# data[].attributes.attachment_link.readable_text
Healthy Children Project
327 Quaker Meeting House Road
East Sandwich, MA 02537
Ph: 508.888.8044
Fax: 508.888.8050

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

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

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

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

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

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

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

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

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

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

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

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

Babies are warmer.

Babies are calmer.

Babies can hear their mother's heartbeat.

Heart and breathing rates are normalized.

Milk supply may be improved.

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

What To Do in the First Hour with Mother

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

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

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

Kajsa Brimdyr, PhD, CLC
Healthy Children Project
327 Quaker Meeting House Road
East Sandwich, MA 02537, (508) 888 8044

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

# data[].attributes.attachment_link.description
Healthy Children Project 327 Quaker Meeting House Road East Sandwich, MA 02537 Ph: 508.888.8044 Fax: 508.888.8050 The First Hour After Birth: A Baby's 9 Instinctive Stages The first hours after birth are a developmentally distinct time for a baby and there are well documented short and long term physical and psychological advantages when a baby is held skin to skin during this time.

# data[].attributes.body
NCT Breastfeeding Counsellor - Tania Grorud
Phone: 07891944070
Email: TaniaGrorud@gmail.com
Available: Tuesday and Thursday 10am-2pm.  Monday and Friday 5-8pm.
NCT Helpine: 0300 330 0700
Usual opening hours

Option 1 then Option 1: Every day, 8am to Midnight, including bank holidays

Option 1 then Options 2-4: Monday-Friday 9-5pm. Closed on Bank Holidays

Option 2: Monday-Friday 9-5pm. Closed on Bank Holidays

Option 3: Monday-Friday 9-5pm. Closed on Bank Holidays

# data[].attributes.attachment_link.title
Hammersmith and Fulham Breastfeeding Support

# data[].attributes.attachment_link.readable_text
How to breastfeed

Breastfeeding is a skill that you and your baby learn together, and it can take time to get used to.

There are lots of different positions you can use to breastfeed. You can try different ones to find out what works best for you. You just need to check the following points:

Are you comfortable? It's worth getting comfortable before a feed. Use pillows or cushions if necessary. Your shoulders and arms should be relaxed.

Are your baby's head and body in a straight line? It's hard for your baby to swallow if their head and neck are twisted.

Are you holding your baby close to you, facing your breast? Supporting their neck, shoulders and back should allow them to tilt their head back and swallow easily.

Always bring your baby to the breast and let them latch themselves. Avoid leaning your breast forward into your baby's mouth, as this can lead to poor attachment.

Your baby needs to get a big mouthful of breast. Placing your baby with their nose level with your nipple will encourage them to open their mouth wide and attach to the breast well.

Try not to hold the back of your baby's head, so that they can tip their head back. This way your nipple goes past the hard roof of their mouth and ends up at the back of their mouth against the soft palate.

Read Start4Life's 3 common breastfeeding positions

How to latch your baby on to your breast

Follow these steps to help your baby latch:

1. Hold your baby close to you with their nose level with the nipple.

2. Let your baby's head tip back a little so that their top lip can brush against your nipple. This should help your baby to make a wide, open mouth.

3. When your baby's mouth is open wide enough their chin should be able to touch your breast first, with their head tipped back so that their tongue can reach as much of your breast as possible.

4. With your baby's chin firmly touching your breast and their nose clear, their mouth should be wide open. When they attach you should see much more of the darker nipple skin above your baby's top lip than below their bottom lip. Your baby's cheeks will look full and rounded as they feed.

See Start4Life's visual guide to latching your baby on

Video: how do I know if my baby is properly latched?

In this video, a midwife talks about how to check if your baby is latched on properly when breast feeding.

Help and support with breastfeeding

If you have any questions or concerns about breastfeeding, you can:

speak to your midwife, health visitor or breastfeeding supporter

call the National Breastfeeding Helpline on 0300 100 0212 (9.30am to 9.30pm, daily)

get online NHS advice about sore nipples and other common breastfeeding problems

Visit healthtalk.org for parents' personal experience about positioning and attaching their babies at the breast

How to tell if your baby is getting enough milk

There are a number of ways you can tell if your baby is getting enough milk.

Your baby starts feeding with a few rapid sucks followed by longer sucks.

Their cheeks stay rounded out, not sucked in, and you can hear them swallowing.

Your baby seems calm during feeding and comes off your breast themselves when they've had enough.

They appear content and satisfied after most feeds.

They should be healthy and gaining weight (although it's normal for babies to lose a little weight in the first week after birth). Talk to your midwife or health visitor if you're concerned your baby is not gaining weight and is unsettled during or after breast feeds.

After the first few days, your baby should have at least 6 wet nappies a day.

After about 5 to 6 days, your baby's poo should stop looking black and thick and they should also have at least 2 soft or runny yellow poos.

Read tips on building up your milk supply

Breastfeeding premature and ill babies

If your baby is in a neonatal or special care unit after the birth, you'll probably be encouraged to try something called kangaroo care once your baby is well enough.

Kangaroo care means holding your baby close to you, usually under your clothes with your baby dressed only in a nappy.

This skin-to-skin contact helps you bond with your premature baby and increase your milk supply.

