁed goes away. Many mothers just continue to enjoy the closeness and connection of breastfeeding for as long as it is working well for them. Natural weaning allows their children to grow at their own pace, giving up breastfeeding according to their own timetable. This gradual process allows a mother's milk to diminish slowly and comfortably.

Returning to work

Breastfeeding can continue if you are returning to work. Some mothers express milk while at work for their baby to have next day-others simply continue nursing while at home. If you decide to wean before you return to work, ﬁrst cut out those feeds that happen during working hours. If things don't go to plan and your child is still nursing once or twice a day when you return to work, breastfeeds will then be at times when you are available. Continuing to enjoy the closeness of nursing can make the periods of separation easier for both of you. It also means your child still gets antibodies through your milk for protection from any infections caught at nursery or when with the childminder.

Mixed feelings

Pregnancy

Pregnant nursing mothers sometimes receive conﬂicting advice about whether to wean. Some continue to breastfeed during pregnancy and may go on to feed both children. This is called tandem nursing. Others wean or ﬁnd their child weans naturally during the pregnancy. The booklet Breastfeeding Through Pregnancy and Beyond or the book Adventures in Tandem Nursing (2nd edition available through the LLLGB shop). may help when considering your options. Some mothers ﬁnd that shortening feeds or partial weaning helps them meet both their needs and those of their older baby or toddler.

Love and attention

Older babies and toddlers

You are in the best position to know what sorts of attention will be the most acceptable substitute for nursing for your child. It can take a little trial and error to work out the best options for your child and some may work better than others at different times of the day.

Don't offer, don't refuse is a simple technique to help when weaning from the breast.
Change daily routines so your child is not reminded about nursing-avoid sitting in your usual nursing chair; get up promptly for breakfast; introduce a bed-time routine that includes a sleep cue, such as a music CD or story which can continue when breastfeeding has stopped.
Enlist your partner's help or that of another adult in giving your child breakfast or settling him to sleep.
Offer a snack just before you expect your child to nurse, so as to increase the length of time between feeds and/or shorten a feed. Sit together and have a drink and a snack yourself. This can emphasise the pleasure of sharing food and is a way of giving attention to compensate for the closeness of breastfeeding.
Suggest an interesting activity to distract a child from nursing: visit the park or a friend; cook together; involve him in helping you with your work. Give your child your full attention and save phone calls, emails and your own activities for later.
Stay at home and keep things calm to help a child who asks to nurse when he is overwhelmed.
Postponement can be an effective weaning method for helping wean older children who can cope with waiting, but note that it can make some children all the more determined to nurse.
Shorter feeds may work for older children and can be combined with substitution and distraction. You could follow a short nursing with a snack and drink. Some mothers count or sing a nursery rhyme to limit the length of a feed.

Bottles or cups

How quickly?

Building plenty of time into your weaning strategy will allow you to try different approaches and decide what works best for you both. It will enable you to slow down the pace if your baby is ill or teething, or when life is hectic. For your own comfort the younger your baby the slower you may need to wean.

If you are actively working towards stopping breastfeeding, cut out one feed per day, no more often than every two or three days. This will allow your milk production to decrease slowly avoiding uncomfortable fullness and reducing your risk of becoming engorged or developing mastitis.

If your breasts feel uncomfortably full or painful, take action to relieve engorgement-it's easiest to just breastfeed. Even a short feed or hand expressing a small amount of milk can make a difference. See Engorged Breasts-avoiding and treating for more suggestions. By keeping the process ﬂexible and taking things at a steady pace you'll stay comfortable and your child can gradually become accustomed to substitutes for breastfeeding, for comfort sucking and at sleep-times.

Naptime and sleep

Naptime and bedtime breastfeeds are often the last to go and can seem the hardest to end, because they are often a cue for sleep. Some mothers continue with these, even when daytime weaning is complete. La Leche League does not advocate sleep-training techniques in which babies or children are left to cry for long periods. These methods for training young babies to fall asleep alone can be distressing for all involved and may be psychologically damaging. A well-attached child likes to know someone who loves him is close by when he goes to sleep. Develop a simple bedtime routine so your little one knows what to expect. At ﬁrst it can include nursing-later you can substitute other sleep cues such as a back rub, songs, stories and kisses. Children love bedtime ritual and it helps to keep the routine consistent by using the same sequence of cues whenever you settle your young child to sleep-day and night. Adults, too, like bedtime routines!

Ideas for night weaning
* A bedtime story and cuddle with a drink and snack can replace the closeness of breastfeeding.
* Once your child is sleepy, he may be able to fall asleep with a cuddle, or while you are gently patting or stroking his back. This way you can help him learn to fall asleep without your nipple in his mouth. You may need to be gently persistent.
* Cuddles in another pair of loving arms can replace nursing at night, if you have another supportive adult available.
* Offer a drink and possibly a midnight snack if he wakes and seems thirsty or hungry. Leave a drink and a snack ready for early risers.
* Delaying or shortening feeds in the night works for some families. If you ﬁnd your child is insistent on nursing why not just nurse him brieﬂy-until he settles? Or offer other comforting until a certain time, say 3 am, then breastfeed as needed after that to ensure that everyone gets some rest.
* An older toddler may be able to make an agreement with you not to ask to nurse until it is light outside.

Babies and toddlers often go back to sleep more easily if they receive attention before they are fully awake. Sleeping close by your toddler may make night waking less of an issue as you can lie down and rest while he settles. Alternatively, some families ﬁnd their little ones are reminded less of nursing if mum and the breast aren't too easily available.

Time and patience

Sometimes new habits are very quickly established, at other times this takes longer, but being aware of your child's feelings and meeting his needs should help weaning go smoothly and pleasantly for you both. Going at your child's pace helps prevent this becoming a battle.

Take a break

If weaning isn't going well-perhaps because your baby isn't developmentally ready, or because he is teething or unwell-you may ﬁnd that having a break from it for a few days, or even a week or so makes a difference. Taking this time to recharge gives you more energy to continue. A week can make a lot of difference to a baby's development and weaning may subsequently become easier. Babies and children need more emotional security at times of developmental change. Stepping back like this takes courage, but it can give you time to consider how to end breastfeeding in a way which suits you both. What may initially seem impossible could soon alter dramatically because babies constantly grow and change. The longer you can allow for your child to adjust to weaning, the easier it will be for him.

Looking after yourself

If you can, reduce unnecessary outside commitments and limit activity to essentials if you are trying to stop breastfeeding. You can then give your child the focused attention he will need and also have time to rest or sleep during the day. A break or rest can be just as important for you as your baby grows as when he was a newborn- particularly if he is very active.
Could you...
* Lie down with your baby to sleep in the day? Sometimes extra closeness helps with weaning.
* Use outside help if there is someone your toddler feels comfortable spending time with?
* Arrange a quiet time, with quiet activities in a safe room? You may be able to cuddle while you rest, even if you cannot sleep. Even when an older child no longer sleeps during the day, maintaining the ritual of a 'quiet time' after lunch or a rest for both of you helps pace the day.
* Go for a walk with your child in the buggy, or for a drive in the car? If he is lulled by the movement and the view, you then have time to recharge your mental batteries.
* Get to bed a little earlier so as to have a longer period of uninterrupted sleep?

When a child isn't ready to wean

It isn't easy when you are ready to stop and your baby is not. Breastfeeding can easily become a struggle and you can end up feeling frustrated and resentful. A baby's fussiness or demands for attention usually increase, at least temporarily, when a major change such as weaning takes place. Your child's behaviour will let you know if weaning is moving too quickly. Increased tantrums, crying, regressive behaviours, anxiety, thumb sucking, increased night waking, new fears of separation and clinginess are possible signs that weaning is moving too fast for your child. If your child is so desperate to nurse that you can't distract or comfort him, slow down or change your weaning tactics to ones that suit him better, or perhaps wait a while before trying again. Children over two years old may be more ﬂexible and open to negotiation about their need to nurse so weaning may often be accomplished more easily by waiting until this point.

An increased need for closeness

Comments from others

Your biggest challenge may be coping with opinions of others on how long you should continue to breastfeed and how weaning should happen.
Because of this you may start feeling uncomfortable about nursing your older toddler in front of others. Some mothers set limits on where and when they nurse, or offer distractions at times when it's inconvenient. Selecting your clothing carefully can help avoid accidental overexposure and choosing a codeword for breastfeeding such as 'num-nums' makes it less obvious when your child asks to nurse when out and about.

Finding support

The decision to wean is a very personal one. Your feelings about nursing are important-more important than any advice from others. Many new mothers cannot envisage nursing a baby beyond six months, let alone a year. But perceptions often change as the breastfeeding relationship grows and develops, and many a mother nurses her baby for longer than initially intended. A La Leche League Leader will always be willing to help you tailor weaning to suit your needs and those of your child, so that your progress towards total weaning becomes more enjoyable. If you are interested in ﬁnding out how different weaning methods are put into practice you may like to attend your local LLL group

Written by Sue Upstone, Karen Butler and mothers of LLLGB

Books
The Womanly Art of Breastfeeding, Eighth edition. Pinter & Martin, 2010.
How Weaning Happens, Bengson, D. Schaumburg, IL: LLLI, 1999.
Sweet Sleep: Nighttime and naptime strategies for the breastfeeding family. Pinter & Martin, London,
Adventures in Tandem Nursing, Second edition. Flower, H, 2019.
Mothering Your Nursing Toddler, Bumgarner, NJ. Schaumburg, IL: LLLI, 1999.

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

Copyright LLLGB 2016

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Thinking of Weaning? - La Leche League GB

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Weaning is the process whereby a child learns to take nourishment other than his mother's milk. It starts when the child is introduced to foods and drinks in addition to breastmilk, and ends when he ﬁnally stops nursing. Introducing a baby to the exciting world of food alongside breastfeeding is covered in Starting Solid Food.

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Continuing to breastfeed when you return to work

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Continuing to breastfeed when you return to work

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Breastfeeding after returning to work or study

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Breastfeeding after returning to work or study

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By Kelly Bonyata, BS, IBCLC

How can I use breastfeeding to prevent pregnancy?

The Exclusive Breastfeeding method of birth control is also called the Lactational Amenorrhea Method of birth control, or LAM. Lactational amenorrhea refers to the natural postpartum infertility that occurs when a woman is not menstruating due to breastfeeding. Many mothers receive conflicting information on the subject of breastfeeding and fertility.

Myth #1 - Breastfeeding cannot be relied upon to prevent pregnancy.

Myth #2 - Any amount of breastfeeding will prevent pregnancy, regardless of the frequency of breastfeeding or whether mom's period has returned.

Exclusive breastfeeding has in fact been shown to be an excellent form of birth control, but there are certain criteria that must be met for breastfeeding to be used effectively.

Exclusive breastfeeding (by itself) is 98-99.5% effective in preventing pregnancy as long as all of the following conditions are met:

1. Your baby is less than six months old

2. Your menstrual periods have not yet returned

3. Baby is breastfeeding on cue (both day & night), and gets nothing but breastmilk or only token amounts of other foods.

Effectiveness of Birth Control Methods
Number of Pregnancies per 100 Women

* Adapted from information at plannedparenthood.org.

How can I maximize my natural period of infertility?

Timing for the return to fertility varies greatly from woman to woman and depends upon baby's nursing pattern and how sensitive mom's body is to the hormones involved in lactation.

Breastfeeding frequency and total amount of time spent breastfeeding per 24 hours are the strongest factors leading to the return of fertility: a mother is more likely to see the return of fertility if baby's nursing frequency and/or duration is reduced, particularly if the change is abrupt.

In some populations, research has shown that night nursing slows the return to fertility.

One study showed that mothers who were separated from their infants (but expressed milk to provide 100% breastmilk for baby) had a higher pregnancy risk (5.2%) during the first 6 months (Valdes 2000).

The introduction of solid food can also be a factor in the return of fertility. Once baby starts solids (if mom's cycles have not returned), the natural period of infertility may be prolonged by breastfeeding before offering solids, starting solids gradually, and not restricting nursing.

You can achieve higher effectiveness by practicing ecological breastfeeding:

keeping baby close

breastfeeding on cue (day and night)

using breastfeeding to comfort your baby

breastfeeding in a lying-down position for naps and at night

using no bottles or pacifiers

If you practice ecological breastfeeding:

Chance of pregnancy is practically zero during the first three months, less than 2% between 3 and 6 months, and about 6% after 6 months (assuming mom's menstrual periods have not yet returned).

The average time for the return of menstrual periods is 14.6 months.

Moms whose cycles return early tend to be infertile for the first few cycles. Moms whose cycles return later are more likely to ovulate before their first period.
Source: Natural Child Spacing and Breastfeeding by Jen O'Quinn

Source: Natural Child Spacing and Breastfeeding by Jen O'Quinn

While it is possible for a nursing mom to become pregnant while she is breastfeeding and before she has her first menstrual period, it is rare. Most moms do not get pregnant until after their first period (often referred to as the "warning period"). Even after that, while some can become pregnant the first cycle, others will require months of cycles before pregnancy can occur. Still others (this is quite uncommon) may not be able to become pregnant until complete weaning has occurred.

The transition to full fertility

Several studies have indicated that fertility and ovarian activity return step by step (Ellison 1996, p. 326-327):

1. Follicular activity without ovulation (No chance of pregnancy.)
1a. Menstruation without ovulation (This does not always occur-see below.)

2. Ovulation without luteal competence (After the egg is released, fertilization may take place. During the luteal phase, the uterine lining is prepared for implantation as the egg travels down the fallopian tube and into the uterus. If the uterine lining is not adequately prepared for implantation, the implantation will probably not be successful.)

3. Full luteal competence (Full fertility - at this point breastfeeding no longer has any effect on your chance of pregnancy.)

It is possible to have one or (occasionally) more periods before you start ovulating. In this case, menstruation begins during the first stage of the return to fertility -before ovulation returns. Cycles without ovulation are most common during the first six months postpartum. For other mothers, the first menstruation is preceded by ovulation - a longer period of lactational amenorrhea increases the likelihood that you will ovulate before that first period.

A very small percentage of women will become pregnant during their first postpartum ovulation, without having had a postpartum period. Per fertility researcher Alan S. McNeilly, this "is rare and in our experience is related to a rapid reduction in suckling input."

It is not uncommon for breastfeeding mothers to report cyclical cramping or PMS-type symptoms - symptoms of an oncoming period without the period - for weeks or even months before their period returns. When this happens, the body is probably "gearing up" for the return of menstruation, but breastfeeding is still delaying the return of fertility.

The amount of time that it takes for the transition to full fertility varies from woman to woman. In general, the earlier that your menses return, the more gradual the return to full fertility.

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Do I need to wean to get pregnant?

Probably not. If you are still transitioning to full fertility (as discussed above), breastfeeding may affect the success of implantation. Once implantation is successful, breastfeeding should not affect a healthy pregnancy (see A New Look at the Safety of Breastfeeding During Pregnancy for more information). If your periods have come back and settled into a regular pattern, it is likely that breastfeeding is no longer affecting your fertility.

Many moms can conceive without deliberately changing their toddler's nursing patterns. There is no "magic" threshold of breastfeeding that will allow you to conceive - every mother is different. Some moms need to stretch out nursing frequency and/or shorten nursing sessions to make it easier to conceive - babies naturally do this themselves as they get older, so one of your options is simply to wait a bit.

Changes that are more abrupt tend to bring fertility back faster (e.g., cutting out one nursing session abruptly, rather than gradually decreasing nursing time at that session) - even if you continue to breastfeed a great deal - this is why many mothers experience the return of fertility when their child sleeps through the night or starts solid foods. If you decide to make changes to your nursing pattern, the time of day that you make the change (e.g., cutting out or shortening a nighttime nursing session as opposed to a daytime nursing session) should not make that much of a difference. Current research indicates that nursing frequency and total amount of time at the breast per 24 hours are the most important factors, rather than the time of day that the suckling occurs.

A few moms do find it impossible to conceive while nursing, but this is not at all common.

Many mothers wonder whether breastfeeding will affect the reliability of pregnancy tests. It does not - pregnancy tests measure the amount of the hormone hCG (human chorionic gonadotropin) in blood or urine, and hCG levels are not affected by breastfeeding. The developing placenta begins releasing hCG upon implantation; a pregnancy can generally be detected with a pregnancy test within 7-14 days after implantation.

For more information, see Getting Pregnant While Breastfeeding by Hilary Flower.

When you do get pregnant while breastfeeding, what next? See Nursing During Pregnancy & Tandem Nursing for more information.

References and Additional Resources

Fertility and conceiving while breastfeeding

Birth Control and Breastfeeding @

Menstruation and Breastfeeding by Becky Flora, IBCLC

Breastfeeding and Menstruation, Birth Control and Vaginal Dryness by Paula Yount

Can I get pregnant while I am breastfeeding? LLL FAQ

The Garden of Fertility by Katie Singer

Breastfeeding and Birth Control by Anne Smith, IBCLC

Breastfeeding and Fertility by Sherri Hedberg, IBCLC

Taking Charge of Your Fertility website - check out the library and the discussion boards.

Campino C, Torres C, Rioseco A, Poblete A, Pugin E, Valdes V, Catalan S,
Belmar C, Seron-Ferre M. Plasma prolactin/oestradiol ratio at 38 weeks gestation predicts the duration of lactational amenorrhoea. Hum Reprod. 2001 Dec;16(12):2540-5. "At 38 weeks gestation, the ratio PRL/oestradiol identified all individual women according to the subsequent duration of their lactational amenorrhoea, suggesting that duration of lactational amenorrhoea is conditioned during pregnancy."

Ellison, PT. Breastfeeding, Fertility, and Maternal Condition. In: Stuart-Macadam P, Dettwyler KA, ed. Breastfeeding: Biocultural Perspectives. Hawthorne, NY: Aldine de Gruyter, 1995:305-345.

Eslami SS, Gray RH, Apelo R, Ramos R. The reliability of menses to indicate the return of ovulation in breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.

Gray RH, Campbell OM, Apelo R, Eslami SS, Zacur H, Ramos RM, Gehret JC, Labbok MH. Risk of ovulation during lactation. Lancet. 1990 Jan 6;335(8680):25-9.

Howie PW, McNeilly AS, Houston MJ, Cook A, Boyle H. Fertility after childbirth: infant feeding patterns, basal PRL levels and post-partum ovulation. Clin Endocrinol (Oxf). 1982 Oct;17(4):315-22.

Several papers and discussions on fertility and breastfeeding from The United Nations University Press Food and Nutrition Bulletin Volume 17, Number 4, December 1996.

Exclusive breastfeeding/Lactational Amenorrhea Method of birth control

What is the contraceptive effect of breastfeeding my baby? from the Managing Contraception website

The Garden of Fertility by Katie Singer

Breastfeeding and Childspacing by Dr. William Sears

What is LAM?. Did you know that exclusive breastfeeding can prevent pregnancy for up to six months? This site answers your questions!

The Lactational Amenorrhea Method (LAM): Another Choice for Mothers by Miriam H. Labbok, MD, MPH, from Breastfeeding Abstracts, August 1993, Volume 13, Number 1, pp. 3-4.

Fact Sheet on the Lactational Amenorrhea Method (LAM) ( PDF version).

Managing Fertility Naturally During Breastfeeding. From the Billings Ovulation Method of Natural Family Planning. Continue on to their home page for more info on the method.

Taylor, H. William, et al. Continuously Recorded Suckling Behaviour and Its Effect on Lactational Amenorrhoea. J Biosoc Sci. 1999;31: 289-310.

Valdes V, Labbok MH, Pugin E, Perez A. The efficacy of the lactational amenorrhea method (LAM) among working women. Contraception. 2000 Nov;62(5):217-9.

Breastfeeding as a means to fertility regulation: reviewing the evidence. Progress in Reproductive Health Research. 2000;55:1-7.

Print Resources

Your Fertility Signals by Merryl Winstein

Taking Charge of Your Fertility by Toni Weschler

Breastfeeding and Natural Child Spacing by S.K. Kippley

A Pocket Guide to Managing Contraception by Robert Anthony Hatcher, M.D., MPH, et. al. includes accurate information on LAM and other methods of contraception

Ellison, Peter T. "Breastfeeding, Fertility and Maternal Condition,"from Breastfeeding: Biocultural Perspectives (Stuart-Macadam, P. and Dettwyler, K., ed.), New York: Walter de Gruyter, Inc., 1995, p. 305-345.

Mohrbacher N. Breastfeeding Answers Made Simple. Amarilla, TX: Hale Publishing; 2010:490-510.

Valdés V, Labbok MH, Pugin E, and Perez A. The efficacy of the lactational amenorrhea method (LAM) among working women. Contraception, 01 Nov 2000; 62(5): 217-9.

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Breastfeeding and Fertility * KellyMom.com

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How can I use breastfeeding to prevent pregnancy? The Exclusive Breastfeeding method of birth control is also called the Lactational Amenorrhea Method of birth control, or LAM. Lactational amenorrhea refers to the natural postpartum infertility that occurs when a woman is not menstruating due to breastfeeding.

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When will my periods start again after pregnancy?

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When will my periods start again after pregnancy?

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It's hard to be exact about when your periods will start again, as everyone is different.

If you bottle feed your baby, or combine bottle feeding with breastfeeding, your first period could start as soon as 5 to 6 weeks after you give birth.

If you fully breastfeed (including at night) without any bottle feeding, your periods may not start again until you stop breastfeeding, or until you stop night-time breastfeeding.

This is because the hormone that causes your body to make breast milk can stop your body making the hormones that control your periods.

As your baby starts breastfeeding less often, around 3 feeds a day, you may start "spotting". Spotting is a light and irregular period that usually appears as spots of blood.

What will my first period after labour be like?

You first period may be different from how your period was before.

You may have:

irregular periods - especially if it returns while you're breastfeeding

cramping - this may be worse or better than before you were pregnant

heavier periods

small blood clots in your periods

If you have had blood clots in your period that have lasted a week, or have much heavier blood loss than you have had before, you should speak to your midwife, health visitor or GP.

When would I be able to get pregnant again?

You may be able to get pregnant as little as 3 weeks after the birth of your baby, even if your periods haven't started again yet.

Read about sex and contraception after birth.

Further information

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When will my periods start again after pregnancy?

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It's hard to be exact about when your periods will start again, as everyone is different. If you bottle feed your baby, or combine bottle feeding with breastfeeding, your first period could start as soon as 5 to 6 weeks after you give birth.

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Why is my baby refusing the breast? 8 tips that help NCT

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Why won't my newborn baby breastfeed?

Sometimes, newborn babies struggle to latch on to breastfeed after they're born. It can be worrying for new parents when this happens - you might think something's wrong.

There may be a simple explanation. This information could help you find your own solution, or decide if you need further support.

Some of the more common reasons for newborn babies finding it difficult to latch onto the breast could be:

a difficult labour or birth - your baby might feel sore or have a headache if the mother has had interventions in labour or if they were born very quickly

medication used during labour - anaesthesia, epidural or pethidine can make your baby sleepy or groggy

your baby being separated from you after birth - even for a few minutes

discomfort due to a birth injury or bruising

swallowing mucus at birth can make your baby feel congested, nauseous or uncomfortable

an early unpleasant experience of attempting to breastfeed, such as being forced onto the breast

the baby might have tongue-tie

Why won't my baby breastfeed anymore?

Sometimes, older babies seem to refuse to breastfeed when they'd been breastfeeding just fine until then. This is known as a 'nursing strike.' They might refuse to breastfeed for 2-4 days, but it can be up to 10 days (Mohrbacher, 2013).

Reasons that your older baby might refuse to feed at the breast could include:

something has changed that makes it difficult for baby to latch

a strong or fast flow of milk, which your baby is struggling to take

a painful mouth, due to an infection like thrush or because they're teething

being more aware of their surroundings and being easily distracted, for example by noise

a change in the taste of your milk, such as that due to your menstrual cycle

the introduction of more solid food

a small number of babies might struggle because of severe or persistent reflux, known as gastro-oesophageal reflux disease (GORD), so they may link feeding with pain.

(Mohrbacher, 2013; Gonzalez, 2014; BellyBelly, 2016; NICE, 2017; Public Health England, ND)

What can I do when my baby refuses to breastfeed?

8 top tips to help your baby who's refusing to breastfeed:

1. Try to identify what's going on for your baby. Knowing the cause can help not only with a plan but it can be reassuring to understand what is happening and know there's a solution. You could think about the following:

Do they have a cold or an infection?

Was there something that might have caused them to not want to feed?

Talk to one of our Breastfeeding Counsellors or contact our Infant Feeding Line on 0300 330 0700 (option 1) for further support. It can be a great way to get some help to find out what's happening.

You could also contact a health professional to investigate any medical reasons why your baby might not be feeding.

2. Try to stay calm and not force a feed. Instead, allow your baby to take the lead.

3. Especially for young babies, many mums find skin-to-skin contact in a laid-back position helps to take the pressure out of the situation. It allows your baby to use their own natural instincts to feed (Burbridge, 2017).

4. Don't worry if your baby bobs their head or moves it from side to side, they're not rejecting the breast as it might appear. These are your baby's natural ways of finding your breast (Coulson, 2012).

5. Try a different feeding position to see if you can get your baby more comfortable. Some babies find a laid-back breastfeeding (also called biological nurturing) position helpful if they are struggling to get a deep latch or if you have a strong let-down of milk (Coulson, 2012).

6. Sometimes, feeding your baby while they're sleepy or even asleep can be helpful. Many mums say that these 'dream feeds' can be very effective for a baby who is uninterested when awake (Pitman and Bennett, 2008).

7. You could try feeding your baby while rocking them or walking around, singing or playing with them or playing white noise or background music to them (Australian Breastfeeding Association, 2017).

8. You might want to try feeding in a quiet room, away from distractions, as some babies are so keen to be involved that they limit their feeds (Gonzalez, 2014).

What can I do if I've tried everything but my baby still won't breastfeed?

One of the key things to consider is maintaining your milk supply. You might need to consider expressing, either by hand or with a pump. You can find more information about expressing and storing your milk here.

Another consideration is making sure your baby is getting enough milk. How might you know how much milk your baby is getting, you might ask. The answer lies in their dirty and wet nappies. You can expect six wet nappies in 24 hours if your baby is over a week old (UNICEF, 2016). If you're unsure, it's best to ask for support from your health visitor, GP or NCT breastfeeding counsellor.

In the short term, you might need to look at alternative ways to feed your baby if you think they're not getting enough milk. A newborn baby needs to be fed regularly and parents can use syringe or cup feeding as an alternative to a bottle in the early days (Flint et al, 2016; NHS, 2016).

If you decide to use a bottle, it might be helpful to feed with plenty of skin-to-skin contact (UNICEF, 2018). Gently offering the bottle to your baby by tickling their top lip, waiting for the wide-open gape might also help mimic a breastfeed (UNICEF, 2019). That can support the transition back to the breast.

Taking frequent breaks during the bottle feed, and perhaps swapping sides, can be helpful (UNICEF 2018). Continuing to have skin-to-skin time with your baby and allowing them access to the breast will help this. It'll also be a bonding and calming experience for you both.

How can I deal with the stress of my baby refusing to breastfeed?

When a newborn refuses the breast, or an older baby goes through a nursing strike, it can be very upsetting for both you and your baby. You're definitely not alone in struggling with the emotions of breastfeeding problems. So here are some tips that might help:

1. Try to take time to enjoy plenty of extra cuddles and quiet time together.

2. Many mums find a 'babymoon' helpful for allowing their baby access to the breast in a non-pressurised way. A babymoon means spending some hours together in a relaxed setting, such as lying down snuggling in bed. This can allow you to enjoy your baby without worrying about feeding.

3. For older babies, some mums find that having a bath with their baby or bringing their baby into bed with them helps their baby to latch.

4. Try to find some support from other mums and trained breastfeeding supporters. Chatting with other people about this can help to unburden the stresses and worries you might be feeling. Breast refusal is not uncommon and you might find that chatting to someone who understands is invaluable while you're struggling.

5. For many mums, time and patience can help the situation. Your baby's instincts and behaviour can change and develop, especially in the early days.

6. If you're struggling, do contact the NCT Infant Feeding Line and speak to a breastfeeding counsellor. They'll listen, offer you information and will support you to find your own path.

This page was last reviewed in August 2019.
Further information

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

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

NHS information on mastitis.

Best Beginnings - Bump to Breastfeeding DVD Chapter 7 'Overcoming Challenges'.

Healthtalkonline.org: Managing Breastfeeding - dealing with difficult times.

Australian for Breastfeeding Association (2017) Breast refusal. https://www.breastfeeding.asn.au/bf-info/breast-refusal [Accessed 22nd February 2019]

BellyBelly. (2016) Breast refusal - 13 tips for a baby that refuses the breast.
https://www.bellybelly.com.au/breastfeeding/breast-refusal/ [Accessed 22nd February 2019]

Burbridge A. (2017) Nursing strikes. La Leche League GB. Available at: https://www.laleche.org.uk/nursing-strikes/ [Accessed 1st August 2019]

Coulson S. (2012) Biological nurturing: the laid-back breastfeeding revolution. Midwifery Today, 101 Available at: https://midwiferytoday.com/mt-articles/biological-nurturing/ [Accessed 1st August 2019]

Flint A, New K, Davies MW. (2016) Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. Cochrane Database Syst Rev. (8):CD005092. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005092.pub3... [Accessed 1st August 2019]

Gonzalez C. (2014) Breastfeeding Made Easy. London: Pinter &Martin

LLLGB. (2016) My baby won't breastfeed. Available at https://www.laleche.org.uk/my-baby-wont-breastfeed/ [Accessed 1st August 2019]

Mohrbacher N. (2013) Is your formerly nursing baby refusing to breastfeed? Breastfeeding Reporter Blog. Available at http://www.nancymohrbacher.com/articles/2013/1/26/is-your-formerly-nursing-baby-refusing-to-breastfeed.html?rq=refusing [Accessed 1st August 2019]

NICE. (2017) Breastfeeding problems. National Institute for health and Care Excellence, Clinical Knowledge Summaries. Available at: https://cks.nice.org.uk/breastfeeding-problems#!scenario [Accessed 1st August 2019]

Pitman T, Bennett H. (2008) 0-1 year: nursing strikes; breastfeeding while baby's falling asleep may help end a nursing strike. Today's Parent. 7:137.

Public Health England. (ND) Breastfeeding challenges. NHS, Start 4 life. Available at: https://www.nhs.uk/start4life/baby/breastfeeding/breastfeeding-challenges/reflux/ [Accessed 1st August 2019]

UNICEF. (2016) Breastfeeding checklist for mothers - How can I tell that breastfeeding is going well? UNICEF UK Baby Friendly Initiative. Available at https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf [Accessed 1st August 2019]

UNICEF. (2018) Skin-to-skin contact. Available from: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/guidance-for-health-professionals/implementing-the-baby-friendly-standards/further-guidance-on-implementing-the-standards/skin-to-skin-contact/ [Accessed 1st August 2019]

UNICEF. (2019) Responsive bottle feeding. Available from: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2019/04/Infant-formula-and-responsive-bottle-feeding.pdf [Accessed 1st August 2019]

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Why is my baby refusing the breast? 8 tips that help | Baby & toddler, Feeding articles & support | NCT

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Sometimes, newborn babies struggle to latch on to breastfeed after they're born. It can be worrying for new parents when this happens - you might think something's wrong. There may be a simple explanation. This information could help you find your own solution, or decide if you need further support.

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Thrush (of the breast/nipple) and Breastfeeding 

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Thrush (of the breast/nipple) and Breastfeeding 

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

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

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BFAR - Breastfeeding After Breast and Nipple Surgeries

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BFAR - Breastfeeding After Breast and Nipple Surgeries

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BFAR - Breastfeeding After Breast and Nipple Surgeries

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The BFAR website provides information and support to mothers who wish to breastfeed after breast or nipple surgery, and their friends and family. It is also an online resource for healthcare providers who help mothers breastfeed.

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Looking after a baby or young child when you have epilepsy

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Looking after a baby or young child when you have epilepsy

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Looking after a baby or young child - Epilepsy Action

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Tips for looking after a baby or young child when you have epilepsy

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List of factsheets available on Breastfeeding and Medication

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List of factsheets Breastfeeding and Medication
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A list of all the factsheets available on Breastfeeding-and-Medication.co.uk.

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What is a food intolerance?

Having a food intolerance means the body finds it hard digesting a particular food or foods. This causes a reaction and unpleasant symptoms (NHS, 2019a). A food intolerance isn't the same as a food allergy because no immune system reaction takes place (NHS, 2019a).

It can be hard to diagnose a food intolerance, as symptoms could be caused by something else and there are no tests for it.

What are the symptoms of a food intolerance?

Symptoms usually occur some time after eating the food. Compared with an allergic reaction, a larger amount of food is needed to trigger symptoms and these are never life-threatening.

The symptoms of a food intolerance are different to those of allergies and may include repeated episodes of:

diarrhoea

tummy pain

skin rashes and itching

passing wind often

bloating.

The most commonly suspected intolerance in babies and small children is lactose intolerance.

What is lactose intolerance?

Lactose is a sugar found in all milks. It's made by the mother's body and is not related to her diet (Australian Breastfeeding Association, 2017).

Lactose intolerance is not the same as cow's milk protein allergy. Someone with lactose intolerance does not make enough of the enzyme lactase, which is needed to digest lactose (NHS, 2019b).

This means undigested lactose ferments in the gut and produces acids and gases, resulting in liquid/frothy/green poos, farting and discomfort.

Primary lactose intolerance

Primary lactose intolerance is caused by a gradual decrease in lactase production, which happens as a child's diet becomes less reliant on milk and dairy products (NHS, 2019b). It is rare in babies (First Steps Nutrition Trust, 2019) and usually happens after the age of two years old (NHS, 2019b).

Some human populations have evolved 'lactase persistence' and will continue making lactase. This means they can digest milk and dairy products as adults (Mattar et al, 2012).

Secondary lactose intolerance

Secondary lactose intolerance is caused by a problem in the small intestine. It may be a temporary condition that can result from something disturbing the gut, such as gastroenteritis (a tummy bug) or a long course of antibiotics (NHS, 2019b).

The NHS suggests that parents continue to give their baby their usual milk. With an older child, parents may wish to exclude solid foods containing dairy products while the gut is recovering (NHS, 2019b).

Congenital lactose intolerance

This is a very rare inherited condition which means a baby will not produce any lactase (NHS, 2019b). It causes abdominal pain, diarrhoea, flatulence and/or bloating.

This will be picked up in the early days after a baby is born and they will be prescribed a special formula milk (First Steps Nutrition Trust, 2019).

Developmental lactose intolerance

Some babies born before 37 weeks of pregnancy may not yet be producing a lot of lactase. This will usually improve as the baby gets older (NHS, 2019b).

What should I do if I suspect a food intolerance?

If you think your child has a food intolerance, you can speak to your GP. A breastfeeding counsellor on our Infant Feeding Support Line may also be able to help (8am-midnight): 0300 330 0700.

Always check with your GP before eliminating foods from your child's diet in the long term (NHS, 2019c). Most children who have primary or secondary lactose intolerance can consume small amounts of lactose without experiencing symptoms.

You may be referred to a dietician for nutritional advice because it's important for young children to have certain nutrients in their diet.

How to cope emotionally

If your little one has symptoms of a food intolerance, it can be very stressful. For practical and emotional support you can contact our Infant Feeding Support Line (8am-midnight): 0300 330 0700.

You can read about one mum's experience of having a child with food allergies and reflux here.

Your GP will be able to help you work out what may be causing your child's symptoms and refer you to a specialist if necessary (NHS, 2019c).

While it can be tough getting to the bottom of the cause, most intolerances are mild and can be managed. Food manufacturers are getting better at catering for people with food allergies and intolerances, so there's now more choice available.
This page was last reviewed in December 2021.
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 our NCT New Baby groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.
Act On Cows' Milk Allergy Anaphylaxis Campaign National Eczema Association

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Food intolerances in babies | Baby & toddler, Your baby's health articles & support | NCT

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It can be hard to tell if your child has a food intolerance or an allergy. We look at signs of a food intolerance, what you can do to help and how to cope.

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What are food allergies?

An allergy is when your body has an immune reaction to a particular food or substance within minutes of eating it (Spector, 2022; Allergy UK, 2021a). This abnormal immune response may take years to develop, so it doesn't always happen the first time we come into contact with something.

Allergies are common in the UK, particularly among children (NHS, 2021). Some allergies will go away as a child gets older, while others are lifelong (NHS, 2021).

There is often confusion between allergies and food intolerance. A food intolerance is when a person has trouble digesting a specific food, which may take up to a couple of days for a person to notice (NHS, 2021; Spector, 2022). You can read more about food intolerances in babies in our article here.

What are the most common food allergies?

The most common foods that cause allergic reactions are cow's milk, nuts, eggs, foods containing gluten (e.g. wheat), seeds, soya, fish and shellfish (NHS, 2021).

Most allergies are mild but some can cause a severe allergic reaction, and they tend to become more severe with each exposure to the substance. Trying to figure out whether a child has an allergy can be difficult, so it's good to be aware of the signs. It's also good to keep in mind that some symptoms could indicate another issue like a food intolerance or they could be something else entirely (NHS, 2019a).

What are the symptoms of an allergy?

Symptoms might include one or more of the following:

itchy skin or rash

swollen lips and throat

runny or blocked nose

sore, red itchy eyes

cough

vomiting

diarrhoea.

If you think your child has an allergy, you could talk to your GP about their symptoms.

What is anaphylactic shock?

Occasionally, an allergy can lead to a severe allergic reaction, called anaphylaxis, which can be life threatening. This affects the whole body and usually develops within minutes of coming into contact with something the person is allergic to.

The symptoms of anaphylactic shock come on and worsen quickly. Its symptoms might include those listed above, as well as:

feeling lightheaded or faint

clammy skin

difficulty breathing

wheezing

a fast heartbeat

collapsing or losing consciousness

confusion and anxiety.

Call 999 immediately if you suspect anaphylactic shock.

Reaction to cow's milk

Some babies react to cow's milk. They might have either an allergic reaction or an intolerance to the protein in cow's milk, or an intolerance to lactose, the sugar in cow's milk (Walsh et al, 2016).

Cow's milk protein allergy (CMPA) is one of the most common childhood food allergies but it's still rare (Allergy UK, 2021b). An estimated two to eight in 100 babies up to one year old have a suspected CMPA. Half will have grown out of it by the end of their first year and eight or nine in ten have grown out of it by the age of five years old (Caffarelli et al, 2010).

Symptoms of the allergy (see above) might show up straight after a feed or they may be delayed. This is known as immediate and delayed CMPA. Occasionally, CMPA can cause a severe allergic reaction or anaphylaxis (see symptoms above), which is a medical emergency - call 999.

Babies sometimes develop CMPA when they first consume cow's milk in their diet, either in formula or when they start eating solids (NHS, 2019c). CMPA can also, occasionally, affect exclusively breastfed babies as cow's milk from the mum's diet can pass to their baby (NHS, 2019c).

If a baby has a CMPA and is formula fed, parents often find their health professional suggests a hydrolysed formula. In this formula, the cow's milk protein is already partially digested. You don't need a prescription, and nine out of ten babies find this easier to digest (Cafferelli et al, 2010). If that doesn't work, you can get prescription formulas that don't contain cow's milk.

It is useful to remember that between 2006 and 2016, prescriptions of specialist infant milk for CMPA increased dramatically, despite no evidence of a real increase in milk allergy (Spector, 2022). Overdiagnosis is potentially harmful to mums and babies and might confuse parents (Spector, 2022).

Going dairy-free

Mums who exclusively breastfeed a baby who is allergic to cow's milk might be advised to exclude dairy products from their diets (NHS, 2019c). A dairy-free diet can seem overwhelming but your GP can refer you to a dietician who will make sure you don't miss out on eating vital nutrients.

Nut allergies

Allergies to nuts, nut products and some seeds affect one in 50 people (Allergy UK, 2021a).

Your child has a higher risk of developing a peanut allergy if they already have an allergy, like eczema or a diagnosed food allergy (NHS, 2021). There's also more chance if there's a history of allergies in their immediate family, including asthma, eczema or hay fever (NHS, 2021).

If you're concerned about a potential allergic reaction, it's worth talking to your GP or health visitor. They might be able to offer advice or reassurance.

If your child does have a nut allergy, avoid giving them food that contains peanuts, including peanut butter and peanut oil. Also, it's important to read food labels carefully before giving them any snacks (NHS, 2021). Pre-packed food often has a list of ingredients with possible allergens written in bold, italic or coloured type to make the ingredients easier to spot (Food Standards Agency, 2021).

While lots of children outgrow allergies to milk or eggs, a peanut allergy tends to be lifelong (NHS, 2021).

How can I lower the chance of my child developing an allergy?

The advice from the World Health Organization is to exclusively breastfeed babies until the age of six months (WHO, 2002). There is evidence to suggest this can reduce the risk of allergies (UNICEF, no date). See our article here for more information about the benefits of breastfeeding.

When introducing your baby to solids, it's a good idea to introduce new foods slowly. Offer milk, eggs, gluten (including wheat), nuts, seeds, soya, shellfish and fish one at a time and in small amounts. That'll mean you can spot potential reactions (NHS, 2021).

Allergy UK has a downloadable fact sheet about weaning your baby when you're introducing foods that can be associated with allergies.

Allergic reaction - what's next?

If you think your child has had an allergic reaction, you could see your GP. They can help to determine whether it's likely to be an allergy or something caused by another condition.

Your GP also can offer advice and treatment to manage the allergy. If it's severe or hard to tell what's causing the reaction, they might refer you to an allergy specialist for testing or treatment advice.

To confirm an allergy, a specialist will conduct a range of assessments, including a physical examination, history-taking, blood tests and food challenge (Spector, 2022). Any of these without the others can be misleading (Spector, 2022). It could be tempting to seek an alternative to a medical doctor but it's good to remember that other tests are unregulated (Spector, 2022).

How to cope emotionally

Allergies can at times be worrying, frustrating, stressful and restrictive.

While it can be tough for parents and little ones alike, it's good to remember most allergies are mild and they can be managed.

Food manufacturers are getting better at catering for people with food allergies, so there's more choice of dairy-free, lactose-free or nut-free foods available. On your doctor's advice, your baby might be prescribed different types of baby formula milk if they have allergies to a certain type of milk (NHS, 2019d).

If you're concerned about your child's health or think they may have an allergy or food intolerance, your GP should be able to help. There is information and support available if you need it (see below). You can also see our article about one mum's experience with her child's food allergies and reflux.
This page was last reviewed in December 2021.
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 our 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.

For further information and support about allergies, you can see the Allergy UK website or call their helpline on 01322 619898.

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Coping with your child's food allergies | Baby & toddler, Feeding articles & support | NCT

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Food allergies are becoming more common. Here we look at how to spot the signs of an allergy, help your child and cope emotionally.

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What should I do if I think my baby is allergic or intolerant to cows' milk?

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What should I do if I think my baby is allergic or intolerant to cows' milk?

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If you think your baby is having a reaction to cows' milk, see your GP or health visitor to discuss your concerns.

They will be able to assess if your baby's symptoms may be caused by a cows' milk allergy or something else. Make sure you get medical advice before taking cows' milk out of your child's diet as it contains important nutrients.

Cows' milk allergy in babies

Cows' milk allergy (CMA), also called cows' milk protein allergy, is one of the most common childhood food allergies. It is estimated to affect around 7% of babies under 1, though most children grow out of it.

CMA typically develops when cows' milk is first introduced into your baby's diet either in formula or when your baby starts eating solids.

More rarely, it can affect babies who are exclusively breastfed because of cows' milk from the mother's diet passing to the baby through breast milk.

There are 2 main types of CMA:

immediate CMA - where symptoms typically begin within minutes of having cows' milk

delayed CMA - where symptoms typically begin several hours, or even days, after having cows' milk

Symptoms of cows' milk allergy

Cows' milk allergy can cause a wide range of symptoms, including:

skin reactions - such as an itchy rash or swelling of the lips, face and around the eyes

digestive problems - such as stomach ache, vomiting, colic, diarrhoea or constipation

hay fever-like symptoms - such as a runny or blocked nose

eczema that does not improve with treatment

Occasionally CMA can cause severe allergic symptoms that come on suddenly, such as swelling in the mouth or throat, wheezing, cough, shortness of breath, and difficult, noisy breathing.

A severe allergic reaction ( anaphylaxis) is a medical emergency. Call 999 for an ambulance immediately if you think your child has anaphylaxis (even if they start to feel better).

Treatment for CMA

If your baby is diagnosed with CMA, you'll be offered advice by your GP or an allergy specialist on how to manage their allergy. You may also be referred to a dietitian.

Treatment involves removing all cows' milk from your child's diet for a period of time.

If your baby is formula-fed, your GP can prescribe special infant formula.

Do not give your child any other type of milk without first getting medical advice.

If your baby is exclusively breastfed, the mother will be advised to avoid all cows' milk products.

Your child should be assessed around every 6 to 18 months to see if they have grown out of their allergy.

Read more about cows' milk allergy in children on National Institute for Health and Care Excellence (NICE).

Could it be lactose intolerance?

Lactose intolerance is another type of reaction to milk, when the body cannot digest lactose, a natural sugar found in milk. However, this is not an allergy.

Lactose intolerance can be temporary - for example, it can come on for a few days or weeks after a tummy bug.

Symptoms of lactose intolerance include:

diarrhoea

vomiting

stomach rumbling and pains

wind

Treatment for lactose intolerance

Treatment depends on the extent of your child's intolerance. Some children with lactose intolerance may be able to have small amounts of dairy products without having symptoms.

Your child may be referred to a dietitian for specialist advice.

Read more about treatment for lactose intolerance.

Further information:

Page last reviewed: 28 November 2022
Next review due: 28 November 2025

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What should I do if I think my baby is allergic or intolerant to cows' milk?

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If you think your baby is having a reaction to cows' milk, talk to your health visitor or GP. If your baby is diagnosed with a milk allergy, your GP can prescribe alternatives to cows' milk-based infant formula.

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Vitamin D helps regulate the amount of calcium and phosphate in the body.
These nutrients are needed to keep bones, teeth and muscles healthy.

A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain caused by a condition called osteomalacia in adults.

Government advice is that everyone should consider taking a daily vitamin D supplement during the autumn and winter.

People at high risk of not getting enough vitamin D, all children aged 1 to 4, and all babies (unless they're having more than 500ml of infant formula a day) should take a daily supplement throughout the year.

There have been some reports about vitamin D reducing the risk of coronavirus (COVID-19). But there is currently not enough evidence to support taking vitamin D solely to prevent or treat COVID-19.

Good sources of vitamin D

From about late March/early April to the end of September, most people should be able to make all the vitamin D they need from sunlight.

The body creates vitamin D from direct sunlight on the skin when outdoors.

But between October and early March we do not make enough vitamin D from sunlight. Read more about vitamin D and sunlight.

Vitamin D is also found in a small number of foods.

Sources include:

oily fish - such as salmon, sardines, herring and mackerel

red meat

liver

egg yolks

fortified foods - such as some fat spreads and breakfast cereals

Another source of vitamin D is dietary supplements.

In the UK, cows' milk is generally not a good source of vitamin D because it is not fortified, as it is in some other countries.

How much vitamin D do I need?

From about late March/early April to the end of September, the majority of people should be able to make all the vitamin D they need from sunlight on their skin.

Children from the age of 1 year and adults need 10 micrograms of vitamin D a day. This includes pregnant and breastfeeding women, and people at risk of vitamin D deficiency.

Babies up to the age of 1 year need 8.5 to 10 micrograms of vitamin D a day.

A microgram is 1,000 times smaller than a milligram (mg). The word microgram is sometimes written with the Greek symbol μ followed by the letter g (μg).

Sometimes the amount of vitamin D is expressed as International Units (IU). 1 microgram of vitamin D is equal to 40 IU. So 10 micrograms of vitamin D is equal to 400 IU.

Should I take a vitamin D supplement?

Advice for adults and children over 4 years old

During the autumn and winter, you need to get vitamin D from your diet because the sun is not strong enough for the body to make vitamin D.

But since it's difficult for people to get enough vitamin D from food alone, everyone (including pregnant and breastfeeding women) should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter.

Between late March/early April to the end of September, most people can make all the vitamin D they need through sunlight on their skin and from a balanced diet.

You may choose not to take a vitamin D supplement during these months.

People at risk of vitamin D deficiency

Some people will not make enough vitamin D from sunlight because they have very little or no sunshine exposure.

The Department of Health and Social Care recommends that adults and children over 4 take a daily supplement containing 10 micrograms of vitamin D throughout the year if they:

are not often outdoors - for example, if they're frail or housebound

are in an institution like a care home

usually wear clothes that cover up most of their skin when outdoors

If you have dark skin - for example you have an African, African-Caribbean or south Asian background - you may also not make enough vitamin D from sunlight.

You should consider taking a daily supplement containing 10 micrograms of vitamin D throughout the year.

Advice for infants and young children

The Department of Health and Social Care recommends that babies from birth to 1 year of age should have a daily supplement containing 8.5 to 10 micrograms of vitamin D throughout the year if they are:

breastfed

formula-fed and are having less than 500ml (about a pint) of infant formula a day, as infant formula is already fortified with vitamin D

Children aged 1 to 4 years old should be given a daily supplement containing 10 micrograms of vitamin D throughout the year.

You can buy vitamin D supplements or vitamin drops containing vitamin D (for under 5s) at most pharmacies and supermarkets.

Women and children who qualify for the Healthy Start scheme can get free supplements containing vitamin D.

See the Healthy Start website for more information.

What happens if I take too much vitamin D?

Taking too many vitamin D supplements over a long period of time can cause too much calcium to build up in the body (hypercalcaemia). This can weaken the bones and damage the kidneys and the heart.

If you choose to take vitamin D supplements, 10 micrograms a day will be enough for most people.

Do not take more than 100 micrograms (4,000 IU) of vitamin D a day as it could be harmful. This applies to adults, including pregnant and breastfeeding women and the elderly, and children aged 11 to 17 years.

Children aged 1 to 10 years should not have more than 50 micrograms (2,000 IU) a day. Infants under 12 months should not have more than 25 micrograms (1,000 IU) a day.

Some people have medical conditions that mean they may not be able to safely take as much. If in doubt, you should consult your doctor.

If your doctor has recommended you take a different amount of vitamin D, you should follow their advice.

You cannot overdose on vitamin D through exposure to sunlight. But always remember to cover up or protect your skin if you're out in the sun for long periods to reduce the risk of skin damage and skin cancer.

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Vitamin D helps regulate the amount of calcium and phosphate in the body. These nutrients are needed to keep bones, teeth and muscles healthy. A lack of vitamin D can lead to bone deformities such as rickets in children, and bone pain caused by a condition called osteomalacia in adults.

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By Kelly Bonyata, IBCLC

A vegetarian or vegan mother does not need to take any special dietary precautions as long as she is maintaining a diet with adequate amounts of vitamin B12, calcium and zinc. This is something that mom needs to do for herself, even if she is not breastfeeding.

If you are avoiding meat but eating any other type of animal protein (eggs, milk, cheese or other dairy products, fish, poultry) you will normally get enough vitamin B12.

If, on the other hand, you are consuming no animal protein at all - no fish, meat, poultry, eggs or dairy products - you will need to make sure you get enough vitamin B12 to prevent your baby (and you) from becoming deficient in this vitamin. Vitamin B12 supplements and vitamin B12 fortified foods are available. Supplementing your baby with vitamin B12 is an option if you are vitamin B12 deficient, but you would still need the vitamin B12 for yourself (and if you're getting enough, baby won't need the supplement).

If you don't eat dairy products, check to make sure that you're getting sufficient calcium and zinc (this is for your health - baby will get enough of these minerals through your milk even if your diet is deficient). Pregnant and breastfeeding mothers do not need more calcium than normally required for their age group -the Dietary Reference Intake (DRI) for calcium for women aged 19-50 is 1000 mg per day. The DRI for zinc for breastfeeding mothers is 12 mg per day.

Additional information

@

@ other websites

Breastfeeding While Vegan by Anayah [link has been updated]

The Vegetarian Breastfeeding Mother by Mel Wolk, from Leaven, Vol. 33 No. 3, June-July 1997, p. 69.

The Vegan Diet During Pregnancy and Lactation by Reed Mangels, Ph.D., RD.

Iron in the Vegan Diet by Reed Mangels, Ph.D., R.D.

Mangels AR, Messina V. Considerations in planning vegan diets: infants. J Am Diet Assoc. 2001 Jun;101(6):670-7.

Hamosh M, Dewey, Garza C, et al: Nutrition During Lactation. Institute of Medicine, Washington, DC; National Academy Press 1991. This book is available free from the HRSA Information Center (look under Nutrition publications).

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Vegetarian Diets and Breastfeeding * KellyMom.com

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A vegetarian or vegan mother does not need to take any special dietary precautions as long as she is maintaining a diet with adequate amounts of vitamin B12, calcium and zinc. This is something that mom needs to do for herself, even if she is not breastfeeding.

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Eating healthily during pregnancy is important for your own health and the health of your developing baby.
It's important to eat a varied and balanced diet during pregnancy to provide enough nutrients for you and the development and growth of your baby.

If you're pregnant and a vegetarian or vegan, you need to make sure you get enough iron and vitamin B12, which are mainly found in meat and fish, and vitamin D, calcium and iodine.

Iron in your diet

Good sources of iron for vegetarians and vegans include:

pulses

dark green vegetables

wholemeal bread and flour

nuts

fortified breakfast cereals (with added iron)

dried fruit, such as apricots

Vitamin B12 in your diet

Good sources of vitamin B12 for vegetarians include milk, cheese and eggs.

Good sources for vegans include:

breakfast cereals fortified with vitamin B12

unsweetened soya drinks fortified with vitamin B12

yeast extract, such as Marmite, and nutritional yeast flakes which are fortified with vitamin B12

Vitamin D in your diet

From late March or early April until the end of September, most people should be able to get enough vitamin D from sunlight.

Although we get vitamin D from sunlight, vegetarian food sources include:

egg yolk

foods fortified with vitamin D, including some breakfast cereals and fat spreads

dietary supplements

Because vitamin D is found only in a small number of foods, it is difficult to get enough from foods that naturally contain vitamin D and fortified foods alone.

That's why the government recommends that all adults, including those who are pregnant and breastfeeding, should consider taking a daily supplement containing 10 micrograms of vitamin D during the winter months (October until the end of March).

You may be at particular risk of not having enough vitamin D if:

you have brown or black skin (for example, if you're of African, African Caribbean or south Asian origin)

you cover your skin when outside or spend lots of time indoors

You may need to consider taking a daily supplement of vitamin D all year. Talk to a midwife or doctor for advice.

If you're vegan, check the label to make sure your vitamin D is suitable for vegans.

Calcium in your diet

If you're a vegan, you also need to make sure you get enough calcium. This is because non-vegans get most of their calcium from dairy foods.

Good sources of calcium for vegans include:

dark green leafy vegetables

pulses

fortified unsweetened soya, pea and oat drinks

brown and white bread

calcium-set tofu

sesame seeds and tahini

dried fruit

Talk to your midwife or doctor about how you can get all the nutrients you need for you and your baby.

Iodine in your diet

Good sources of iodine for vegetarians include cow's milk, dairy products and eggs.

Iodine can also be found in plant foods, such as cereals and grains, but the levels vary depending on the amount of iodine in the soil where the plants are grown.

If you're vegan then you may want to consider taking an iodine supplement or eating foods fortified with iodine, such as some types of plant-based drinks.

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Find out how to keep you and your baby healthy while pregnant if you follow a vegetarian or vegan diet.

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It's never too early to think about good nutrition

Optimising your diet during pregnancy and your infant's diet early in life can help to protect their health into adulthood. A totally plant-based diet can meet everyone's nutritional needs, including those who are pregnant or breastfeeding.

Ideally, pregnancy planning should include a review of your diet. As a starting point, read this to check your understanding of general healthy eating for vegans. The next step is to look into special considerations for pregnancy. Here are some basic tips:

Eat plenty of foods rich in iron, such as lentils, chickpeas, beans, tofu, cashew nuts, chia seeds, ground linseed, hemp seeds, pumpkin seeds, kale, dried apricots, dried figs, raisins, quinoa and fortified breakfast cereal

Eat plenty of calcium-rich foods, such as calcium-fortified foods and calcium-set tofu

Ensure a reliable daily intake of vitamin B12 from fortified foods or a supplement

Ensure a reliable iodine intake by using a supplement

Whilst trying for a baby and during the first 12 weeks of pregnancy, take a daily folic acid supplement

Take a daily supplement containing vitamin D

Consider microalgae omega-3 fat supplementation

Limit caffeine to 200 milligrams per day, which equates to a mug of filter coffee, two mugs of instant coffee, or two mugs of tea

Follow advice about food safety during pregnancy

Keep active

Monitor weight gain

Need more information about pregnancy? Read our detailed PDF.

Breast is best

Exclusive breastfeeding is recommended for the first six months of your baby's life. It is also recommended that you continue to breastfeed until your child is at least two years old. Here are some basic tips about eating well during breastfeeding:

Drink plenty of fluid

Breastfeeding requires extra protein and zinc, so make sure that your meals contain good sources, such as beans, chickpeas, lentils, tofu, cashew nuts, chia seeds, ground linseed, hemp seeds, pumpkin seeds and quinoa

The calcium requirement for breastfeeding is nearly 80% more than the general requirement for adults, so it is strongly recommended that you include plenty of calcium-rich foods in your daily diet, such as calcium-fortified foods and calcium-set tofu

Ensure a reliable intake of vitamin B12 from fortified foods or a supplement

Ensure a reliable iodine intake by using a supplement

Take a daily supplement containing vitamin D

Consider microalgae omega-3 fat supplementation

If breastfeeding is not an option, infant formula is recommended. Soya-based infant formula can be fed to vegan infants when breastfeeding is not an option, but please speak to your health visitor or doctor before using it.

Need more information about breastfeeding? Read our detailed PDF.

Further information

Go here for NHS advice about food safety during pregnancy

If you need advice on talking to people about your vegan pregnancy, read our blog

Try Cooking Vegan by Dietitian Vesanto Melina and Chef Joseph Forest for nutritionally analysed recipes for all ages.

These are general guidelines about nutrition. If you have concerns about your diet, please talk to your doctor about seeing a dietitian. Discussing the use of supplements with a health professional will help to ensure that they are suitable for you.

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Optimising your diet during pregnancy and your infant's diet early in life can help to protect their health into adulthood. A totally plant-based diet can meet everyone's nutritional needs, including those who are pregnant or breastfeeding. Ideally, pregnancy planning should include a review of your diet.

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I cannot tell you how many times I hear the words "s/he slept so well between 10 and 16 weeks, we were getting five, six, even seven hour stretches in the crib/bassinet/basket and s/he would settle back to sleep easily and quickly after a feed. Things started to go wrong at around four months, I don't what we did wrong, s/he was such as good sleeper, but since then it's all been downhill. I just don't understand".

We ('we' meaning society) seem to think that baby sleep is linear. By that I mean we seem to think that it gets better as babies grow older. Or at least we believe it is static, ie. it won't get worse again. The thing is, it's not linear (certainly not in an upwards trajectory) and it's not static. It goes up and down (mostly down in the first year). This is entirely normal and very, very common (that doesn't mean there is anything wrong if your baby's sleep got better and better, you're just in the lucky minority!).

This chart is far more representative of what happens sleep wise in the first 18 months. Yes it is depressing, but it's realistic and once you know that something is totally normal, not your fault and most importantly *not permanent* it is so much easier to relax a little.

As it happens, 3 months is the peak of sleep in the first year, that means it's as good as it gets. There is a very, very high likelihood that your baby will sleep the best they are going to sleep until their first birthday (and later) around the age of about 3 months. It's really not uncommon for 3 months to be happy to be put down, to only wake once or twice in the night and to go to sleep easily after a quick feed/cuddle.

Then 4 and 5mths happen, they're not fun months. You get lulled into a false sense of security at 3mths, then suddenly your baby is waking every hour, won't be put down and is awake for an hour or more refusing to go back to sleep. This is normal development, it is temporary and you didn't do anything wrong! You also don't need to do anything to change it, keep doing what you're doing. Don't be scared of bad habits and especially don't consider sleep training. It's temporary!

You often get a blissful little blip of better sleep around 5-6mths, then just when you think "finally, it's getting a bit better", bam, thinks get worse again, usually not as bad as they were at 4mths, but still far worse than you'd hope.

7-8/9mths are often months that promise hope, with any luck you'll be back somewhere to where you were around 3mths (but probably not as good), but then - oh my goodness - 8-10mths hits. This is the worst sleep gets in the whole of the first year. At this age 84% of babies are waking (and feeding) regularly at night. Who would have thought that your baby would sleep significantly worse at 10mths than they did at 3?!!

Thankfully from around 11mths things start to improve again, fairly steadily for the next 6mths or so (although not the golden heyday of 3mths!). You can still expect nightwaking and night feeds at this age though.

I didn't draw the rest of the chart, as it's a bit depressing, but when can you expect 'good' sleep fairly reliably? somewhere between 2-3yrs of age (there is a common dip at about 2.5yrs however). That's a *lot* later than most people think and certainly a lot later than most professionals advise, but it's the reality, it's just such a shame that we've lost touch with reality when it comes to infant sleep! The secret to all of this is you - what you can do to stay calm, rested and able to cope with this normal sleep pattern. Having realistic expectations is a huge start.
The NEWLY UPDATED Gentle Sleep Book - out now! If you would like to understand and learn how to improve your baby, toddler, or pre-schooler's sleep WITHOUT cry-based conventional sleep training, this is the book for you! p.s: Come and chat with me on Facebook, Twitter and Instagram Or watch my videos on YouTube You can also sign up for my free parenting newsletter HERE.

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We ('we' meaning society) seem to think that baby sleep is linear. By that I mean we seem to think that it gets better as babies grow older. Or at least we believe it is static, ie. it won't get worse again. The thing is, it's not linear (certainly not in an upwards trajectory) and...

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Reprinted from Mother-2-Mother.com (2000-2006), with permission from the author, Paula Y.

A note about exclusive pumping:

There are occasions that arise which may prevent a mom from being able to nurse her baby. A mother who has a baby who cannot or will not latch, for whatever reason, may assume there is no choice but for her to use infant formula. There is another option however, and one that doesn't seem to get the support or acknowledgment it deserves - exclusively pumping, also known as " EPing ".

In most cases, a mother who has made the decision to exclusively pump has not done so "lightly". She is aware of the irreplaceable benefits of her milk, and she wants her baby to have the best, so the most logical conclusion for her is to pump and provide her milk to baby by bottle.

Sadly, many (including health care providers) will tell mom that this is crazy idea, and "it'll never work"; "you'll run out of milk"; or will say "you simply will not be able to keep up". Without the support and information she needs, a mom may simply give up.

Those who don't give up often are faced with other issues to overcome. They often feel like they are in a class by themselves, excluded from the usual groups of moms who typically form into "support groups" either for breastfeeding mothers, or for formula feeding mothers.

They may feel they must explain "why" they are "bottle feeding" breastmilk - even to their health care providers who often ask.. "breast or bottle" assuming "bottle" is formula.

While everyone does agree that there are irreplaceable benefits to nursing baby directly from breast, everyone also must agree that breastmilk itself is irreplaceable. When faced with providing breastmilk, or not, then whenever possible it should be breastmilk regardless of the method of delivery.

There is no room or need for guilt here - the mother who has done all she can to bf "normally" isn't a failure - she is just doing the best she can in the situation she is in. Mothers who choose to exclusively pump are very dedicated mothers - determined to do the best they can for their precious babies, and they deserve respect and support.

Here are some tips and information regarding exclusive pumping:

All About Exclusive Pumping and Tips for EPing Moms by EPing Moms:
The Best... Expressed!
(italicized info shared by Shanna)
HOW OFTEN TO PUMP & WHEN?:

First and foremost - one should have a good quality, double electric pump. Some mothers rent them, others buy pumps such as the Hygeia EnJoye. The quality of the pump can make all the difference in the world!

A normal newborn baby nurses on average 8 to 12 times in a 24 hour period. Most experts suggest it is best if mom can come close to matching what the normal nursing baby would do at the breast, and recommend she pump about every two hours, not going longer than three hours between sessions. Understanding how milk production works can help moms in their efforts to establish good milk supply. The more frequently the breasts are emptied, the more milk mother should have. Therefore, if she were to pump at least every 3 hours, for about 20 minutes, she should establish and maintain a good milk supply. In the first couple of weeks, she may also want to pump at least twice at night, but not all mothers do this.

"It's insanely hard in the beginning but you need to pump every 2 to 3 hours around the clock. Prolactin levels (the hormone that tells your body to make milk) are highest in the early morning hours so mom would want to make sure she is pumping then as well. This is like the 1am to 5am stretch of time. If mom can at least get one pump in during this time, it will really help. The main concern is to get enough pumps in per day - a minimum of 7 pumps per day. I will say from experience that when I pushed myself to get in 8 pumps per day, my supply REALLY increased. Most of the time, I just couldn't push myself and ended up with 7 times. And to create a little bit of sanity, it is the number of pumps per day that you get in and not necessarily the amount of time you wait in between pumps that counts. So, if I needed to run an errand or just wanted to get out of the house without dragging my pump along, I would pump every 2 hours in the morning and then have a window of about 4 or 5 hours in the afternoon to do everything and would then pump again every 2 hours in the evening to get my total of 7 pumps in for the day. That being said, I did NOT get up to pump in the middle of the night if my baby wasn't awake. I thought that was cruel and couldn't do it! Ha! The sleep was more important to me (especially after the c-section). A lot of pumping is trial and error and this is why keeping info in a spreadsheet (or journal) is helpful. If you start sleeping through the night or going longer stretches and see a huge decline in your volume, you can always set you alarm to add another pump back in. I never had to but this can vary from mom to mom. I did the early morning pump as long as I was up feeding the baby, but if she slept 5 hours through the night, so did I! "

PUMPING - HOW LONG?

Most experts agree that whatever the reason for pumping, moms should pump for about 20 minutes. Most agree its best to pump at least 15 minutes, and to avoid going much longer than 20 minutes. Experts also encourage pumping about five minutes past when the milk stops flowing, often by doing so mom will elicit another letdown, and at the very least will maintain production as well as encouraging increase in supply if needed.

"The standard advice is to pump for 15-20 minutes. Even if you don't have milk flowing that entire time, you need to pump that long to get enough nipple stimulation. Also pumping at least 5 minutes after your milk stops flowing will tell your body that you need more milk; thus increasing your supply. 15 minutes should absolutely be the minimum pumping time. I've talked to women who only pumped for 10 minutes and eventually started losing their supply. They had to work really hard to rebuild it."

Pump Settings

"More is not better" when it comes to the suction settings on the breast pump. Most experienced moms do not set the pump speed on high, but rather keep it on lower setting for comfort.
"This one was a BIGGIE for me and I want to definitely pass this one on! There should be a suction setting on your pump and a speed dial. This is very important, the higher the suction does NOT mean the more milk you make. Your pump will probably have a suction setting of minimum, medium, and maximum. I had mine set on medium when I developed a blister. Once it healed, I turned it down to minimum and have never had another blister or pain again. I keep the speed at 3 but if you feel like too much areola is being sucked into the horn, then turning down the speed will remedy that. If you are in a lot of pain and turn down the settings, you might actually get more milk because you are more relaxed!"

HOW MUCH MILK PER BOTTLE?

Moms may find it surprising that the breastfed baby often takes less milk in the bottle than formula babies take in. This is because breastmilk is so well utilized by the baby's body that less is needed. Since breastmilk is so easily and completely digested, the breastfed baby needs to eat more often, but they don't need as much per bottle.

When a baby is nursed from the breast, research shows us that baby will vary their intake of milk from feeding to feeding, and the length of time at the breast doesn't always correlate with the amount of milk taken from the breast. Overall, the average bf baby takes in between 19 and 30 oz (or 570 - 900 mL) per day (24 hrs), but the amount taken per bottle may vary somewhat from feeding to feeding, just as it does at the breast, depending on baby's need at the time.

" According to the most current breastfeeding research, exclusively breastfed babies take in an average of 25 oz (750 mL) per day between the ages of 1 month and 6 months. This may vary a little from baby to baby, but the average range of milk intake is 19-30 oz per day (570-900 mL per day).
To estimate the average amount of milk baby will need at a feeding:

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

Then divide 25 oz by the number of nursings.

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

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

NOTE: Current breastfeeding research does not indicate that breastmilk intake changes with baby's age or weight between one and six months."

You can find a quick and easy expressed breastmilk calculator here.

HOW TO BOTTLEFEED

It is important to remember that it is very easy to overfeed a baby using bottles. This is because the way a baby drinks from a bottle is very different than how a baby would nurse from the breast. A baby cannot control the flow of milk from a bottle thus experts recommend using slow flow or "newborn" type nipples, to reduce the risk of overfeeding.

The breastmilk should never be warmed in the microwave, since doing so not only creates hot spots that cannot fully be distributed evenly even when the milk is mixed (the heat adheres to the fats which "glob" together, and can result in scalding of a baby's mouth and throat), but it actually alters the composition of the breastmilk, damaging some of the nutrients. Shaking breastmilk is also not recommended (gently swirl to mix, instead).

Ideally bottlefeeding the baby should mimic how a mother breastfeeds her baby. The baby should be fed on cue, or demand, and not according to a rigid schedule. Breastmilk digests in about 90 minutes, so one would expect the feedings to be anywhere from 1.5 hrs to 3 hours apart. (younger babies often need to eat more frequently than older babies).

The bottle should be offered gently, in a non-stressful manner, with the baby drawing the nipple into the mouth. The type of bottle or nipple is not as important as the manner in which the bottle is offered. A typical nursing session lasts about 15 to 20 min, and care should be taken to allow baby to take his/her time to drink the bottle, not "rushing" through a feeding as quickly as possible. Changing position mid-way through a feeding is often recommended, as is holding baby is a more upright position. Propping a bottle is also not recommended.

INCREASING YOUR SUPPLY

There are wonderful tips on increasing milk supply below - those that work for nursing mothers also work for mothers who exclusively pump, the biggest "difference" is that nursing mothers are encouraged to put baby to breast often, and pumping mothers are encouraged to pump often. Probably THE most important thing to remember is to pump often and pump long enough to soften (or "empty") the breast.
"Some little tips to help increase your supply if you really need it. It's nice to have these on hand just in case:
First drink plenty of water. I don't drink a ton but I make sure to stay hydrated. Check your pee when you go (I know, sounds funny!). If it is light yellow to clear, you are plenty hydrated.
Make sure you eat! While you are pumping, you will keep the weight off, I promise! It can make you hungry as a horse and it does that for a reason. You need the extra calories because you are burning so much off! When I didn't eat enough, I would get really light headed and feel like I was going to drop my baby...not good! Eventually, your hunger should taper off (mine has).

Eat REAL oatmeal, not the instant. You can eat the quick oats (the ones that cook in 1 minute) or the old fashioned oats (that cook in 5 minutes). You can also make cookies that have oatmeal in them and get oatmeal that way (I prefer this way! Ha!). The way they process the instant oatmeal, it doesn't give you the same results. No one is sure how the oatmeal works but it does!

Get some rest (yeah, I know easier said than done!) If you are exhausted and have the opportunity to take a nap (even if it pushes your pump back) do it! You will actually get more milk that way! Even if you're not sleeping, rest by sitting down a lot. Conserving energy is important.

Don't stress too much. This all depends on how you personally handle stress. I tend to be a thinker, so I think things out a lot. It has to be some MAJOR stressful situation for it to hurt my supply.

Some suggest drinking dark beer, with or without alcohol. Some say it's the barley in it or something, that helps to increase supply. Plus some women just swear by the relaxation it gives them! You can have 1 or 2 beers without much crossing into your milk. ( Note: Most breastfeeding experts do not routinely recommend using alcohol to boost milk supply. More on alcohol and breastfeeding here.)

There is a tea called Mothers Milk Tea and it is supposed to increase your supply if you drink it.

There are herbs like Fenugreek and also prescription medications that will increase your supply if you really need it. I would use these as a last resort but they can be effective and are available!
Most importantly, good pumping habits will keep your supply up and increase it!"

PUMPING TRICKS & More Tips For EPing Moms by EPing Moms

(aka "Tricks of the Trade" shared by Shanna)

"Go hands free! This was the best trick I learned!! I went hands free and set my pump up by my computer and read my pumping board while I pump. It keeps me from looking down into my bottles wondering how much I'm getting, being bored out of my mind, and makes time FLY by! You can use an old nursing bra and just cut slits in the flap. Then you just slide the horns through. I did this for a while but I didn't want to wear the cut up bra all day long so that meant I had to literally change bras before each pump. At 7 times a day, that was a bit much!! So, I bought a pumping bra and LOVE it! It's the Easy Expressions bustier.

The best thing about this bustier is that it can be worn over any nursing bra. So, when it's time to pump, I put the flaps down on my nursing bra, wrap the bustier around, slide the horns through the holes, position them and zip it up. That's all!"
"The refrigerator trick. This is where you rinse your horns and/or collection bottles after each pumping session. You put them in a ziplock bag (or not, this is optional), and put them in the refrigerator. The idea is that since breast milk is good in the fridge for 5-8 days, any residue left on the horns won't matter. Then you can wash the horns/bottles once at night. I throw mine into the dishwasher (all except the white membranes) and it's easy, easy, easy!""Storage bags. Many of us started out using the Gerber Seal-N-Go bag but they get very pricey quickly. They are like $5.50 for a box of 25 bags. After researching it online, I found many other women were using regular freezer bags for freezing the milk....MUCH cheaper! Everything I've read shows that they are safe to use. From what I have found, I only buy Glad and not Ziploc. Ziploc seems to have a much higher rate of leaks. I write the date and amount of ounces on the label with a sharpie and put the milk in and freeze flat. I then take several of them and put them into a gallon size freezer bag and write the dates that are enclosed on the gallon bag. This helps by double bagging and keeping them grouped. This way the corners on the bags won't get poked and possibly cause the bag to leak. Also, whenever I want to get a bag, I can just dig through gallon size bags instead of tons of little bags floating around! : I usually put one or two days worth in a gallon bag." "Lube Up! It is perfectly safe to put the lansinoh on before pumping and still use the milk. Putting it on before and after pumping really helps to keep you from getting too sore. Purelan100 is also good (and cheaper). I've used this from the beginning. You can also rub Olive Oil on the horns and inside the nipple chamber to reduce friction. Olive Oil is antibacterial so it is helpful. This is also safe to use and pump milk with. I've done both of these and hadn't had a problem. There are times when I seem to get sorer than other times with no real explanation. But, it then goes away as quickly as it came! Who knows!""Taking Care of Baby When Pumping. Once I went hands free and had to do those early morning feedings by myself, I would sit on the floor and prop my baby up in her boppy pillow on the floor. I would get hooked up to the pump and start it and pump while I fed her. About the time she was done eating, I was done pumping and I would put her back in bed and go to sleep myself. This will cut down on your time tremendously! It also helps to do this if your pumping time happens to correspond to your baby's feeding time during the day. The bouncy seat is my best friend! I would put her in the bouncy seat and bounce it with my foot while surfing the net and pumping. It made time fly by and she was content. You may find other solutions if you have older children, or extra help.""Taking Care of Older Children, and Pumping. You may not need a lot of tricks for this one depending on the age of the child, or children. They will probably understand if you just explain that while you are pumping, they can't get up and get things without help. Some tricks other moms had mentioned to keep their other child entertained and kind of reward them would be to go shopping and let your child pick out a special toy or video that she really wants. Then when ever it comes time for you to pump, she can play with it. But, she ONLY gets to play with it when you pump. This helps to make pumping time special for her as well and can help prevent any resentment she might begin to feel."Excessive caffeine may cause problems (like keeping the baby wired!). I avoid caffeine completely (except chocolate) but even if you have 1 drink a day, it won't hurt. Just don't go over board. (More on caffeine here.)

Medications that have Sudafed (pseudoephedrine HCl) in them can affect milk supply! Be careful!
Regular birth control pills will impact milk supply, and some women even have a problem with the mini pill. Breastfeeding (and yes that's what you are doing even if it's not from "the tap") is a good deterrent for ovulation but not 100% so be careful! However, you may find you get hot flashes and things like that. It is normal because your body is acting like it's going through menopause. This suppresses ovulation and allows you to make milk. I thought I was going crazy until I learned this! Ha! Sometimes if you get your period back while pumping, it can decrease your supply. This can be fixed by taking a calcium/magnesium supplement. (I don't have mine back yet and loving it!).
"WHEN DOES THIS GET EASIER?
Around 3 months your supply will probably be established. This is when you can begin to drop the number of times per day that you pump and not see too much of a decrease in total output (this is again, where the spreadsheet comes in handy). That's why if you do the hard work in the beginning, I promise it will pay off when this time comes! If you don't keep up the number of pumps per day in the beginning, you may continue to have to pump a high number of times per day just to maintain a small supply. Of course, this is all dependent on how each woman produces milk. So, you may have such a great supply and so much frozen that you can drop pumps earlier. I began dropping pumps at 10 weeks and by 3 months I was down to 4 pumps per day! I lost a little with each drop but am currently at 50 ounces per day. There's no way my baby will ever eat that much so I see no reason to pump more. You will have to decide for yourself. Once you start dropping pumps, you will need to pump longer at each session (because you've gone longer in between pumps and need longer to empty your breasts). This is also dependent on the woman. I pump about 35-40 minutes per pump now on 4 times because I get another let down at about 36 minutes into it!"

I firmly believe that pumping is 10% physical and 90% psychological. If you try to view this as positively as possible, I think you will have a better outcome. That's why going hands free and doing everything to minimize your stress about pumping is important.

A lot of people don't understand pumping. I still get stupid questions like, "Why don't you just nurse?" Well, DUH! She won't nurse! Ha! You should do whatever makes you comfortable. Sometimes strangers ask me if I'm breastfeeding and if I don't feel like dealing with anything, I just say yes. I am after all! She's just getting it "to go" instead of from "the tap"! Ha!

Mostly though, I do all I can to educate. I know many women who didn't know this option was even possible and wished they had when breastfeeding didn't work out. Don't listen to doctors or nurses who tell you this isn't possible. There just isn't enough wide spread info out there and unfortunately most health care professionals give really bad advice (like only pump for 10 minutes). So, when they hear back from their patients on how they had supply problems or dried up, they just assume it's not possible to pump long term. On my online group, there are women who have been pumping for a year or longer! It is DEFINITELY possible!

Most importantly, if for any reason you just don't want to do it anymore, it is perfectly fine! Remember, a happy mommy = a happy baby. You have to do whatever is right for your entire family. Pumping is hard and can take its toll on you. There is no right or wrong when it comes to how you feed your baby! Remember that! We all have days when we want to wean. That's why support is SOOO important!"

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There are occasions that arise which may prevent a mom from being able to nurse her baby. A mother who has a baby who cannot or will not latch, for whatever reason, may assume there is no choice but for her to use infant formula.

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Expressing and storing your breastmilk - NCT

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Over Supply - Block feeding Dos & Don'ts

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Over Supply - Block feeding Dos & Don'ts

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This morning I talked with a breastfeeding mother whose story is becoming all too common. Her 1-month-old third baby was having trouble coping with her fast milk flow. At many feedings, she coughed, sputtered, and sometimes pulled off the breast crying. This mom assumed from this behavior that she had an overactive let-down (OALD) and started a strategy called "block feeding."
What is Block Feeding?
Block feeding involves restricting baby to one breast for 3-hour or longer blocks of time before giving the other breast. It is very effective at bringing down milk production when a mother is making way too much milk. Allowing the breasts to stay full for a set period of time sends the signal to slow milk production.
Block Feeding Dos
This strategy can be a lifesaver in some cases, as oversupply (aka "hyperlactation" or "overabundant milk production") can decrease quality of life for both mother and baby. For a mother, the drawbacks of making too much milk include regularly full and uncomfortable breasts and recurring plugged ducts. For the baby, oversupply can cause a very fast milk flow that can be hard to manage. In this case, block feeding used for no longer than 1 week can be a boon for both mother and baby.
Block Feeding Don'ts
What seems to be more and more common, though, is the assumption that any struggle with milk flow is due to OALD or oversupply, when there is usually another cause. As a result, some mothers bring down their milk production with block feeding when their supply is actually at a healthy level, leading to other problems, such as slow weight gain.

As I told the mother this morning, during the early weeks, most newborns cough and sputter during breastfeeding some of the time. It takes practice and maturity for babies to learn to coordinate sucking, swallowing, and breathing during breastfeeding. Some episodes of milk flow struggles and pulling away are completely normal and are not necessarily signs of overactive let-down (OALD) or oversupply.
How to Know If Block Feeding Will Help
The most reliable gauge of whether block feeding may be helpful is baby's weight gain.If breastfeeding is going well, during the first 3 months, most babies gain on average about 2 lb/mo. (0.90 kg/mo.). If baby's weight gain is double this or more, block feeding for no longer than 1 week makes sense. If baby's weight gain isn't this high, it is likely that block feeding will cause more problems than it solves.
Alternatives When Baby Struggles with Milk Flow

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Block Feeding Dos & Don'ts - Nancy Mohrbacher

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This morning I talked with a breastfeeding mother whose story is becoming all too common. Her 1-month-old third baby was having trouble coping with her fast milk flow. At many feedings, she coughed, sputtered, and sometimes pulled off the breast crying. This mom assumed from this behavior that she h

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By Kelly Bonyata, BS, IBCLC

To understand how to effectively increase (or decrease) milk supply, we need to look at how milk production works...
For the most part, milk production is a "use it or lose it" process. The more often and effectively your baby nurses, the more milk you will make.
In the Beginning...

Endocrine (Hormonal) Control of Milk Synthesis - Lactogenesis I & II

Milk production doesn't start out as a supply and demand process. During pregnancy and the first few days postpartum, milk supply is hormonally driven - this is called the endocrine control system. Essentially, as long as the proper hormones are in place, mom will start making colostrum about halfway through pregnancy (Lactogenesis I) and her milk will increase in volume (Lactogenesis II) around 30-40 hours after birth.

Now infants can get
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During the latter part of pregnancy, the breasts are making colostrum, but high levels of progesterone inhibit milk secretion and keep the volume "turned down". At birth, the delivery of the placenta results in a sudden drop in progesterone/estrogen/HPL levels. This abrupt withdrawal of progesterone in the presence of high prolactin levels cues Lactogenesis II (copious milk production). Other hormones (insulin, thyroxine, cortisol) are also involved, but their roles are not yet well understood. Although biochemical markers indicate that Lactogenesis II commences approximately 30-40 hours after birth, mothers do not typically begin feeling increased breast fullness (the sensation of milk "coming in") until 50-73 hours (2-3 days) after birth.

These first two stages of lactation are hormonally driven - they occur whether or not a mother is breastfeeding her baby.

Established Lactation...

Autocrine (Local) Control of Milk Synthesis - Lactogenesis III

After Lactogenesis II, there is a switch to the autocrine (or local) control system. This maintenance stage of milk production is also called Lactogenesis III. In the maintenance stage, milk synthesis is controlled at the breast - milk removal is the primary control mechanism for supply. Milk removal is driven by baby's appetite. Although hormonal problems can still interfere with milk supply, hormonal levels play a much lesser role in established lactation. Under normal circumstances, the breasts will continue to make milk indefinitely as long as milk removal continues.

By understanding how local/autocrine control of milk synthesis works, we can gain an understanding of how to effectively increase (or decrease) milk supply.

What does current research tell us about milk production?

Current research suggests that there are two factors that control milk synthesis:

Milk contains a small whey protein called Feedback Inhibitor of Lactation (FIL) - the role of FIL appears to be to slow milk synthesis when the breast is full. Thus milk production slows when milk accumulates in the breast (and more FIL is present), and speeds up when the breast is emptier (and less FIL is present).

The hormone prolactin must be present for milk synthesis to occur. On the walls of the lactocytes (milk-producing cells of the alveoli) are prolactin receptor sites that allow the prolactin in the blood stream to move into the lactocytes and stimulate the synthesis of breastmilk components. When the alveolus is full of milk, the walls expand/stretch and alter the shape of prolactin receptors so that prolactin cannot enter via those receptor sites - thus rate of milk synthesis decreases. As milk empties from the alveolus, increasing numbers of prolactin receptors return to their normal shape and allow prolactin to pass through - thus rate of milk synthesis increases. The prolactin receptor theory suggests that frequent milk removal in the early weeks will increase the number of receptor sites. More receptor sites means that more prolactin can pass into the lactocytes and thus milk production capability would be increased.

Both of the above factors support research findings that tell us:

FULL
Breast
=
SLOWER
Milk
Production

EMPTY
Breast
=
FASTER
Milk
Production

Research indicates that fat content of the milk is also determined by how empty the breast is (emptier breast = higher fat milk), rather than by the time of day or stage of the feed.

How does milk supply vary throughout the day?

Earlier researchers observed that milk volume is typically greater in the morning hours (a good time to pump if you need to store milk), and falls gradually as the day progresses. Fat content tends to increase as the day progresses (Hurgoiu V, 1985). These observations are consistent with current research if we assume the researchers were observing babies with a fairly typical nursing pattern, where baby has a longer sleep period at night and gradually decreases the amount of time between nursing as the day progresses.

Storage capacity: Another factor that affects milk production and breastfeeding management is mom's milk storage capacity. Storage capacity is the amount of milk that the breast can store between feedings. This can vary widely from mom to mom and also between breasts for the same mom. Storage capacity is not determined by breast size, although breast size can certainly limit the amount of milk that can be stored. Moms with large or small storage capacities can produce plenty of milk for baby. A mother with a larger milk storage capacity may be able to go longer between feedings without impacting milk supply and baby's growth. A mother with a smaller storage capacity, however, will need to nurse baby more often to satisfy baby's appetite and maintain milk supply since her breasts will become full (slowing production) more quickly.

Think of storage capacity as a cup - you can easily drink a large amount of water throughout the day using any size of cup - small, medium or large - but if you use a smaller cup it will be refilled more often.

What does the research tell us about increasing milk supply?

Milk is being produced at all times, with speed of production depending upon how empty the breast is. Milk collects in mom's breasts between feedings, so the amount of milk stored in the breast between feedings is greater when more time has passed since the last feed. The more milk in the breast, the slower the speed of milk production.

To speed milk synthesis and increase daily milk production, the key is to remove more milk from the breast and to do this quickly and frequently, so that less milk accumulates in the breast between feedings:

EMPTY
Breast
=
FASTER
Milk
Production

In practice, this means that a mother who wishes to increase milk supply should aim to keep the breasts as empty as possible throughout the day.

To accomplish this goal and increase milk production:

1. Empty the breasts more frequently (by nursing more often and/or adding pumping sessions between nursing sessions)

2. Empty the breasts as thoroughly as possible at each nursing/pumping session.

To better empty the breasts:

Make sure baby is nursing efficiently.

Use breast massage and compression.

Offer both sides at each nursing; wait until baby is finished with the first side before offering the second. Switch nursing may be helpful if baby is not draining the breast well.

Pump after nursing if baby does not adequately soften both breasts. If baby empties the breasts well, then pumping is more useful if done between nursing sessions (in light of our goal to keep the breasts as empty as possible).

Are you having problems with oversupply?

Mothers who are working to remedy oversupply usually need to decrease supply without decreasing overall nursing frequency or weaning baby. One way to accomplish this is by "block nursing" - mom nurses baby as frequently as usual but restricts baby to one breast for a set period of time (often 3-4 hours but sometimes longer) before switching sides. In this way, more milk accumulates in the breast before mom switches sides (thus slowing milk production) but baby's nursing frequency is not limited.

See also:
Frequently Asked Questions about Milk Production I'm confused about foremilk and hindmilk - how does this work?
Anatomy of the human breast. Diagram by DT Ramsay, RL Hartmann, PE Hartmann

Note: the graphics above are copyrighted. Do not use without express written permission.

Many thanks to Denise Fisher of Health e-Learning for the valuable feedback!

Additional information

How the breasts make and deliver milk from AskDrSears.com

Examining the Evidence for Cue Feeding Breastfed Infants by Lisa Marasco, BA, IBCLC and Jan Barger, MA, RN, IBCLC

Human Milk and Lactation by Carol L Wagner, MD

References

Cox DB, Kent JC, Casey TM, Owens RA, Hartmann PE. Breast growth and the urinary excretion of lactose during human pregnancy and early lactation: endocrine relationships. Exp Physiol. 1999;84(2):421-34.

Cox DB, Owens RA, Hartmann PE. Studies on Human Lactation: The Development of the Computerized Breast Measurement System. June 1998. Accessed May 28, 2004.

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

Cregan MD, Mitoulas LR, Hartmann PE. Milk prolactin, feed volume and duration between feeds in women breastfeeding their full-term infants over a 24 h period. Exp Physiol. 2002 Mar;87(2):207-14.

Hartmann PE, Prosser CG. Physiological basis of longitudinal changes in human milk yield and composition. Fed Proc. 1984 Jun; 43(9): 2448-53.

Hurgoiu V, Marcu A, Sopon E, Olariu M. Dynamics of the composition of lipids in human milk during lactation. [French]. Pediatrie. 1985 Apr-May;40(3):201-5.

Ingram J, Woolridge M, Greenwood R. Breastfeeding: it is worth trying with the second baby. Lancet. 2001 Sep 22;358(9286):986-7.

Marasco L, Barger J. Cue Feeding: Wisdom and Science. Breastfeeding Abstracts. 1999 May;18(4):28-29

Mohrbacher N. Breastfeeding Answers Made Simple. First Edition. Amarillo, Texas: Hale Publishing; 2010. 390-401.

Neville MC, Morton J. Physiology and endocrine changes underlying human lactogenesis II. J Nutr. 2001 Nov; 131(11): 3005S-8S.

Neville MC. Anatomy and physiology of lactation. Pediatr Clin North Am. 2001 Feb; 48(1): 13-34.

Neville MC, Morton J, Umemura S. Lactogenesis. The transition from pregnancy to lactation. Pediatr Clin North Am. 2001 Feb; 48(1): 35-52.

Peaker M, Wilde CJ. Feedback control of milk secretion from milk. J Mammary Gland Biol Neoplasia. 1996 Jul;1(3):307-15.

Perez-Escamilla R, Chapman DJ. Validity and public health implications of maternal perception of the onset of lactation: an international analytical overview. J Nutr. 2001 Nov;131(11):3021S-4S.

Ramsay DT, Kent JC, Owens RA, Hartmann PE. Ultrasound imaging of milk ejection in the breast of lactating women. Pediatrics. 2004 Feb;113(2):361-7.

Walker M. Physiology of the Breast During Pregnancy and Lactation. In: Walker M, editor. Core Curriculum for Lactation Consultant Practice, Sudbury, Massachusetts: Jones and Bartlett; 2002. 27-34.

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How does milk production work? * KellyMom.com

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To understand how to effectively increase (or decrease) milk supply, we need to look at how milk production works... For the most part, milk production is a "use it or lose it" process. The more often and effectively your baby nurses, the more milk you will make.

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NHS 'Healthy feeding Healthy weight' leaflet

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NHS 'Healthy feeding Healthy weight' leaflet

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Emma Pickett
IBCLC, Lactation Consultant and Breastfeeding Counsellor

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Responsive Bottle-Feeding - Attachment Parenting UK

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We know bottle feeding isn’t just about the milk. It’s also about holding the baby in a particular way & responding to cues.

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Our work to support breastfeeding is based on extensive and resounding evidence that breastfeeding saves lives, improves health and cuts costs in every country worldwide.

Infant health: Breastfeeding protects children from a vast range of illnesses, including infection, diabetes, asthma, heart disease and obesity, as well as cot death (Sudden Infant Death Syndrome)

Maternal health: Breastfeeding also protects mothers from breast and ovarian cancers and heart disease

Relationship-building: Breastfeeding supports the mother-baby relationship and the mental health of both baby and mother

Worldwide benefits: The benefits are seen in both high- and low-income countries, with a study published in The Lancet in 2016 finding that increasing breastfeeding rates around the world to near universal levels could prevent 823,000 annual deaths in children younger than five years and 20,000 annual maternal deaths from breast cancer

Cost savings: Breastfeeding contributes to significant savings to the NHS, with initial investments paying off within just a few years. A NICE costing report estimates that Baby Friendly accreditation will start to save a facility money after three years, owing to a reduction in the incidence of certain childhood illnesses. Baby Friendly's report Preventing disease and saving resources found that moderate increases in breastfeeding would translate into cost savings for the NHS of many millions of pounds, and tens of thousands of fewer hospital admissions and GP consultations. In addition, Baby Friendly's staged approach to assessment and accreditation allows facilities to spread costs and enables better financial planning.

Key sources of breastfeeding research

Lancet breastfeeding series: Confirms the benefits of breastfeeding for children and mothers, regardless of whether they live in high- or low-income nations, and that countries are not doing enough to support breastfeeding

Acta Paediatrica special issue on breastfeeding: Finds that the health benefits of breastfeeding are substantial, lasting well beyond the period of breastfeeding and affecting high- and low-income populations alike, whilst also demonstrating that the Baby Friendly Initiative is highly effective in improving breastfeeding rates

Evidence and rationale for the Baby Friendly standards

Preventing disease and saving resources: Looks at the potential health and cost contributions of increasing breastfeeding rates in the UK.

Find our more in our research section.

Breastfeeding is a natural 'safety net' against the worst effects of poverty ... Exclusive breastfeeding goes a long way toward cancelling out the health difference between being born into poverty and being born into affluence ... It is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born.

James P. Grant, Executive Director of UNICEF (1980-1995)

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The benefits of breastfeeding - Baby Friendly Initiative

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Learn more about Baby Friendly's work to support breastfeeding in order to save lives, improve health and cut costs worldwide.

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

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

breast milk protects your baby from infections and diseases

breastfeeding provides health benefits for you

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

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

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

Health benefits of breastfeeding for your baby

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

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

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

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

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

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

Health benefits of breastfeeding for you

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

Breastfeeding lowers your risk of:

Got a breastfeeding question?

Sign in to Facebook and message the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

Get Better Health: Start for Life

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

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

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

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Biological Nurturing - Laid-Back Breastfeeding

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Biological Nurturing - Laid-Back Breastfeeding

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NCT laidback breastfeeding information sheet

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Kangaroo care and skin-to-skin contact: FAQs

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Kangaroo care and skin-to-skin contact: FAQs

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What is kangaroo care?

It gained the name because of the way kangaroos keep their babies (joeys) in their pouch. It actually means giving uninterrupted skin-to-skin contact to your baby. It can also include exclusively breastfeeding if this is possible. Some call it kangaroo mother care (KMC) but in fact both parents can do it.

"Kangaroo care is a powerful yet easy way to help your baby to stay healthy and well whether they were born preterm or full-term (WHO, 2003)."

It's also thought to decrease neonatal mortality and help small babies to be discharged from hospital early (Richardson, 1997; WHO, 2003).

When do I start kangaroo care?

You'd usually start kangaroo care in hospital then continue it at home. It's done by carrying your baby close to you, usually on your chest.

Kangaroo care is most often used for premature babies, although not those who are very premature (Tommy's, 2017). It's good for premature babies when they no longer have any medical problems and all they need is to feed and grow (Tommy's, 2017). It's a kind of alternative to an incubator.

If you're interested, ask the medical staff what their policy is on kangaroo care. Some baby units might not be willing to offer it if it's not familiar to them. But if the staff have experience with kangaroo care, they will be happy for parents to use it from around 28 to 30 weeks (Tommy's, 2017). Parents usually practice kangaroo care until their baby reaches full term (40 weeks) (Tommy's, 2017).

What are the benefits of kangaroo care and skin-to-skin contact for my baby?

Mentally

Kangaroo care will calm and relax your baby. Just being close to your chest will comfort them thanks to things like the reassuring rhythm of your heartbeat (Ludington et al, 2005; UNICEF UK, 2018). Kangaroo care also decreases arousal in babies, which can mean they spend more time in a deep sleep (Richardson, 1997; Jefferies, 2012).

Babies are more alert for longer periods with kangaroo care too (Richardson, 1997). And it's linked with rapid brain development (Richardson, 1997).

Feeding

Kangaroo care is thought to be associated with breastfeeding for longer, producing more milk and being more likely to exclusively breastfeed (UNICEF UK, 2018). It can also help your baby to gain weight (Richardson, 1997; UNICEF UK, 2018).

Comfort

Kangaroo care can help your baby to keep warm too by regulating their temperature (Jefferies, 2012). This skin-to-skin contact releases oxytocin, which is a pain reliever for you and your baby (Johnston et al, 2014). That's why babies given kangaroo care can experience less pain and cry less than those who are in incubators (Kostandy et al, 2008).

Physically

Kangaroo care can help babies to regulate their heart and breathing rates (Jefferies, 2012).

What are the benefits of kangaroo care and skin-to-skin contact for me?

Mentally

Kangaroo care can calm and relax you, generally improving your mental wellbeing. It'll also help to reduce the chance of you getting postnatal depression or ease it if you already have it. This is thanks to your friend, the love hormone oxytocin (Dombrowski et al, 2001; UNICEF UK, 2018).

Kangaroo care can also help you feel like you are actively helping your premature baby. It can help you feel in control, giving you confidence and a sense of your role as a mother (WHO, 2003; Richardson, 1997). It can also help with bonding and help you to feel closer to your baby (Richardson, 1997; Jefferies, 2012).

Feeding

Kangaroo care makes breastfeeding easier and aids milk production. (Though of course, if your baby is not feeding enough or needs supplementing, there is nothing wrong with using formula as well as or instead of breast milk.) This will only be the case from around 32 weeks as until then the baby will probably be tube fed. Syringes or cups can be used too.

Practicalities

Using kangaroo care means your baby is more likely to be able to go home with you sooner (WHO, 2003; UNICEF UK, 2018). Hoorah for that.

What do you need for kangaroo care?

The only real 'equipment' you need is a support bind to keep your baby next to your skin. It's usually a soft piece of fabric, about a metre squared, folded diagonally in two and secured with a knot or tucked in your armpit.

If you're at home or in hospital, you won't need the fabric as your baby will just rest on your chest (for women, between the breasts). See here for a more details and pictures of how to practice kangaroo care.

When the temperature is 22°C to 24°C, you can carry your baby naked except for a nappy, a cosy hat and socks. When it falls below 22°C, you could pop your baby into a sleeveless cotton top that you can leave open at the front to allow you to snuggle them skin-to-skin. You can cover them in a blanket if you're in hospital or at home. Otherwise, you could wrap your own clothes around them (WHO, 2003).

It's possible you might need other equipment, for example if your baby is premature. Equipment you might need includes:

Neonatal scales with 10g intervals.

A thermometer for measuring body temperature.

Basic resuscitation equipment and oxygen - this should be available where possible for preterm babies.

Drugs for preventing and treating the problems preterm babies frequently experience.

Your baby will only need to come off your chest for nappy changes and any medical assessment they might need. They can even sleep there if they are strapped to you but get guidance on this if you choose to do it.

How do you know whether kangaroo care is right for you?

If you are available to do it and be with your baby full time.

If you're healthy enough yourself.

If it's something you want to do.

If you have a support network around you to do other things like housework, as giving kangaroo care means you will be able to do very little else.

This page was last reviewed in September 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.

Attending a Baby Cafe or other breastfeeding support drop-in is often helpful.

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.

Dombrowski MA, Anderson GC, Santori C, Burkhammer M. (2001) Kangaroo (skin-to-skin) care with a postpartum woman who felt depressed. MCN Am J Matern Child Nurs. 26 (4):214-216. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11452667 [Accessed 24th September 2018].

Engler AJ, Cusson RM, Bahnsen M, Coates P, McHargue L, Settle M. (2002) Kangaroo care: national survey of practice, knowledge, barriers and perceptions. MCN Am J Matern Child Nurs. 27(3):146-153. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12015442 [Accessed 24th September 2018].

Jefferies AL; Canadian Paediatric Society; Fetus and Newborn Committee. (2012) Kangaroo care for the preterm infant and family. 17(3):141-143. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287094/ [Accessed 24th September 2018].

Johnston C, Campbell Y, Disher T, Benoit B, Fernandes A, Streiner D, Inglis D, Zee R. (2017) Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev. (2):CD008435. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008435.pub3... [Accessed 24th September 2018].

Kostandy R, Cong X, Abouelfettoh A, Bronson C, Stankus A, Ludington SM. (2008) Effect of kangaroo care (skin contact) on crying response to pain in preterm neonates. Pain Manag Nurs . 9(2):55-65. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647362/ [Accessed 24th September 2018].

Ludington-Hoe S, Hosseini R, Torowicz D. (2005) Skin-to-skin contact (kangaroo care) analgesia for preterm infant heel stick. AACN Clin Issues. 16(3):373-87. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1890009/ [Accessed 24th September 2018].

Richardson H. (1997) Kangaroo care: why does it work? Midwifery Today. 44. Available at: https://midwiferytoday.com/mt-articles/kangaroo-care-work/ [Accessed 24th September 2018].

Tommy's. (2017) Kangaroo care. Available at: https://www.tommys.org/pregnancy-information/pregnancy-complications/premature-birth/your-babys-time-hospital/kangaroo-care [Accessed 24th September 2018].

UNICEF UK. (2018) The baby friendly initiative. Skin-to-skin contact. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact/ [Accessed 24th September 2018].

WHO. (2003) Kangaroo mother care: a practical guide. Available at: http://www.who.int/maternal_child_adolescent/documents/9241590351/en/ [Accessed 24th September 2018].

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Kangaroo care and skin-to-skin contact: FAQs | Baby & toddler articles & support | NCT

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Kangaroo care is a way of giving babies, especially those born early, all the benefits of skin-to-skin contact. But how might kangaroo care help you and your baby?

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Produced by Williams Lea for Public Health England 

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Free Breastfeeding Drop-in at St. Mary's Church in Andover every Friday 10-11.30am. (except Bank Holidays)

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Offering families coping with multiple births the opportunity to socialise and support each other in a safe and friendly environment, supported by our staff & volunteers.  Please note that attendance at this Group is  membership only.

This group meets every Tuesday morning – term time only at Rucstall Community Centre, Basingstoke.

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A resource for new dads, developed with the NHS.

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I was a bit scared when we found out we were having a baby, obviously happy, but a bit scared and in the beginning I was a bit clueless. The child development part is my favourite bit, but there's things in there, like things about mental health, that I didn't know about and that I didn't know you needed to know about.

Ross, 22

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DadPad | The Essential Guide for New Dads | Support Guide for New Dads

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Developed with the NHS, DadPad gives new dads and dads-to-be the knowledge and skills needed to gain confidence and give their baby the best start in life.

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

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

Find more useful organisations.

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

Resources to support you

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

Overcoming breastfeeding problems

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

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

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

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Support for parents - Baby Friendly Initiative

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

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Created by Corinne Thorn (NCT BFC) using images from the Academy of breastfeeding Medicine Protocol #36 (2022)

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Information on premature and sick babies 

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Information on premature and sick babies 

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Ieally important that the baby is awake and alert, and that the milk isn't just tipped into their mouth. They need to be sitting upright too. It can feel a bit fiddly to start with so ask for some help

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Did you cup feed your little one? Really important that the baby is awake and alert, and that the milk isn't just tipped into their mouth. They need to be sitting upright too. It can feel a bit fiddly to start with so ask for some help x #breastfedbaby #breastfeeding #cupfeeding #colostrum #breastmilk #latching #ibclc #lactationconsultant #midwife #ebm | LMJ Infant Feeding Support | LMJ Infant Feeding Support · Original audio

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7.6K views, 52 likes, 13 comments, 33 shares, Facebook Reels from LMJ Infant Feeding Support: Did you cup feed your little one? Really important that the baby is awake and alert, and that the milk...

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Introducing your baby to their first foods is an important time in your baby's life and can be lots of fun. Health professionals agree you should start giving your baby their first solids when they are around six months old (NHS, 2019a). A baby's digestive system needs time to develop so that it can cope with solid foods (UNICEF, no date).

While not all babies instantly enjoy solids, you may see some happy and funny faces as your baby tries their first foods. Family life is about to get messier as your baby explores new tastes and textures.

When should my baby try their first foods?

Your baby should only need breastmilk or formula milk for the first six months of their life. Experts say that introducing solid food earlier than this has no advantages. It may even increase the risk of your baby getting an infection or illness (UNICEF, no date; First Steps Nutrition Trust, 2020).

Waiting until your baby is six months old before you introduce solids also means they'll be more likely to be able to feed themselves (Rapley and Murkett, 2010; Brown, 2017). At this age, your baby will also be able to manage foods in their mouth and swallow properly, which reduces the risk of choking (Rapley and Murkett, 2010). Babies don't produce all the enzymes needed to digest food thoroughly until they are about one year old (Naylor and Morrow, 2001; Brown and Lee, 2013).

How do I know if my baby is ready for solids?

Your baby will give you various signs that they might be ready for their first foods:

Your baby can sit up with support and hold their head steady.

They can swallow their food - babies who aren't ready automatically push food out of their mouth with their tongue.

They can pick up food and put it in their mouth. (NHS, 2019a)

Sometimes, your baby might seem hungrier but this on its own does not mean they need to start solids. Babies sometimes have growth and accompanying appetite spurts. Although some people believe that solids will help babies to sleep through the night, research doesn't support this (Brown and Harries, 2015; Murcia et al, 2019).

In the first six months of their life, you can respond to your baby's increased need for milk by feeding them more frequently if breastfeeding. You can also give them more milk feeds up to the maximum daily recommended amount if formula feeding (Marasco and Barger, 1999).

Most babies start to cut teeth when they're around six months old, and this helps them to bite and chew their food. Some babies get their first teeth earlier than this. Whenever they get their first teeth, babies don't need teeth to chew and will manage pieces of food quite well without (Brown, 2017).

A baby who is unsettled and putting their fists in their mouth a lot may be teething rather than hungry (NHS, 2019b).

What if my baby was premature?

If your baby was born prematurely, there is no definitive age when introducing solids is recommended. Some healthcare practitioners say a baby's four months corrected age is the youngest age to introduce solids. Looking out for the signs of readiness listed above is even more important with a premature baby (Bliss, no date).

You might want to speak to your GP or health visitor for further advice (NHS, 2019a).

Getting started: Introducing solid foods

From six months old, babies can eat a wide variety of foods and there's no need to begin with bland flavours. Babies will only need small quantities at first, because their tummies are still small (NHS, 2019b).

Some parents opt for baby-led weaning. Others choose to make homemade dishes and then purée or mash foods.

You might opt for pre-packaged baby purees and baby foods, or a combination - it's up to you. It's important to check the sugar content of commercially produced infant food, as it can be very high. Purees in pouches are not recommended for this reason (First Steps Nutrition Trust, 2018). Read our tips on how to get started with introducing your baby to their first foods.

Baby-led weaning

Baby-led weaning is when parents offer pieces of food for their baby to grasp in their hands and feed themselves. Rather than you feeding your baby, baby-led weaning puts your baby in charge of picking up and eating what they choose. Read more in our baby-led weaning for beginners and baby-led weaning tips articles.

It can be slow to begin with. Your baby joining in at family meals can help them as they'll watch and copy other family members.

Your baby's first solid foods

You can offer your baby their first solid foods at a time that suits both of you, although it might be easier if your baby is not tired or too hungry (NHS, 2019a).

There is little evidence to tell us which foods are best for your baby to start with. But vegetables and fruit can make good first foods. You could try starting with:

Soft fruit or cooked vegetables chopped into sticks or pieces large and firm enough for your baby to pick up with their whole fist.

Mashed or pureed fruit or vegetables.

Baby rice or cereal - mix the rice with a bit of your baby's usual milk.

For a younger baby who is being spoon-fed starting on solid foods, you can add expressed breastmilk or formula.

You might be surprised that your baby can cope with pieces of lean, well-cooked meat or fish, pasta, pulses, beans or bread that they can hold and suck. (NHS, 2019a; First Steps Nutrition Trust, 2020)

Food for babies should not have salt added at either the cooking stage or afterwards (NHS, 2018). Babies also don't need sweet foods, such as biscuits or cakes, or foods high in saturated fats (NHS, 2018).

Iron-rich foods for babies

Anaemia (low iron levels) is one of the most common problems among young children (Daniels et al, 2018). So iron-rich foods are important in your baby's diet.

Iron-rich foods include red meat, pulses (peas and beans) and iron-fortified cereals. Vitamin C, which is in fresh fruit and fresh or frozen vegetables, can help your baby absorb iron. Breast milk and formula milk also contain iron.

Which foods should be avoided?

After six months of age, babies can eat small quantities of most foods except:

whole nuts and similarly unyeilding foods that could cause them to choke

foods that might cause food poisoning under the age of one year, such as raw egg (if no Lion mark is present), unpasteurised cheeses and raw shellfish

honey because of the risk of botulism

rice drinks because of the levels of arsenic

shark, swordfish or marlin due to high mercury levels.

What about food allergies?

If your baby already has an allergy or there is a family history of allergies, you might want to be particularly careful when introducing foods and perhaps speak to your GP or health visitor first (NHS, 2021). There is no evidence that introducing egg or peanut products before six months old rather than at six months prevents allergies (SACN-COT, 2016; NHS, 2021).

Some studies have suggested that babies at increased risk of peanut allergy might benefit from early introduction to peanut-containing foods (Du Toit et al, 2015). But it's too soon to say whether guidance to families will change.

Keeping your baby safe

Some parents worry that starting to eat solids puts their baby at risk of choking. Here are some precautions you can take to keep them safe when you're feeding your baby solid food:

Make sure your baby is sitting upright and steady.

Always stay with your baby while they are eating.

Don't rush your baby - let them take their time.

Cut food items like grapes and baby tomatoes lengthways.

Avoid foods like whole nuts, which children under five years should not have, because they are a choking hazard.

(Rapley and Murkett, 2010; NHS, 2021)

As well as being extra careful, you could learn what to do if your baby is choking. If they are choking, they won't make any noise at all (NCT, 2016). You might find it helpful to attend an NCT baby first aid course at this stage to help build your confidence.
This page was last reviewed in December 2021.
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 our NCT New Baby courses helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

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

You might find attending one of NCT's Introducing Solids Foods workshops helpful as they cover topics like when to start your baby on their first foods. They also cover topics like purees, baby-led weaning and what foods to avoid. These courses are run by NCT qualified practitioners and you will also get to meet other local parents with babies of a similar age to yours.

Some parents find attending a Baby First aid course helpful.

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Introducing your baby to solids | Baby & toddler, Feeding articles & support | NCT

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Here you'll find lots of helpful information on when to introduce your baby to solid foods and tips to make it easier, and what baby-led weaning is.

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Does your baby need more milk?
How to know your baby is getting enough breastmilk
Increasing your milk production
If supplements are needed
Feeding methods
Expressing your milk

Does your baby need more milk?

Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk production. Perhaps you and your baby had a difficult start, or were not given the support you needed to establish breastfeeding. Or maybe things were going well until your baby's weight gain faltered.

If others question your milk production and your baby is fussy, wants to feed much of the time, seems small, or gains weight slowly, you may be wondering whether you have enough milk.

Follow your baby not the book

Young babies need to nurse frequently to get enough milk and establish their mother's milk production. Following feeding schedules, using regular supplements, nipple shields, or a dummy can really reduce your milk production.

Breastmilk is also a drink and frequent nursing is normal. Adults rarely go longer than two hours without a drink, snack or meal. Your baby's tummy is tiny and breastmilk is quickly digested, so they need frequent feeds to help them grow. It is recommended that your baby is weighed no more than once a month for the first six months, unless there are concerns.

Sleepy Baby
A baby who sleeps a lot rather than waking to feed every 2-3 hours may need to be woken up to nurse, particularly if they have jaundice or aren't gaining enough weight. If this is difficult or your baby is lethargic, ask your midwife, health visitor or GP to check that all is well.

See our article Sleepy Baby - why and what to do for more information.

How to know your baby is getting enough breastmilk

Weight gain
It is normal for newborns to lose up to 7% of their birth weight in the first few days. Once your milk production increases, usually on day 3-4, expect your baby to begin gaining weight. Most babies regain their birth weight by the age of 10-14 days. You may also find it helpful to see Is my baby getting enough milk?

Plot your baby's weight gain on a UK-WHO growth chart based on the growth rates of breastfed babies (see examples below and Further Reading). Although they will be growing at their own individual rate, it will give you an indication of how they are doing.

Monitor your baby's weight over a period of time rather than week by week. Your baby's weight may generally follow the chart, or climb up, crossing the percentile lines. A gradual drop from one percentile line to the next (or the equivalent distance) is unlikely to be a problem unless their weight is low for their age. Heavier newborns often show 'catch-down' growth - they gain weight steadily but drop gradually against the chart lines.

Dropping against the chart is more of a worry for lower weight babies
If your baby's growth curve drops across two lines of the chart (or the equivalent distance), or if their weight is below the lowest line of the chart:

Follow the suggestions here to ensure they get more milk.

Seek help from your GP to rule out an underlying medical reason for your baby's slow weight gain.

If you have doubts about your baby's growth, you may find it reassuring to talk to an LLL Leader.

Wet and dirty nappies
If your baby receives enough milk, the thick and sticky black meconium poos will be passed within three days of birth, followed by at least 6-8 wet and 3-5 dirty nappies in each 24 hours. Expect yellow, loose, unformed poos at least the size of a 2p coin. From about six weeks, some babies have abundant poos once every few days. This isn't a problem when a baby has plenty of wet nappies.

Look at your baby
You may instinctively know how your baby is doing. Are they nursing vigorously? Is their skin firm? Do they look healthy and seem active and alert? Are they meeting developmental milestones?

Remember
Even if your breasts feel empty, there's always some milk there. Full breasts and engorgement slow milk production - you may need to nurse more often. Removing even small amounts of milk from soft breasts increases milk production.

Babies nurse for comfort as well as for food. Those little 'snack' comfort feeds can really increase your milk production and their calorie intake.

Expect your baby to want to breastfeed very often from time to time. Your breasts will quickly adjust to making more milk if you follow your baby's cues.

Every baby has a unique feeding pattern. If your baby is gaining weight adequately, following their own feeding pattern is the best way of ensuring you are meeting their needs. It's rare that a mother cannot produce enough milk for her baby, and there are lots of ways to increase the amount of breastmilk your baby gets.

Increasing your milk production

After the first few weeks, supply and demand drives milk production. To increase your milk supply, focus on feeding more often and getting more milk out at each feed. For more information about how breasts make milk, see our article How milk production works and also How to increase your milk supply.
Breastfeeding basics

Breastfeed as often as possible - at least 10 times in 24 hours. Wake your baby if necessary.

Switch sides when your baby's suck-swallow pattern starts to slow. Continue to switch sides (four times or more) until they reject the breast.

Use breast compression (see below).

Instead of breastfeeding at set intervals, encourage 'cluster feeding' - breastfeeding very often at times when your baby is willing to.

Encourage breastfeeding for comfort as well as for food. It can really help your milk production. Stop using dummies - breastfeed instead.

Ensure you are meeting your baby's needs for milk during the night, feeding at least once every four hours.

Cut back a little on your baby's solid foods if your milk production is dropping (see below).

An effective latch
A baby may spend a long time at the breast but not get very much milk if they are not latched on effectively. Check your baby is well attached - watch and listen for swallowing which is frequent at the start and then slows down.

Contact an LLL Leader for one-to-one support and see Further Reading for more information. It's important to seek skilled help early on if you are finding breastfeeding difficult, uncomfortable or painful.

Take a 'baby moon'
Get some help with the housework and eat simple, easily-prepared meals for a week or two so you can concentrate on breastfeeding your baby. A couple of days' bed rest together, feeding your baby on demand can really boost your milk production. Or at least take some time each day to rest with them and concentrate on breastfeeding.

Try laid-back breastfeeding
Many babies instinctively seek the breast and feed frequently if they can snuggle up close to their mother's chest.

Try letting your baby lie on your body, skin to skin (with a blanket if needed) as you recline, so both their chest and tummy are against you. This close body contact gives your baby lots of opportunity to breastfeed, even in a light sleep, and boosts levels of the hormones that increase your milk. A soft carrier or sling helps to keep your baby close and encourages breastfeeding. (see Positioning and Attachment for more on laid back breastfeeding)

Breast compression
This technique puts pressure on the milk ducts and can help to make feeding more efficient:

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

2. Wait while your baby breastfeeds actively, their jaw moving all the way to their ear. When their swallowing slows, compress your breast firmly to increase milk flow and encourage swallowing. Hold it squeezed while they continue nursing actively, then release your hand.

3. Rotate your hand around the breast and repeat step 2 on different areas of the breast.

Go gently - this should not hurt.

Other foods
Babies need only human milk for the first six months (human milk is higher in calories than many weaning foods). Too much solid food replacing human milk can affect weight gain in older babies. Breastfeed before offering solid foods if your baby is under 12 months old. Even at 12 months, both human milk and solids are equally important. Breastfeed frequently and, rather than spoon-feeding, offer your baby a variety of foods, letting them feed themselves to ensure they take only what they need.

Continued low milk production
If you've tried all these suggestions and your milk production has not increased enough, there may be a medical reason. Some medical conditions can lead to low milk production, though appropriate treatment can reduce the impact. These situations are rare, but you can discuss possibilities with an LLL Leader. For more information see our article How to increase your milk supply and Further Reading.

Signs your milk is increasing
Watch for weight gain and an increase in your baby's wet and dirty nappies. Your breasts may feel fuller before feeds and begin to leak.

Looking after yourself
Don't forget to be kind to yourself, especially if you're feeling under pressure. Now is the time to call in favours from friends and relatives so you can concentrate on your baby. If your baby needs more milk, talking to your local LLL Leader will help. You can share your concerns with other mothers at an LLL meeting, who will be able to give you encouragement and support.

If supplements are needed

It can be a challenge fitting in breastfeeding, supplementing and expressing. You could try the following approach, aiming for at least 8 feeds in 24 hours. At each feed:

1. Start with breastfeeding, observing your baby's swallowing pattern. Use breast compressions to maximise the flow. When swallowing slows, switch sides and repeat. If your baby has enough energy, you can repeat this process (known as 'switch nursing'). This part of the feed might take 10-30 minutes, but use swallowing as your guide. A baby who is not swallowing isn't taking in any milk so move to step 2.

2. Give your supplement with a spoon, syringe, nursing supplementer, finger feeding tube, or bottle. Give stored breastmilk first, then supplement with other milk. Follow your baby's lead until they are satisfied. A baby who is underweight may become extra hungry for a while. By giving them extra milk, you will help them gain weight and get the energy they need to breastfeed better. To save time, this step could be done by your support person while you express. For more on ways to give your baby more milk, see our article on Bottles and other tools.

3. Express both breasts using a combination of pumping and hand expression, switching back and forth as milk flow slows. Store this milk in the fridge ready for the next feed. By removing the milk your baby couldn't, you build your future milk production and have milk to supplement the next feed. This is an important step, especially if you are working to eliminate formula supplements.

4. Finish at the breast. The whole feed may take 60-90 minutes. If it works for you, you might offer the breast at the end of the feed so your baby associates the breast with being calm, happy and satisfied. Suckling can help them settle to sleep, too.

Keep a record of the amounts of each supplement your baby takes at each feed and also what you express. This can help you see your progress and maybe useful for anyone supporting you with breastfeeding.

Feeding methods

Cup, spoon and syringe feeding can work when small amounts are needed.

A nursing supplementer can be used to give larger amounts while your baby is at the breast. Another option is finger feeding, using an infant feeding tube. One end of the tube is taped to your finger. As your baby sucks on your finger, milk flows along the tube from a container which can be raised or lowered to change flow. An LLL Leader can help you find out more and choose an option that works best for you.

If using a bottle, paced bottle feeding can help ensure your baby doesn't take more milk than they need.

A smaller teat hole prevents a baby taking milk too quickly.

Hold them in an upright position, using your hand to support their neck and head.

To encourage your baby to open wide, place the teat across their lips with the tip between the upper lip and nose.

Allow your baby some control. Let them take the bottle teat into their mouth themself. Avoid pushing the teat into their mouth.

Tilt the bottle just enough to fill the tip of the teat and give a gentle flow so your baby isn't overwhelmed with milk. As the bottle empties, gradually tilt the bottle more and lean your baby back.

Encourage frequent pauses to mimic breastfeeding, and allow your baby to decide when they have had enough.

For more information see Bottles and other tools.

Expressing your milk

A baby nursing well at the breast is more effective than any pump. But while your baby isn't breastfeeding well or you're giving supplements, expressing your milk will stimulate milk production. Give any expressed milk before you give infant formula, so none of your precious breastmilk is wasted.

Nurse your baby frequently so they get the extra milk you make. An increase in the amount you can express is a sign that you can reduce supplements if your baby is nursing well and often.

Hospital-grade pumps are the most effective for mothers needing to increase their milk, but any pump that works well for you is fine.

Try hands-on pumping: use breast massage and breast compressions while pumping, then hand express afterwards to get the last few drops of milk. For more on hand expressing see our article: Hand expression

Pumping on both sides at the same time boosts milk-producing hormones. When pumping one side at a time, switch back and forth several times as milk flow slows.

Consider power pumping: experiment with pumping very frequently for short periods to mimic cluster feeding.

Wash your pump with hot soapy water, or sterilise it once a day. Pump equipment can be left at room temperature for short periods, or stored in the fridge for longer periods. For more information, see our article Expressing Your Milk.
Good times to express milk

After feeds while your baby sleeps - 'putting in an order' for more milk later. Milk expressed after a feed may be small in quantity, but is high in calories.

Between feeds if your baby is too sleepy to nurse frequently.

While holding your baby, or with them nearby. Expressing little and often can be better than long sessions. Try some 'power pumping' during the evening, or fit in some extra pumping sessions one day. You should notice an increase in milk production a couple of days later.

Using donor milk and formula to support breastfeeding
The use of donor milk or infant formula is sometimes essential to meet a baby's nutritional needs. You may need to use donor milk or formula as a short-term measure while you work to increase your milk production. See our article Using donor milk & formula to support breastfeeding for more information.

Supplementing with donor milk or formula without protecting your milk supply may reduce the duration of your breastfeeding journey.

Powdered infant formula is not a sterile product. To reduce health risks associated with using infant formula, carefully follow the NHS guidelines for preparing it. La Leche League does not recommend the use of homemade formula. The NHS guide to bottle feeding is available online (see Further Reading).

Written by Karen Butler and mothers of LLLGB

Further Reading

How to increase your milk supply
How milk production works
Using donor milk and formula to support breastfeeding
Dummies and Breastfeeding
Hand expressing of breastmilk
Comfortable Breastfeeding
Is my baby getting enough milk?
Nursing Supplementers
Positioning & Attachment
Rhythms and Routines
Safe sleep and the Breastfed Baby
Sleep baby - why and what to do
Storing your milk
After a difficult start

Books
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Making more milk, second edition, Marasco, L. and West, D. New York: McGraw-Hill Education, 2019.
Other websites
Natural (laid-back) breastfeeding naturalbreastfeeding.com
Biological nurturing™ www.biologicalnurturing.com
Maximising milk production when expressing https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html
UK-WHO Growth Charts These charts are based on the growth rates of breastfed babies and can be found in your baby's Personal Child Health Record (red book). Further copies, the more detailed hospital 0-4 charts and specialised charts for low weight babies can all be downloaded from: www.rcpch.ac.uk/growthcharts
NHS guide to bottle feeding

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

Copyright LLLGB 2022

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My baby needs more milk - La Leche League GB

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Does your baby need more milk? How to know your baby is getting enough breastmilk Increasing your milk production If supplements are needed Feeding methods Expressing your milk Does your baby need more milk? Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk [...]

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KellyMom.com - Breastfeeding and Parenting

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A nipple shield is a flexible silicone nipple that is worn over the mom’s nipple during a feeding. Nipple shields should in general be considered a short-term solution and should be used under the guidance of a lactation consultant.

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Reflux, spitting up or possetting are all names used to describe babies bringing back some of the milk that they swallowed earlier. Some spitting up is

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As long as breastfeeding feels comfortable and your baby is getting plenty of breast milk, it doesn't matter which position you prefer to use. This article describes some of the more popular breastfeeding positions for newborns and you can find more ideas for helping your baby attach to the breast comfortably in Latching Tips or see clips of mothers breastfeeding in Breastfeeding Videos.

As long as breastfeeding feels comfortable and your baby is getting plenty of breast milk, it doesn't matter which position you prefer to use. Click To Tweet

Natural or laid-back breastfeeding

Baby mammals are hard-wired to breastfeed without any help-by using their reflexes and instinctive behaviours. By contrast, human babies can often seem helpless to overcome difficulties with latching to the breast. However, when a mother reclines with her baby on her tummy, human babies are often able to use their natural instincts to crawl to the breast and latch on (attach) comfortably, just like other baby mammals. This type of position is sometimes called natural breastfeeding or laid-back breastfeeding. Skin-to-skin contact in this position, while not essential, also has many benefits to help the process of self-latching. If you place your baby between your breasts as you semi-recline (lean back) into a chair, your body will take your baby's weight and you will notice he starts to bob about searching for the nipple using all his senses. You can still guide him and help him to latch. Many mothers find this is a comfortable way to breastfeed.

Cross cradle hold

This position can be very useful if you are struggling with latch-on as it can give you more control to bring baby to the breast. Hold your baby against your body with the hand and arm opposite to the breast he is about to latch to. Your other hand will be free to shape or support the breast for the latch-see Latching Tips. It's tempting to hold the back of your baby's head in this position but remember not to do this and to support his neck and shoulders instead. If you lean back slightly during the latch or after baby is latched, your body can help support your baby's weight.

Rugby, clutch or football hold

This position has many names but they all refer to your baby positioned alongside you, coming towards the breast from behind you. You may need a cushion or two behind your back to bring yourself forward to leave enough room for your baby's body along your side. And you will probably need a pillow under your baby to lift him to breast height so that you don't have to lean down to reach him. Check that your baby's nose is level with your nipple before he latches. In this hold, your baby's bottom might be snuggled into the back of the chair or sofa with his legs in the air. The rugby hold can be useful if you have had a caesarean and your incision is painful in other positions, or if you're feeding two babies at the same time. Sometimes it just seems to work when other positions feel awkward. Some mothers choose to breastfeed cross cradle on one breast and rugby hold on the other at first, you can choose whatever works best for you. As with cross cradle you have a hand free to shape or support the breast.

Cradle hold

In a cradle hold baby is held in the crook of the arm in a similar position to how a baby is held for bottle feeding, but baby is turned on their side snuggled against their mother and facing the breast. Ensure your baby doesn't have to turn their head to reach the breast as it is not easy to swallow if your head is turned to the side and this would make breastfeeding challenging for them. The cradle hold may be more difficult to use initially when you and your baby are learning to breastfeed as it gives you less control for the latch. Check that your baby feels safe and supported in this position and that his legs aren't dangling off the side of your lap. Try to curl his body around yours following all the latching tips you can. Leaning back and letting your body take your baby's weight can help the stability of this position.

Side-lying

Learning to breastfeed lying down gives you an opportunity to rest and can be very comfortable if you have had an episiotomy or caesarean. It can be tricky to do; you may need to latch in a semi reclining position and then slide down to side-lying at first. Check out Bed-Sharing With Baby to make sure your sleeping surface is safe if you should fall asleep while feeding. As in all positions, have your baby snuggled in close with his nose level with your nipple just before the latch. Check that he isn't flat on his back and expected to turn his head to latch, he won't be comfortable or able to swallow in that position. Your arm around him will keep him on his side while he feeds.

Standing up

Sometimes a baby can be upset and too anxious, frustrated or angry to latch-walking around with him in your arms will often calm him. He may even enjoy latching while you are standing up, with some gentle swaying and movement rocking him. Later, breastfeeding standing up, with the help of a sling, can let you carry on with tasks around the house without interrupting your baby's feed. Breast and Bottle Feeding Safely in a Sling by Dr Rosie Knowles discusses how to use a sling safely.

Straddle hold

Some babies do well in a straddle hold where they sit astride your thigh facing the breast. You may be sitting upright or in a reclining straddle hold.

If breastfeeding hurts

If you can't get comfortable in any position, contact an IBCLC lactation consultant to help you with positioning in person. An IBCLC will watch a breastfeed and take a full history to help solve why breastfeeding might be feeling difficult or painful. They will be able to check how your baby uses his tongue or whether he seems to have any other issues such as high muscle tone. Your lactation consultant will help you find the right position for yours and your baby's unique anatomy and circumstances.

Summary

Positioning is important. If breastfeeding hurts or pinches your nipples, not only will it be uncomfortable and cause sore nipples, but your baby will find it difficult to take the full amount of breast milk he needs because his tongue won't be in the right position to stimulate the breast. If this happens, your milk supply may begin to drop because your breasts will not be being emptied properly. Holding your baby in a way that helps him get a deep mouthful of breast tissue as well as the nipple, while feeling safe and supported, is the key to comfortable feeds and plenty of breast milk. There are lots of different breastfeeding positions to try and many breastfeeding specialists to help you.

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A description of all the variations on breastfeeding positions for newborns including laid back, cross cradle, cradle, rugby, standing up and straddle holds

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KellyMom.com - Breastfeeding and Parenting

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Breastmilk Storage & Handling - KellyMom.com

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To avoid waste and for easier thawing & warming, store milk in 1-4 ounce portions. Date milk before storing. Milk from different pumping sessions/days may be combined in one container – use the date of the first milk expressed.

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Transitioning from bottle feeding to breastfeeding

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Transitioning from bottle feeding to breastfeeding

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THE BABY WHO DOESN'T NURSE

Some babies don't latch on as newborns. Some may have started out nursing and then stopped. Or maybe they never started. We'll look at possible causes and solutions for each of these situations. If your baby is past the newborn stage, please skip to the section on Getting an Older Baby Back to the Breast below.
You may also find our resources onnursing strikes helpful.

THE NEWBORN WHO DOESN'T NURSE

All mammals nurse after birth, without any special instructions, unless something interferes. If a newborn "won't" nurse, it's because the baby nurse for some reason. Newborns may be unable to nurse because of:

Prematurity or immaturity. Babies as early as 28 weeks may be able to nurse, but often it takes some weeks for them to latch or to nurse effectively. Time, patience, gentleness, and togetherness are your friends.

Birth and surgical medications. Some drugs take days or weeks to leave a newborn's body. Again, time, patience, gentleness, and togetherness.

Physical and medical issues. While you and your health care team sort things out, remember time, patience, gentleness, and togetherness.

Knowing too little... or knowing too much. Breastfeeding helpers have made many mistakes over the years, always with the best of intentions but not always with the best of results. Sometimes it helps to take a step back, and remember that our bodies have adapted to feed our babies.

Whatever the reason for your issues, you need to 1) keep your baby fed, 3) support and build your milk production, and 3) learn together. You can do all these most easily if you keep your baby with you as much as you can, especially on your body and front to front. Have your bare skins together (skin-to-skin) as much as you can.

Keeping your baby fed

Ask your health care team to show you how to hand express your colostrum. You may find that you can express the most colostrum in the first several hours after birth, when newborns typically have a long breastfeed. You will probably find hand-expressing directly onto a spoon the most effective and efficient way to go (cafeteria or takeaway spoons work well.) If you have a helper, they can tip the spoon into your baby's mouth or wipe the droplets onto the tongue while you hand express into a second spoon. You can also express directly into a syringe which you can get from a pharmacy or your healthcare provider.

Mothers and babies typically fall into a deep and peaceful sleep for more than an hour after their first nursing. Even if your baby didn't nurse, keep cuddling together, skin-to-skin, which allows your baby easy access to your breast.

Supporting your increasing milk production

Expect your baby to want to feed at least every hour or two on the first day. Keep clean spoons handy and express your milk every hour or so, to begin building your milk production and to avoid breast problems.

In the first few days, hand expression is usually much more effective than pumping. Colostrum is thick, sticky, and produced in very small amounts - often too small to cover the bottom of a container, so much of it simply sticks to the pump parts. If you choose to pump, wipe off all the droplets you can with a clean finger, and give them to your baby.

It's important that you take of your breast more colostrum and milk than your baby takes Your baby may be eating a bit less because of this unaccustomed way of feeding, and you want to set up normal milk production. Your milk production will increase automatically over the first few days, and frequent expression helps that happen faster, more smoothly, more fully, and with fewer problems.

As your thick, small-quantity, sticky colostrum changes to thin, larger-quantity liquid milk, your baby will probably take more at each meal, and meals will probably be more widely spaced. A good quality electric breast pump may become an effective option at that point. Most of the world uses only hand expression, so if you prefer it, it's a great technique. Whatever method you use, at this stage express milk at least eight times each day - 10 or more if you can. It's much easier to cut back later than it is to boost your production if it's set too low at the start. For more information on expressing milk after the early days, see our posts here: Hand expressing

Learning together

Here's some of what we know babies are looking for when they want to nurse.

They expect to have their whole front supported. Some people call it belly to belly or chest to chest, or "baby doing a chest plant". Have both your baby's nipples, both elbows, navel, and the insides of both knees touching you, head turned, and cheek against breast.

They expect their head higher than their hips. Babies can eat in many positions, but just like adults, they tend to prefer a more upright position than a totally sideways one.

They expect to have their feet supported. No one feels secure with their feet dangling. Even babies tend to feel more "grounded" when their feet touch something. Maybe that's why a mother, leaning back with her baby on her chest, tends to play with the baby's feet.

They expect to feel their way to where they're going. Babies "lead with their face," often turning their head side to side, feeling their way cheek by cheek. They reach with their hands too, maybe holding Mama's nipple when they find it, like little mountain climbers.

They expect to "come from below." Babies can push themselves forward, but they can't back up. If they "overshoot," it can help to move them back a little so they can push forward again.

They expect their mouth to "come from below" too. Babies tend to tip their head back to take the breast, so that they take in not just the nipple but the part of the breast that their tongue lies against. They're not so interested in the part of the breast near their nose, so "centering the nipple in the baby's mouth" doesn't make sense to them.

They don't expect to be told what to do. Too often, we get caught up in holds, and positions, and trapping an arm or leg, and curling their lip out for them, as if they didn't know what they were doing. It makes more sense to give them time to sort things out for themselves.

The easiest way to meet their expectations is to lean back in a propped-up hospital bed or in a similar position at home, so that your chest-planted baby is held on you by gravity. Be a cheerleader, not an instructor. Help if you like, but follow instead of leading. A skilled breastfeeding helper can give you on-the-spot pointers. Some other things that may help:

Offer to nurse when your baby is asleep or very sleepy, such as during the night or while napping. Babies can nurse without opening their eyes and even without waking up completely. Sometimes they do better half-asleep than fully awake.

Dim the lights and practice in a place that's free from distractions.

Offer to nurse when your baby is already partly full, not frantic. If your baby falls asleep at your breast without nursing, it still builds good memories for both of you.

Use lavish praise when you practice together, and be business-like with other ways of feeding: "This spoon/eyedropper/bottle feeds your tummy, but being at my breast feeds your soul."

Relax with your baby in different positions - both of you lying on your side, your nipple about level with your baby's eye; sitting up, if you're large-breasted, your baby in your lap; leaning back, your baby's foot resting on your thigh; your baby more sideways or more vertical. Look for positions that keep as much of your baby's front against you as you can. Or try something that ignores everyone's suggestions. There are no rules.

Consider sleeping together, once you're home, with both of you topless. Many babies have started nursing at night "accidentally", when the pressure is off and the breast is right there waiting. Before you bedshare, be sure to read our so you know how to make your bed as safe as possible.

Provide plenty of skin contact. Some babies latch on by themselves if you lean back and relax in a warm bath together, baby on your chest.

Use a baby sling or carrier to keep your baby close between feedings.

Keep the process happy. Play at nursing rather than working at nursing. You don't have to try at every feeding, or even every day. Everything will come together in time, especially if you have a skilled, gentle, hands-off helper.

Be patient. Love your baby.

You'll find much more information on expressing milk, supplementing, the early days in general, and finding a good helper in The Womanly Art of Breastfeeding , 8 th edition (older editions are not as thorough or up-to-date).

Getting an older baby back to the breast

There are a number of reasons why an older baby may have stopped feeding at the breast, or may never have fed at the breast. They include being adopted, being unable to nurse for medical reasons such as having a cleft palate, mother and/ or baby having experienced a long period of illness, or maybe mother and baby have had a long period of separation.

Sometimes a mother may regret her decision to stop breastfeeding and decide to relactate. You can find information about relactating here.

If your baby is beyond the early months, has been breastfeeding happily and stops suddenly this may be a nursing strike, you can read more about nursing strikes here.

If your baby has not been breastfeeding, ever or for a sustained period, it may take time to coax him to feed at your breast regardless of whether you have a good milk supply or not. Forcing your baby to your breast is extremely unlikely to work, it is more likely to cause your baby stress, and may result in him forming an aversion to breastfeeding. As your baby gets better at nursing and is able to get more milk at your breast, he will grow to trust that breastfeeding works and will have more patience when latching on.

Lots of skin-to-skin contact (baby in only a diaper against your bare chest) 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, don't worry if you're not successful at first, keep offering.

If you allow your baby to fall asleep, skin-to-skin, at your chest, you can catch his earliest hunger cues when he wakes again. If your baby moves toward your breast and then falls asleep before even mouthing your nipple, or after sucking a few times, then these are positive first steps, not failures.

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 your baby on your hip while doing other things, play with your baby, and give him lots of focused attention.

Sleep near your baby. If he sleeps with you, you'll get more skin-to-skin contact, plus give him more access to your breast. See our post on sleep. If your baby is not in the same bed, have his cot/bed beside your bed or in the same room so that you can catch his early feeding cues, breastfeed easier at night, and get more sleep.

Offer your breast when he is not hungry. Try giving him most of his feeding by bottle and then switching over to breastfeeding.

If he is used to a bottle, and completely refusing your breast, he may be willing to breastfeed with a nipple shield.

The following approach works for some families. You will need an at breast, or chest, supplementer link to do this.

Only mom feeds the baby (both solids and bottles).

Baby is always held by mom when being fed.

Don't allow baby to hold his own bottle. If baby is used to holding his own bottle you may need to gradually get him used to you holding it. Put a sock over it so that it looks more like a piece of clothing than a bottle.

When baby is comfortable with mom holding the bottle, and being held by mom while feeding you are ready to try the at breast supplementer.

The first step is to thread the tube of the supplementer through the nipple of the bottle he usually takes, and feed him that. It may contain your expressed milk or a supplement.

Next, move the bottle nipple over your own nipple.

Once he is comfortable sucking on the nipple with the at breast supplementer over your nipple you are ready to try and move him to your breast. Toward the end of the feeding try and switch him to your breast.

You may try to feed at first with the supplementer (even if you have a good supply) as baby may like the faster flow he is used to getting from the bottle. You can eventually wean your baby off the supplementer.

Even if you don't manage to wean your baby off the supplementer it is a lovely way to share a nurturing at-breast relationship with your baby.

Read more about at-breast supplementers here.

Revised January 2020

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The Baby Who Doesn't Nurse | La Leche League International

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THE BABY WHO DOESN'T NURSE Some babies don't latch on as newborns. Some may have started out nursing and then stopped. Or maybe they never started. We'll look at possible causes and solutions for each of these situations. If your baby is past the newborn stage, please skip to the section on Getting an Older Baby Back to the Breast below.

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Expressing colostrum during pregnancy - South Tees Hospitals NHS Foundation Trust

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South Tees Hospitals NHS Foundation Trust

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What is colostrum?

Colostrum is the first breastmilk that you produce for your baby. Each drop is packed with valuable nutrition and germ fighting cells. Even if you don't plan to breastfeed we can
support you to collect colostrum before birth - all babies benefit from this first milk.

Why might I express colostrum in pregnancy?

Learning to hand express your colostrum in pregnancy is a great way to prepare for your breastfeeding journey. It can help you to feel more confident to get feeding off to a good start and to overcome any feeding challenges should they arise.

Expressing colostrum before your baby is born can be useful for everyone, but especially in the following situations:

If you have diabetes (gestational or pre-existing)

If your body mass index (BMI) is above 30

If you have high blood pressure

If you have any problems with your thyroid

If you are having a planned caesarean birth

If your labour is being induced

Top tips

Massage first

Low lights

Calm environment

Relaxation

Warm bath

Don't worry if you still can't express anything - you can try again later.
Benefits of colostrum

Helps to regulate your baby's blood sugar

Protects against infection and some diseases

Easy to digest

It encourages early bowel movements

It can reduce the effects of jaundice in your baby

Getting started

A member of the maternity team will provide you with colostrum collectors on/around 36 weeks of pregnancy. Colostrum collectors are a syringe with a blunt end(no needle) that you can use to collect your colostrum.

We recommend trying no sooner than 37 weeks of pregnancy as there is a small chance that trying before this time might stimulate pre-term labour which can be dangerous for your baby.

If your birth is planned or anticipated before 37 weeks, please ask to discuss this with your midwife/obstetrician who will support you to decide the best time to begin expressing.

Expressing colostrum

1. Ensure you have freshly washed hands and a sterile container/colostrum collector to hand.

2. It is important to feel that you are comfortable, calm and relaxed before you begin, as this will help you to express (remove) the colostrum from your breast more easily. Having the lights low lights or getting into a warm bath might help - see our top tips below.

3. We recommend a few minutes of gentle breast massage, stroking and shaking of your breasts before you begin. This helps to trigger the hormones needed for your milk to come out. Massage and stroke gently over both breasts, your nipples and under your arms - this should be gentle enough so that it is comfortable and does not mark your skin.

4. Making a 'C' shape with your hand as shown in the image, gently compress the breast tissue with your thumb and forefinger, then release. Repeat this action in a rhythmic motion. You may notice some small 'beads' of a clear/yellow/orange sticky substance starting to appear. It can often take a few minutes before you notice anything.

5. Continue until the flow stops. Then adjust/rotate your hand to a different position and start again, as this will drain another area of your breast. Repeat until the flow stops, then move to the next breast.

Trouble shooting

If you do not notice any colostrum appearing, try adjusting your hand position. Move your thumb and forefinger closer to the nipple or further back, until you to find the right spot. Pushing back against the chest wall before you compress might also help. As you then compress, trying rolling your thumb in a downwards motion as though you are making a thumb print - See image below. If you are still unable to express any colostrum, do not worry. You can try again later the same day or leave it until another day when you feel ready to try again.

Storing and transporting colostrum

You can use the colostrum collector multiple times in the same day

At the end of each day (or if the syringe is full), label it with your name and the date and time it was collected

Colostrum/breastmilk can be stored as follows:

In the back of a fridge for up to five days

In the ice compartment in a fridge for up to two weeks

In a deep freezer for up to six months

Defrost in a fridge or hold in a warm hand

Once defrosted, colostrum/breastmilk must be used immediately

Before bringing into hospital, ensure your colostrum syringes/containers are together in one sealed, clear bag with your name, address and date of birth.

Transport frozen colostrum in an insulated bag with an icepack.

Inform the maternity team immediately on arrival so it can be put straight into the freezer

You can access support face to face, online or over the phone 24 hours a day, seven days a week:

South Tees maternity advice line

National Breastfeeding Helpline

Start4Life

Expressing colostrum during pregnancy (887.02kB, PDF)

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Expressing colostrum during pregnancy - South Tees Hospitals NHS Foundation Trust

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Colostrum is the first breastmilk that you produce for your baby. Each drop is packed with valuable nutrition and germ fighting cells. Even if you don't plan to breastfeed we cansupport you to collect colostrum before birth - all babies benefit from this first milk.

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PDF document by York and Scarborough Teaching Hospitals Foundation trust

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Antenatal Colostrum Harvesting - Information for patients, relatives and carers

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Antenatal Colostrum Harvesting - Information for patients, relatives and carers

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Feeding away from home - Formula feeding 

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Feeding away from home - Formula feeding 

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When you're making up formula for your baby, you need to be very careful to do it safely and hygienically. Formula powder isn't sterile, so any bacteria in the powder can grow when the formula is made up. Your baby's immune system is still not fully developed so they are sensitive to contaminated food and may become very ill if they consume it.

Read about how to make up formula safely here. The same guidelines apply when making up bottles of formula milk when you're out, but more precautions may be needed.

Here's how to prepare to bottle feed your baby formula when you're out...

What is needed for formula feeding when out?

If you need to prepare formula to feed your little one away from home, you'll need to take with you:

a measured amount of formula powder in a small, sterile, dry container

a vacuum flask of hot water that's just been boiled

an empty sterilised feeding bottle with cap and retaining ring in place.

The vacuum flask doesn't need to be sterilised but it should be cleaned thoroughly and only used for your baby. Boiling water should kill any bacteria present in the flask. If the flask is full and sealed, the water will stay above 70°C for several hours (NHS, 2019a).

How to prepare a bottle of formula in advance

Make up a fresh feed only when your baby needs it. The water must still be above 70°C when you use it, to kill any bacteria that could be present in the formula powder.

Remember to cool the bottle (with the lid on) under cold running water. Always test the milk temperature on the inside of your wrist before you feed it to your baby.

Alternatively, you could use a carton of ready-to-feed liquid baby formula when you're away from home. This is a convenient but more expensive option. Once open, it will need to be sealed, stored at the back of the fridge and used within 24 hours.

To protect your baby from the bacteria that can grow in formula, a fresh feed should be made up when your baby needs it. If this isn't possible, prepare the feed at home, cool it quickly and store it in the back of the fridge for at least one hour. Take the formula out just before you leave, and transport it in a cool bag with an ice pack and use within four hours. Use within two hours if you do not have access to a fridge or cool bag.

(NHS, 2019a,b; Public Health Scotland, 2021)

How long is formula OK for once made?

If you need to make up formula in advance, it should be used within:

24 hours if stored in a fridge

four hours in a cool bag with an ice pack

two hours at room temperature.

(NHS, 2019a; Public Health Scotland, 2021)

Bacteria can still survive and grow in the fridge or a cool bag, but at a slower rate than at room temperature. The longer the prepared formula is stored for, the greater the risk of infection (NHS, 2019a; Public Health Scotland, 2021).

Can I use bottled water to make up infant formula?

Bottled water is not recommended for making up infant formula feeds for your baby. This is because it's not usually sterile and may contain too much salt (sodium) or sulphate (NHS, 2019a).

If you're abroad and unsure of the water quality, it might be better not to use tap water. In this case you may need to use bottled water. Water that is labelled as 'natural mineral water' may contain too much sodium or sulphate for your baby. So choose still (not sparkling) water, making sure the seal isn't broken. It will still need to be boiled to make sure it is sterile. Check the label to make sure that:

the figure for sodium (also written as Na) is no higher than 200 milligrams (mg) per litre

the figure for sulphate (also written as SO or SO4) is less than 250 milligrams (mg) per litre.

Once opened, store the bottled water in a fridge and use within the time recommended on the bottle; for example, it might say 'use within 3 days' (Public Health Scotland, 2021).
This page was last reviewed in February 2022.
Further information

NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, call our support line on 0300 330 0700, whether you are using formula milk, breastfeeding or mixed feeding. If you're concerned about your baby's health talk to your health visitor or GP.

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What if I need to formula feed my baby away from home? | Baby & toddler, Feeding articles & support | NCT

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When you're making up formula for your baby, you need to be very careful to do it safely and hygienically. Formula powder isn't sterile, so any bacteria in the powder can grow when the formula is made up.

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FEEDING BREASTMILK other than at the breast

When the nursing parent and baby are separated or the baby cannot feed at the breast, they may need another way of taking breastmilk. These tips assume that your baby is being fed expressed breastmilk. If this is not available, please check with your baby's healthcare provider.

when is the best time to introduce a bottle?

La Leche League's The Womanly Art of Breastfeeding manual suggests that unless it's essential, ideally the introduction of a bottle is left until the baby is at least three to four weeks old, and breastfeeding well. Milk supply can adjust to the baby's needs more easily if he is able to breastfeed directly, and the more practice the baby gets at the breast, the more quickly he will become skilled at breastfeeding.

Some people worry that if they don't introduce a bottle early on, the baby won't take one later. While a younger baby is slightly more likely to accept a bottle than an older one, it's not a strong effect. Most babies of all ages will accept a bottle - some with a little coaxing! If you are thinking ahead to going back to work or study, but you won't be doing this until your baby is older than 6 months, it may be reassuring to know that your baby probably won't need a bottle by then. He will already be eating other foods and drinking water, and could be offered milk in his usual cup. Healthcare providers recommend that by a year, all babies (even those who have been completely bottle-fed) have stopped using bottles, because of their impact on teeth.
When a baby isn't able to breastfeed at all, or isn't able to take enough milk at the breast, it's important to start expressing milk early and often, to protect your milk supply and keep your baby safely fed. You can find information about this here.
IDEAS FOR INTRODUCING A BOTTLE TO A BREASTFED BABY

If you would like to introduce a bottle, here are some ideas that have worked for other families:

Choose a time when your baby is happy and relaxed, and not too hungry. It's difficult to learn a new skill when you're hungry! It can be helpful at first to think of it as a play activity, rather than a meal.

Have someone else offer the bottle to your baby. A breastfed baby may be least likely to accept a bottle from his mother - he knows where he expects the milk to come from! This doesn't mean that he won't accept an alternative when she isn't available. Even very young babies understand that different people care for them in different ways. Often, the best person to give a bottle to a reluctant baby is an experienced, confident bottle-feeder. Ideally, this will be someone who knows the baby well. Limit the number of people feeding your baby to no more than two or three; feeding is an intimate process, and it's important that your baby feels safe and comfortable, and that the feeder can get to know your baby's preferences.

Hold the baby comfortably, but not lying in the crook of your arm. Babies who are bottle-fed lying on their backs can end up taking too much milk, too quickly. Very young babies (under about 6 weeks) can be fed lying on their side, on a pillow on your lap, with their feet towards you. Some younger babies, and most older babies feed best sitting up fairly straight, supported behind their neck and shoulders by your arm or hand.

Gently present the bottle teat across the baby's lips, to stimulate her gaping (mouth-opening) reflex and invite her to take the teat into her mouth. You could gently tickle her lips with it, as many mothers do with the breast. If she accepts it, give her a good mouthful, so she isn't just sucking on the end of the teat. Most babies do best with a teat that encourages them to open their mouth wide.

Keep the bottle in a horizontal (flat) position, so the baby needs to suck actively to get the milk, as he does at the breast. This is often called "paced bottle feeding." You will need to tip the bottle as it becomes emptier, so that there is milk the end of the teat, but the whole teat doesn't need to be full of milk all the way through the feed. Most babies do best with a slow-flow "newborn" teat; you might need to try a few different brands and teats to find one with a speed your baby likes (flow rate is not standardized across different brands). It typically takes about 15-20 minutes to finish a bottle - there's no rush. Tilting the bottle to pour milk into the baby's mouth can lead to him taking more milk than he needs, faster than he can easily manage. This can cause discomfort, as well as frustration when he returns to the breast and the flow of milk is slower.

Watch for signs that the baby needs a break. When breastfeeding, the baby waits for a few seconds up to a minute before the milk "ejects" in a rush, then gradually slows down, allowing natural pauses. Bottle-feeding can be tiring for the baby, because she has to keep sucking at the same speed throughout the feed. The following signs suggest she might need a rest: a wrinkled forehead (frown); wide, alarmed eyes as she gulps quickly; "starfish hands" (fingers splayed out); turning her head away from the bottle; suddenly going to sleep (not just gently drifting off as she becomes full and satisfied). If you notice any of these stress signals, or if milk spills from her mouth, tip the bottle down to stop the flow, or take the bottle away, until she asks for more milk. If she doesn't ask for more, she has had enough for now.

As at the breast, babies may want a feed that comes in two parts. Young babies may want a short nap (often about 10-20 minutes) before taking the second part of their feed. Most adults prefer always to give a bottle using the same hand, but you could even try turning her round to have some more on the "other side"!

help - my baby won't take A BOTTLE!

It can feel really stressful when your baby won't take a bottle, especially if you have a looming deadline, such as returning to work. You may have already tried some of the "usual" hints in the previous section - here are a few more:

If the feeder isn't the mother, they could try wrapping the bottle in something that smells of the mother, like a piece of her clothing, or a cloth that has been used to catch dripping milk.

Some babies like to be bottle-fed skin to skin, in their favorite breastfeeding position.

Other babies do better in a completely different position that doesn't remind them of breastfeeding. You could try propping him in your lap with his back to your chest. He can watch what is going on in the room (or out of the window, or even go to a park or mall!) while drinking from the bottle. Or prop the baby on your slanted forelegs, like in an infant seat, and offer the bottle face-to-face.

Try to feed while moving rhythmically, calming the baby. An outward or sideways-facing baby carrier can be useful for this (make sure you can see the baby's face, to spot signs that he needs a break). Try rocking, swaying, or walking, or sitting in a rocking chair, a swivel chair, or an office chair on rollers

Try different kinds of teats. Some babies like a softer teat designed for premature infants, or prefer a different length, width or rate of flow. Consult a healthcare provider for ideas about teats to try.

Try varying the temperature of the teat. Put it in the refrigerator (teething babies like this) or run warm (not hot) water over it.

Try varying the temperature of the milk. Breastmilk direct from the breast is lukewarm. Some babies prefer that temperature, while others prefer it at room temperature or even cold from the refrigerator.

If your baby is still unwilling to take a bottle, don't panic! Most babies will take one eventually, with a little coaxing. Try again later, when he is in a relaxed, playful mood. If you can, wait a few days.

A healthy, well-grown baby can manage without milk for several hours if necessary, and he may prefer to wait to feed until you get back after a short separation. Just because your baby usually breastfeeds at a particular time doesn't necessarily mean that he will need milk at that time if you aren't there. He may prefer some playtime, or a cuddle, or to be read or sung to, or soothed off to sleep in a stroller or sling. If he really needs milk, he won't starve himself if milk is available. Babies are very smart!

With sensitivity to the baby's needs, and a flexible attitude, the alternative caregiver will figure out ways of managing when you aren't there. Your baby knows that this isn't you looking after her, and won't expect them to do exactly what you usually do. It might look even very different from what you usually do, but as long as she is safe and happy, that's fine!

ALTERNATIVES TO BOTTLES

Most breastfed babies in the world never use a bottle, going straight from the breast to drinking from a cup. And a few babies who are offered a bottle simply refuse to take one, whatever their parents and carers try! Bottles are not the only alternative feeding method - there are lots of other options.

Even premature babies can drink from an open cup, with care and practice. Special cups are available, but any clean cup can work; some parents prefer a small one, such as a shot glass.

To cup feed:

Sit your awake baby upright on your lap, supported behind her neck and shoulders by your arm or hand.

Place the rim of the cup on her lower lip and tilt the cup until the milk approaches her lip. Her tongue will explore and find the liquid. She will then lap or sip the milk - on the first few attempts, this may take a few minutes. You might want to use a bib or cloth to catch spills, until you've got some experience of feeding this way! Don't pour the milk into your baby's mouth. Keep the level constantly by her lower lip and allow her to rest and pause while drinking, but do not remove the cup.

When she has finished, she will let you know by turning her head away, or by other obvious cues.

To learn how to cup feed, try practicing with another adult first - you will quickly work out how far you need to tip the liquid to avoid frustration or spills!

Other feeding methods:

For a tiny baby, other options for offering milk include a dropper, oral syringe or teaspoon.

A baby who can breastfeed but needs extra milk as well could be fed using a nursing supplementer - a gadget that delivers milk via a tube that is taped or held next to your nipple. The baby takes both breast and tube at the same time, and gets milk from the supplementer as he nurses at the breast. Your LLL Leader can help you decide whether this might be a suitable option for you.

Babies who can sit up may prefer to feed themselves (well supervised) from a regular cup or a "sippy cup" with a lid. If you are also breastfeeding, you may want to avoid models that rely on the baby biting or pressing firmly on a valve to get liquid out!

Your baby may enjoy drinking milk from something he often sees you using, such as your favorite coffee mug - just make sure you wash the coffee out first!

When your baby is fed by one of these methods, be sure to breastfeed often when you are together, to satisfy your baby's sucking need.

HOW MUCH MILK?

Most breastfed babies take about 60-120ml (2-4oz) of breastmilk per feed, from 1-6 months of life. The composition of breastmilk changes as the baby grows, but not necessarily the quantity taken at each feed. This is different from artificial milk, which the manufacturers suggest needs to be given in increasing volume, in line with the baby's weight as he grows. Some experts think that this leads to overfeeding, and may be one of the reasons why babies fed on formula milk are at higher risk of overweight and obesity in later life. If you are feeding carefully, in a "paced" way (as described above), you can trust your baby to show you how much he wants at each feed. It may be a quick drink or a full meal - just like adults, babies don't need all their feeds to be the same size. Make sure that your baby's caregiver doesn't give your baby a lot of milk shortly before you return, though; you will probably want to feed as soon as you arrive, to reconnect with your baby and relieve your breasts!

CHANGING FEEDING PATTERNS WHEN MOTHER AND BABY ARE APART

It's common for breastfed babies to refuse a bottle initially when their mother returns to work or study, while they adjust to major changes such as a new daycare environment and caregivers. Adults often feel less hungry when they first start a new job, too! The baby's appetite will come back as he settles into his new rhythm and gets to know his carers. Some babies may choose to "reverse cycle," which means refusing a bottle or taking less milk than normal when away from mum, then nursing a lot when they are together. Breastfeeding isn't just about milk, of course; allow your baby to "fill up" on cuddles, as well as milk, as much as possible when you are together. Give yourselves a week or two to adjust to your new pattern. As long as your baby's diaper output and growth are normal, he's getting enough milk. Babies older than about 6 months, who are also eating other foods, may choose to manage without milk altogether while you are away, managing fine with food and water until you get back. Babies often surprise their mothers by eating much more when you aren't there than they do at home, especially if other children are also eating!

WHEN OTHER PEOPLE WANT TO BOTTLE-FEED YOUR BABY

Often family members sometimes express a desire to bottle-feed a breastfed baby as a way of "bonding" with them. They may be impressed by the powerful connection you are making with your breastfeeding baby, and want the same kind of closeness. It can be helpful to know that what strengthens attachment is touch (especially skin-to-skin holding) and gaze (looking into each other's eyes) - not the transfer of milk. Fathers, co-parents and other key adults who spend lots of time holding babies skin-to-skin and sharing gaze and smiles with them experience a surge of nurturing hormones, like breastfeeding mothers do. If you want to promote a closer connection between your baby and the other important people in her life, encourage them to wear her in a sling, take a bath with her or just hang out together between breastfeeds, and let nature do its magic!

Even very young breastfeeding babies can have strong, loving relationships with several people at once, including other close adults and siblings. But their mother is usually the center of the baby's universe, and especially if they are tired, upset or unwell, there will be times when "only mom will do". Fathers and other close adults can feel frustrated and powerless, and wonder whether life might be easier for them if the baby weren't breastfed. Experienced parents know that these early months and years pass quickly, and the time will come when the baby or young child reaches out to someone else, in preference to their mother! Older babies and toddlers typically go through cycles of intense connection with one favored parent or carer, then another.

In the meantime, there are many ways a loved one can help you and your baby at the same time. They can love, listen to and support the breastfeeding parent. They can change a diaper. They can bathe the baby. They can hold and calm the baby when he is not hungry, especially in those evening hours when young babies often need long periods of intensive soothing. They can "babywear" and spend time skin to skin. They can play with, sing and read to the baby. They can bring mum a glass of water, snack, phone, TV remote, or anything else she needs when she sits down to nurse.. They can take care of housework, errands and meals. They can defend mum to others who may not support breastfeeding or other parenting choices. They can be right there next to mum when she breastfeeds in public, helping her feel confident. They can contact a La Leche League Leader for help! Bottles are not a necessary part of a close relationship with the baby.

DIFFERENCES BETWEEN FEEDING AT THE BREAST AND BEING BOTTLE-FED

Exclusive pumping ("EP"), when a baby is fed completely on his mother's expressed breastmilk, is becoming more popular, for many reasons. Most mothers who express all their milk for their baby have experienced such overwhelming breastfeeding challenges that breastfeeding directly does not feel like an option for them. They invest precious time in milk expression so that their babies can still have the benefits of mother's milk. This is a true "labor of love".

A few mothers may have the option of breastfeeding directly, but wonder whether expressing their milk and feeding by bottle isn't just as good. It may be helpful to know that there are some differences between direct breastfeeding and "breastmilk feeding" by other means.

Your milk has the highest level of antibodies when your baby takes it directly from your breast, and next highest when it is freshly expressed. Your body responds to your baby's saliva - if your baby is exposed to something that he needs antibodies for, this need is communicated to your body as your baby breastfeeds.

The longer milk is stored, the more the active components are deactivated. Your refrigerated or frozen milk still provides excellent nutrition and protection for your baby, just not as much as directly from the breast or freshly expressed

The activity of breastfeeding helps exercise the facial muscles. This promotes the development of strong jaws and balanced facial structure. Several studies have shown breastfeeding to enhance speech development and speech clarity. Increasing duration of breastfeeding is associated with decreasing risk of later need for braces or other orthodontic treatment. One study showed that overbites (malocclusion) requiring orthodontia could be cut in half if infants were breastfed for one year.

Breastfeeding directly is also less time consuming - as any EP mother can tell you! There are no pump parts to wash, a skilled breastfeeding baby can remove milk faster than any pump, and the mother doesn't need to spend extra time pumping and then feeding the expressed milk to her baby. When the baby is hungry or needs to be comforted, you simply put your baby to the breast, without needing to prepare the bottle and warm the milk.

the benefits of skin to skin contact

Skin to skin contact provides a baby with huge benefits. It increases the mother's milk supply by helping her hormones to flow, and helps to "organise" the baby's behaviour so that he learns to feed more easily. Babies who are held skin-to-skin cry less, saving their energy for growing, and have more stable breathing, heart rate, blood sugar, and temperature.

When you are breastfeeding, you have to be in skin-to-skin contact with your baby, even if you don't feel like it! And a baby at the breast is at the perfect distance for gazing at your face, basking in the warmth of your smile. When a baby is fed partly or entirely by bottle (or any means other than the breast), they can still benefit from lots of skin contact, holding and gaze - carers just need to be more intentional about it.

Your baby might enjoy:

Taking a bottle snuggled against your bare breast

Falling asleep with his cheek pillowed on your breast at the end of a feed (some babies may be willing to use the breast to suck themselves peacefully off to sleep after a bottle-feed, even if they get most of their calories by bottle)

Taking a bath with you

Being "worn" in a sling or front carrier near the breast

La Leche League is all about mothering - not just breastfeeding. While we believe that " mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby ", we know that when this isn't an option, or can only be done some of the time, with care and thought, babies can be fed and mothered lovingly and responsively in other ways too. We have supported thousands of mothers to provide human milk for their babies by means other than the breast, and to have wonderfully close, satisfying relationships with their babies. You can too!

La Leche League groups welcome anyone who is pregnant, breastfeeding, providing their own milk, or donor milk, for a baby, or trying to do so. We also welcome those who are interested in the information we offer. Please don't feel awkward about feeding your baby from a bottle or other means during an LLL meeting, or asking questions about it! Breastfeeding mothers understand better than anyone else the challenges of breastfeeding, and the work involved in expressing milk. We would love to meet you and your baby, and support you on your feeding journey.

Introducing a Bottle to a Breastfed Baby
Breastfeeding Is Love - an atypical story of breastfeeding
Milk Donation and Sharing

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Bottles and Other Tools | La Leche League International

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FEEDING BREASTMILK other than at the breast When the nursing parent and baby are separated or the baby cannot feed at the breast, they may need another way of taking breastmilk. These tips assume that your baby is being fed expressed breastmilk. If this is not available, please check with your baby's healthcare provider.

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Introducing a Bottle to a Breastfed Baby

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Introducing a Bottle to a Breastfed Baby

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The information in this post is also contained in our Working & Breastfeeding article

Here is one approach to beginning pumping and introducing bottles that has worked well for many mothers as they prepared to return to work:

Once breastfeeding is well established - usually after about four weeks - begin pumping after one feeding a day where your breasts still feel a little full. Remember you are pumping "leftovers" and should only expect a small amount.

Freeze that first pumping immediately. You can add other pumpings to it after they have been cooled in the freezer.

Your pediatrician may have given you a total number of ounces your baby may feed in a day or a range from the smallest probable amount to the largest, based on your baby's weight.

If dealing with a total volume over a 24-hour period, divide that by the typical number of times your baby feeds for a target volume for the first bottle.

If dealing with a range, store volumes of the lower amount.

Store some extra small volumes in case baby is hungrier than expected.

When you have enough stored to equal the expected volume and a bit more, you can begin to plan a time to introduce a bottle.

EXAMPLE for offering the first bottle:

Your pediatrician suggests that your baby probably takes about 24 ounces a day.

You know that he feeds between eight and 12 times a day.

That means he could take anywhere from 2 to 3 ounces.

You pump until you have a 2-ounce bottle and then have several 1/2 ounce bottles to equal at least three ounces or more saved.

Choose a day that your primary support person will be available and a feeding time where baby tends to be more pleasant and patient for his feeding.

Baby may accept a bottle more easily from someone other than you. He knows milk comes from you and may not understand why he's not going there instead of to this foreign object.

Thaw out the 2-ounce bottle in the refrigerator overnight.

When baby begins to stir, place the bottle from the refrigerator in a bowl of warm water (bath temperature) or a bottle warmer while the person offering the bottle goes to get baby from his bed, changed and ready for the feeding.

Often it helps to run the bottle nipple under warm water, if it was also in the refrigerator, to make it more acceptable to the baby.

Baby should be held in an upright, almost sitting, position that is similar to the position usually used by the support person.

The warmed bottle should be held at an angle tilted just enough to fill the nipple to allow baby to keep control of when and how fast the milk comes.

Tickle the baby's mouth to encourage an open mouth then bring baby up onto the bottle nipple, aiming the nipple toward the palate.

Some have found that it can help to have an article of clothing you have worn, like a nightgown or t-shirt, to place on their arm, shoulder, or chest where the baby can smell your scent.

It is usually best if you are close but not present in the room during this first "experiment" with bottle feeding. Your baby is very wise and will wait for you to come feed her if she knows you are nearby.

Once the feeding is completed, you will pump to create a bottle equal to what the baby consumed. Remember that the baby is always better than a pump! If you do not pump as much as the baby took, it is more likely a pump issue than an issue of not enough milk. Just pump after another breastfeeding and add that amount to what you pumped to get the amount baby took.

You will continue this pattern until you have enough milk stored in your freezer to get you through a normal work day plus a few extra for any hectic day at work where you may not have been able to pump as often. Plan to fully breastfeed for all feedings when not separated from your baby.

Working and Breastfeeding
Feeding Breastmilk From a Bottle
Pumping
Cleaning and Sanitizing Pumping Accessories
Hand Expressing

IS YOUR CONCERN OR QUESTION NOT COVERED HERE?

Please contact a local La Leche League Leaderwith your specific questions, or visit our Breastfeeding Support Online Community.

Our FAQs present information on topics of interest to parents of breastfed children. Not all of the information may be pertinent to your family's lifestyle. This information is general in nature and not intended to be advice, medical or otherwise.
Medical questions and legal questions should be directed to appropriate health care and legal professionals.

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Introducing a Bottle to a Breastfed Baby | La Leche League International

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The information in this post is also contained in our Working & Breastfeeding article Here is one approach to beginning pumping and introducing bottles that has worked well for many mothers as they prepared to return to work: Once breastfeeding is well established - usually after about four weeks - begin pumping after one feeding a day where your breasts still feel a little full.

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Your experiences of support from an NCT Breastfeeding Counsellor

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Your experiences of support from an NCT Breastfeeding Counsellor

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Thank you so much for taking the time to tell us about how you have been supported by an NCT breastfeeding counsellor. The survey should only take a few minutes, and your time is much appreciated.

NCT breastfeeding counsellors support thousands of women and new families every year. This support is free to access and we want to make sure everyone can get the support they need to feed their babies.

Your feedback means a great deal to us and will help us to continue to provide practical and emotional support with breastfeeding into the future.

If you have any questions or would like to receive a reply to your feedback please email us at coursesfeedback@nct.org.uk.

NCT is registered as a controller with the UK Information Commissioner's Office - registration number Z7500160.

We will use the personal information that you provide in this form in accordance with applicable data protection laws and our Privacy Policy - available at www.nct.org.uk/privacy.

We will process your personal information to evaluate and support our breastfeeding counselling service. Your feedback will be aggregated with other feedback and only used anonymously. We will only use contact name and email address for follow up surveys if you consent to this.

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Your experiences of support from an NCT breastfeeding counsellor

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Web survey powered by SurveyMonkey.com. Create your own online survey now with SurveyMonkey's expert certified FREE templates.

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Milk and Motherhood - Johanna Sargeant IBCLC

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"Won't my baby get horrific gas if they suck on all that air during paced bottle feeding?"

A while ago, I taught a midwife friend about the importance... | By Milk and Motherhood - Johanna Sargeant IBCLC | Facebook

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7.5K views, 52 likes, 24 loves, 10 comments, 74 shares, Facebook Watch Videos from Milk and Motherhood - Johanna Sargeant IBCLC: "Won't my baby get horrific gas if they suck on all that air during...

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College of Human and Health Sciences, Swansea University

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Video about expressing colostrum before your baby is born

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Video about expressing colostrum before your baby is born

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I've had lots of questions recently about expressing colostrum before your baby is born so here's my video and post explaining more...

Colostrum is the... | By Nest and Nurture | Facebook

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2.1K views, 22 likes, 11 loves, 1 comments, 25 shares, Facebook Watch Videos from Nest and Nurture: I've had lots of questions recently about expressing colostrum before your baby is born so here's...

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If you've had breast surgery, it's difficult to know which of the above groups you will fall into, until your baby is born and you start to breastfeed.

How your surgery was done can impact upon how fully you can breastfeed.

Breast reduction surgery is more likely to cause milk supply problems than breast augmentation surgery. This is particularly so if your nipple was moved to a new position during the surgery. This will have disrupted the nerve supply to the nipple and areola.

It also depends on how much the surgery disrupted the milk glands and milk ducts. However, nerves can regrow, although slowly, and glandular tissue can develop during pregnancy.

If you had breast augmentation because you didn't have enough breast tissue, then this may also mean you have problems with milk supply. This is particularly so if nerves and milk ducts were cut during surgery.

If you have had a mastectomy, or a partial mastectomy and radiotherapy for breast cancer, you are able to breastfeed from the other breast. Some mothers who have had radiotherapy after a partial mastectomy may be able to partially breastfeed on the affected side as well.

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If you've had breast surgery, it's difficult to know which of the above groups you will fall into, until your baby is born and you start to breastfeed. How your surgery was done can impact upon how fully you can breastfeed. Breast reduction surgery is more likely to cause milk supply problems than breast augmentation surgery.

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Centers for Disease Control and Prevention

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Is it safe for a mother to breastfeed her infant if she has silicone breast implants?

Research is limited; however, there have been no recent reports of clinical problems in infants of mothers with silicone breast implants. In 2001, the American Academy of Pediatrics (AAP) issued a statement regarding the Transfer of Drugs and Other Chemicals into Human Milkexternal icon , indicating that the Committee on Drugs felt there was insufficient evidence to justify classifying silicone implants as a contraindication to breastfeeding.

Learn more about breast implantsexternal icon .

Can a mother breastfeed after breast or nipple surgery?

Usually. Most mothers who have had breast or nipple surgery are able to produce some milk, but not all of these mothers will be able to produce a full milk supply for their infants. Having a full milk supply is not necessary for a successful breastfeeding experience because it is possible to supplement in a way that supports breastfeeding.
Breast Augmentation, lift, and reduction:
Breast augmentation, lift, and reduction procedures have the potential to affect the nerves and ducts within the breast, thus impacting lactation. Breast implants below the muscle usually affect milk production less than implants above the muscle. Incisions around the areola and surgical techniques that include completely detaching the areolae and nipples are more likely to cause reductions in milk production. Over time, ducts that were severed during surgery may grow back together or form new pathways, and nerves may regain functionality, enabling the mother to produce milk. A scar around the whole areola following breast reduction does not indicate complete detachment because it may have remained connected to tissue containing nerves, ducts, and blood supply. The amount of milk made will depend on the number of connected ducts and functionality of the nerves that enable lactation, as well as other factors apart from the surgery, such as hormones and milk removal. Babies of mothers who have had breast surgery should be carefully monitored for adequate weight gain. Mothers may need support to increase milk production and/or to supplement with pasteurized donor human milk or formula.
Mastectomy:
Women who have been treated for breast cancer with partial or total mastectomy may have reduced capability to breastfeed or produce breast milk. Partial or total mastectomy can result in removal of breast tissue and damage to essential nerves involved in lactation. Women with total mastectomy of one breast should plan for unilateral breastfeeding. Women with partial mastectomy and radiation therapy should expect significantly reduced milk production on the affected side(s). A single breast can produce enough breast milk for healthy infant growth. However, dyads should be followed closely for adequate infant weight gain. Further guidance is outlined in the Academy of Breastfeeding Medicine's clinical protocol on Breast Cancer and Breastfeeding.external icon

Women may have varied experiences with breastfeeding after breast cancer treatment and may encounter a range of social and psychological challenges. Providers may need to address psychosocial challenges when supporting the infant feeding decisions of women who have had breast cancer.
Hypoplastic breasts:
Some mothers may have had underdeveloped (hypoplastic) breasts prior to having breast surgery. Mammary hypoplasia, or insufficient glandular tissue, is characterized by breasts that appear tubular, widely-spaced, or significantly asymmetrical, leading some women with this condition to seek reconstructive surgery. Mothers who have had hypoplastic breasts may not be able to produce enough milk (primary lactation failure) and will need lactation support to learn how to stimulate production and/or how to supplement with pasteurized donor human milk or formula.

Can transgender parents who have had breast surgery breastfeed or chestfeed their infants?

Yes. Some transgender parents who have had breast/top surgery may wish to breastfeed, or chestfeed (a term used by some transgender and non-binary parents), their infants. Healthcare providers working with these families should be familiar with medical, emotional, and social aspects of gender transitions to provide optimal family-centered care and meet the nutritional needs of the infant. These families may need help with the following:

Maximizing milk production

Supplementing with pasteurized donor human milk or formula

Medication to induce lactation or avoiding medications that inhibit lactation

Suppressing lactation (for those choosing not to breastfeed or chestfeed)

Finding appropriate lactation management support, peer support, and/or emotional support

Learn more about how to support transgender persons.

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Research is limited; however, there have been no recent reports of clinical problems in infants of mothers with silicone breast implants. In 2001, the American Academy of Pediatrics (AAP) issued a statement regarding the Transfer of Drugs and Other Chemicals into Human Milkexternal icon , indicating that the Committee on Drugs felt there was insufficient evidence to justify classifying silicone implants as a contraindication to breastfeeding.

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Popular beliefs about when babies should be 'sleeping through the night' are based on studies conducted in the 1950s and 1960s on groups of formula-fed babies. However, it is normal for babies - especially breastfed babies - to wake and feed throughout the night during, at least, the first year. Encouraging babies to 'sleep through' before they are ready to do so makes it difficult to keep breastfeeding and may encourage babies to develop mature sleep patterns out of sequence with their other circadian patterns, such as those controlling the regulation of temperature, hormone production, and the genes that control our biological rhythms.

Babies operate according to their own internal biological rhythms, and they are unaware of what their parents are reading or being told. Babies do not have a body clock when they are born. It often takes several months for a baby's day-night pattern of wake and sleep to become established, and for night-time sleep consolidation to happen. During this time many parents just need reassurance that their baby is normal, and that their baby's sleep patterns are developing as expected.

New-born babies may sleep for 18 or so hours a day, but often for only for 2-3 hours at a time. During the first-year overall sleep duration falls to around 15 hours a day, and the majority of sleep becomes concentrated during night-time as the circadian rhythms* develop.
Sleep variation
In a comprehensive systematic review (Galland et al. 2012) combined data from 34 studies relating to normal infant sleep duration. The chart below shows part of this data for babies aged up to one year. Data from each study & age range are represented by a dot which shows the average total sleep experienced. [The dotted line shows the amount of variation around that average.] It is clear that younger babies sleep longer overall, but there is also a lot of variation among individual babies, and within studies for this group.

Sleep is a developmental process, and our sleep needs change throughout our lifetimes. Babies' sleep patterns mature over the first several years of life, and the sleep architecture of newborns is very different to that of adults. Newborns sleep for 18-20 or so hours a day, but only for 2-3 hours at a time. During the first-year overall sleep duration falls to around 15 hours, and the majority of sleep becomes consolidated during night-time as circadian rhythms develop (Parmelee et al 1964).

*Circadian rhythms - biological processes which are roughly tied to the 24-hour day, and periods of daylight and dark. Processes regulated by our circadian rhythms include heart rate, temperature and our 'body clock', along with the production of hormones which make us feel sleepy or alert.*

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Development of The Circadian Rhythm in Infants

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Development of The Circadian Rhythm in Infants

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Babies are not born with any circadian rhythms. So they do not know the difference between day and night. They do not produce melatonin (the hormone that helps us to fall asleep) until about 2 months so if they sleep more at night than during the day it’s literally a miracle!

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Sleeplessness is part of having a baby. As many new parents have noticed, newborns spend their first few weeks and months with little concept of night and day. However, babies consistently develop a normal human circadian rhythm, or roughly 24-hour rhythm, within the first few months of life. New research in chronobiology has determined a few factors that help newborns to begin sensing night and day.

Sleep and the Newborn Brain

Our circadian rhythm is a tightly controlled part of our lives. When our retinas sense light, they send cues to the suprachiasmatic nucleus of the hypothalamus, which in turn communicates with the pineal gland. The pineal gland controls the release of melatonin, one of the hormones that sustain our circadian rhythm.

While newborns have a developed pineal gland, one that is actually large for their tiny size, they do not produce enough melatonin, nor do they produce it consistently at night. This leads to the classic well-known newborn sleep cycle, in which they sleep for very short times and at odd hours.

A recent study of the chronobiology of newborns elaborated more on this process of developing a circadian rhythm. The babies studied began to develop daily rhythms in temperature, social behavior, and wakefulness fluctuation early, but sleeping habits were the last to develop. Evening melatonin levels became high enough for the babies to go to sleep at a family bedtime around the 60th day of life.

This is also the time when purple crying and colic usually resolve on their own. Doctors believe that melatonin may be responsible for the end of nighttime wailing as well as the beginning of more parent-friendly sleep habits.

Breast Milk and Melatonin

However, there is hope for parents who are struggling through the first 60 days and the odd schedule that this time brings. While infants do not make enough melatonin to go to sleep at night on their own, they have another source: breast milk. Melatonin from the mother is present in her milk. This may help breastfed babies to sleep more soundly and also reduce the hours of walking an inconsolable newborn. Some doctors and researchers in circadian biology are even suggesting that supplementing melatonin in these early weeks can prevent colic while helping the infant to transition more quickly to a mature circadian rhythm. However, this issue is still being researched and no parent should give their baby any supplements without a doctor's approval.

Circadian Rhythm in Infants: Hope for New Parents

Until infant supplementation of melatonin has been thoroughly studied for safety, there is light at the end of the tunnel for new parents who long for a good night of sleep. There are ways to help infants develop a circadian rhythm as quickly as possible. First, turning down the lights at bedtime, including televisions and other screens, will encourage newborns to begin sensing night as a time to sleep. Similarly, reducing ambient noise and social interaction can help to encourage the idea that night is a time for sleep and not play. It takes two to three months for the infant brain to develop the ability to produce melatonin in levels needed for sleep, but these environmental and social cues will help.

It is important for all people, including babies and their parents, to have a healthy circadian rhythm. While newborns appear to take time to develop their internal 24-hour clocks, parents can encourage them to sleep at night by breastfeeding and by changing the environment to one that supports nighttime sleeping.

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Development of The Circadian Rhythm in Infants

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As many new parents have noticed, newborns spend their first few weeks and months with little concept of night and day. However, babies consistently develop a normal human circadian rhythm, or roughly 24-hour rhythm, within the first few months of life.

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How to choose the right mattress and bedding for a baby

Where should my baby sleep?

The safest place for a baby to sleep is in their own clear, flat, separate sleep space, such as a cot or Moses basket.

Babies should always be in the same room as you for the first six months for sleep, day and night .

Keep reading for the key information you'll need to help you choose a mattress and bedding for your baby.

Mattress and bedding for a baby: what to look for

Use a firm, flat, waterproof mattress in good condition

You should use a firm and flat mattress that is protected by a waterproof cover. This will help keep the mattress clean and dry, as the cover can be wiped down.

Make sure your baby's mattress is in good condition and that it fits the Moses basket or cot properly.

Do not use a sheepskin in a cot or Moses basket or other sleep space. It is important that baby's sleep space is firm, flat and has a waterproof cover. Adding a sheepskin can reduce firmness and risk overheating.

Avoid using soft or bulky bedding

Firmly tuck in sheets and blankets (not above shoulder height). Sleep your baby in the feet-to-foot position (feet at the bottom of the cot so they can't wriggle down under the blankets). If your baby needs an extra blanket make sure it is lightweight.

Alternatively, you could choose to use a well-fitted baby sleep bag. Most sleep bag manufacturers will recommend a sleep bag is used when baby is a certain weight (usually around 4kg or 8.8lb) rather than age, so make sure to check the product guidance before using it.

Be sure to remove any soft toys from the cot before each sleep period.

Specific types of bedding to avoid:

Soft or bulky bedding is not recommended for babies under 1 year due to the risk of overheating and head covering.
Take a look at our product guide for additional information around selecting a mattress and bedding for a baby.
Pillows can increase the risk of SIDS

Pillow use alone has been shown to increase the chance of SIDS occurring by up to 2.5 times. It is much safer to sleep your baby in a clear, flat, separate sleep space .

Plagiocephaly ('flat head syndrome')

If you were thinking of using a pillow with your baby due to concerns around plagiocephaly ('flat head syndrome'), there are techniques you can use instead which will not increase the risk of SIDS.

For example, we advise that babies have plenty of supervised tummy time in their waking hours to minimise time spent on their back. You should also avoid letting babies sleep in harder contained sleep environments such as car seats and other travel systems.

We understand that plagiocephaly usually corrects itself within a year, but if you feel it is severe you may want to speak to your health professional or seek corrective treatment.

Our advice for using a second-hand mattress

There is some research that found an increased chance of SIDS when using a second-hand mattress brought in from outside of the family home, although the link is not yet proven.

Generally we would advise it is safest to have a new mattress for each baby. However, we know this is not always possible.

To help reduce the risk, we've put a checklist together for you.

The second-hand mattress should:

Have been completely protected by a waterproof cover when in use before

Have no rips or tears

Be in good condition

Still be firm and flat

Tap here for more advice on buying and using second-hand products.
Remove cot bumpers

Cot bumpers can post the risk of an accident to your baby once they begin to roll and move about the cot. There have been a number of cases in the UK and abroad where infants have become entangled in the ties and material, or fallen from pulling themselves up on the bumpers.

A simple mattress with no loose bedding or bumpers is the safest sleeping place for a baby.

Choosing a mattress and bedding for a baby: FAQs

Our room is very small and we can only squeeze in a travel cot. Is this safe?

Click here to open this question

The same 'safer sleep' rules apply to a travel cot. It should have a rigid frame and base, and a firm, flat mattress that is covered in a waterproof material.

Travel cot mattresses are often thinner and feel harder than those in a permanent cot, but don't be tempted to place folded blankets or a quilt under the baby to make them 'more comfortable'. They will be fine (and safer) without.

If you are very tight for space, you may have to consider re-arranging the furniture in the room because a baby's cot should always be positioned away from:

Radiators

Direct sunlight

Blind Cords

Any other hazards

Can I put my twin babies in the same cot to sleep?

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The Lullaby Trust has no evidence that putting twins in the same cot in the early months places them at greater risk of sudden infant death.
However, there are some things you can do to increase safety:

Never put twins together in a Moses basket or small cot. They may overheat in a restricted space.

If you choose to sleep them side by side in one cot, only do this in the early weeks when there is no danger of them rolling towards or over each other.

It is also an option, right from the start, to place them at opposite ends of the cot. This allows both twins to be in the 'feet to foot' position, and have their own firmly tucked in bedding or baby sleeping bag.

Do not use rolled towels, foam wedges or other objects between their heads.

By the time twins are big enough to roll over, they should be moved into their own separate cots. All the safer sleep advice applicable to single babies should be followed whether the babies are in the cot together or not.

Do you recommend baby hammocks?

Click here to open this question

No we do not recommend hammocks. The safest place for a baby to sleep is on a clear, flat, separate sleep space. Please read our product guide on how to choose the safest mattress and bedding for your baby.

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Mattresses and bedding - The Lullaby Trust

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Choosing the right mattress and bedding for a baby can massively reduce a baby's risk of SIDS. The safest mattresses are firm, flat and protected by a waterproof cover.

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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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In the first two weeks, babies will feed throughout the day but with no set pattern. Some feeds may be close together while others may have bigger gaps between them. Parents feed responsively by feeding on baby's cues rather than following a routine.

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There is lots of support available for you on your feeding journey. When you are first discharged from hospital or the birth centre you will receive a brown envelope with contact numbers on the front.

During office hours, you can call for advice to the community midwives team on 07786 266529.

During out of hours, you can call the midwife led birth centre on 023 8120 6012.

For feeding advice, call the infant feeding team on 07786 267584.

Infant feeding support during the COVID-19 outbreak

The infant feeding team will be working in a different way during the COVID-19 outbreak. A member of the team will be concentrating on helping women at the bedside on the post-natal wards.

Once you're home, you can get support over the phone 7 days a week (times will vary). Please call 07786 267584 from Monday to Friday between 10am and 1pm, and 07786 266529 at the weekend.

Breastfeeding workshops

We are sorry that we cannot offer you face to face workshops at this time. We are working on bringing you live workshops and video links that will support you during your breastfeeding journey. Please see the document below for links to services and support.

Breastfeeding workshops

If you'd like to find out more about breastfeeding your baby, we offer antenatal breastfeeding workshops which can be booked through our maternity and parent information service (MISS). Please note that during the COVID-19 outbreak, this service is not running.

Local breastfeeding support groups

Local breastfeeding groups such as Bosom Pals and baby cafes offer help and support from pregnancy and throughout your breastfeeding journey. Most groups run on a weekly basis and there is no need to book - mums are welcome to just turn up. Please note that these groups will not be running during COVID-19 outbreak.

There are various types of breastfeeding support groups, some are supported by midwives and senior midwifery support workers and some by qualified breastfeeding counsellors. All provide a friendly, social place to meet, chat and get information and support if you require it. You don't need to have a problem to come to a group.

Although most people attending the groups are mothers, mums-to-be are welcome too. Sessions are normally free but a small donation to cover refreshments is appreciated.

Further support with breastfeeding

After giving birth you'll be given a breastfeeding diary.

If you'd like to attend a weekly breastfeeding support group nearer to your home or use a telephone helpline for support please refer to the help and support with breastfeeding PDF below.

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Feeding your baby - getting feeding support in Southampton

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There is lots of support available for you on your feeding journey.

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Eastleigh and District NCT - Breastfeeding Support

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Eastleigh and District NCT - Breastfeeding Support

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Our breastfeeding drop in is now back to being in person at Chandler's Ford library on Monday mornings. Booking is essential and places can be booked from the events section on our Facebook page. Virtual and telephone support will also continue for those unable to attend the drop-in. Visit our private Facebook group for details on how to book a  virtual appointment.

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Log into Facebook to start sharing and connecting with your friends, family, and people you know.

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If you feel that you would like to keep track of your baby's feeds, this may be a useful tool

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University Hospital Southampton - Breastfeeding Diary 

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University Hospital Southampton - Breastfeeding Diary 

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Princess Anne Hospital Infant Feeding Team

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Princess Anne Hospital Infant Feeding Team

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Winchester Breastfeeding Support | Winchester and District

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We are the UK’s leading charity for parents, for your First 1,000 Days - right through your pregnancy, birth and beyond.

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Report on women's experiences of support from an NCT Breastfeeding Counsellor September 2017

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What are the recommendations for giving water during infancy?

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What are the recommendations for giving water during infancy?