Find out more about breastfeeding a premature baby

Got a breastfeeding question?

Use the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

# data[].attributes.attachment_link.description
Breastfeeding is a skill that you and your baby learn together, and it can take time to get used to. There are lots of different positions you can use to breastfeed. You can try different ones to find out what works best for you. You just need to check the following points: Are you comfortable?

# data[].attributes.attachment_link.title
Attaching Your Baby at the Breast – Breastfeeding Series

# data[].attributes.body
24/7 online support can be found here: Start4Life’s Breastfeeding Friend chatbot (via Facebook Messenger).

# data[].attributes.body
Association of Breastfeeding Mothers Breastfeeding helpline: 0300 330 5453 (9.30am - 10.30pm). Trained breastfeeding counsellors available.

Breastfeeding Network supporter line: 0300 100 0210. Specially-trained mums who have breastfed.

La Leche League: 0345 120 2918. Friendly, mum-to-mum breastfeeding support.

National Breastfeeding Helpline: 0300 100 0212 (9.30am - 9.30pm, daily). Independent, non-judgemental breastfeeding support and information.

# data[].attributes.attachment_link.title
How do I know I’m holding my baby in the right position to breastfeed?

# data[].attributes.attachment_link.readable_text
When should I feed my baby?

As a rough guide, your baby will feed at least eight to 12 times (sometimes more) over 24 hours during the first few weeks (NHS, 2016a; UNICEF, 2010). That means they'll probably need to feed every two to three hours.

Watch our video for tips on how often and how long to breastfeed your baby for.

Breastfed babies tend to feed more frequently than bottle-fed babies, or those combining breast and bottle (Casiday, 2004). This is because formula milk takes longer to digest (Martin, 2016).

It's best to feed your baby on demand rather than sticking to a feeding schedule. This is also known as responsive or baby-led feeding (WHO, 2009; Crowther et al, 2009; Entwistle, 2013; Fallon et al, 2016). Letting your baby feed when they want will help them get the milk they need. It will also stimulate your milk supply (Infant and Young Child Feeding, 2009).

What if I'm struggling or worried about the number of feeds?

We know from the experiences of new mums that breastfeeding responsively can be emotionally and physically challenging for different reasons (Fallon et al, 2016).

A baby that breastfeeds frequently can give parents a sense of reassurance but it can also cause worry. Sometimes, a baby feeding frequently can be seen as a sign that mum has insufficient milk or that baby isn't getting enough breastmilk during feeds. This sometimes leads to women supplementing feeds with formula milk or deciding to stop breastfeeding (Hoddinott et al, 2012).

Try and keep in mind that a newborn's stomach is really small. They need to feed little and often (NHS, 2017). It's really common for babies to have a good feed and then be hungry again quite quickly. This doesn't mean something is wrong or that they're not getting enough milk. It's just the way newborn babies feed.

If you're worried, it can really help to talk through your concerns with a breastfeeding counsellor. So call our Infant Feeding Support line on 0300 330 0700.

Will I produce enough milk?

The more you breastfeed your baby, the more milk you will produce (Jonas and Woodside, 2016). If your baby is attached properly, and you're both comfortable and feeding them when they ask for it, you will make enough milk for them (Infant and Young Child Feeding, 2009; Kent et al, 2012).

How do I know when to feed my baby?

When your baby is hungry they may give you little signals, known as early feeding cues (NHS, 2016a,b). They might:

* get restless

* suck their fist or fingers

* make murmuring sounds

* turn their head and open their mouth (rooting).

Looking out for and responding to these cues is important. It can help prevent your baby from becoming upset and frustrated, which will make it more difficult to feed them (Infant and Young Child Feeding, 2009).

How long should each feed last?

Every baby is different and they will go through different patterns of feeding as they grow (Kent et al, 2012). How much milk a baby needs per breastfeeding session will vary. It's best to be guided by your child (Kent et al, 2012).

As a general rule, babies who are feeding well will feed for between five and 40 minutes at each feed (UNICEF, 2010). Your baby will let you know when they've had enough milk. They will usually come off the breast themselves, look sleepy or calm, and look around (UNICEF, 2010).

During each breastfeed, your milk changes slightly. So the milk at the end of the feed (when the breast is emptier) is more creamy and filling than the milk at the beginning of the feed (Ballard and Morrow, 2013). Offer one breast and let your baby feed until they have emptied that breast fully. If they still appear hungry, offer the second breast - they may drink all or some of it (NICE, 2015). Start with this breast first next time.

Should I wake my baby up to feed?

In most cases, healthy, thriving newborns will wake up for feeds and get all the milk they need (Australian Breastfeeding Association, 2017). But there might be reasons why a newborn might be more sleepy and therefore need to be woken up for feeds.

This includes medical reasons, such as jaundice, infection or a heart problem, or perhaps because the pain relief used during birth is still affecting them (Australian Breastfeeding Association, 2017). If you're worried your baby might be sleeping too much and this is affecting their feeding, talk to your health visitor or call our Infant Feeding Support line on 0300 330 0700.

Further information

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

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

Australian Breastfeeding Association. (2017) Do I need to wake my baby for feeds? Available at: https://www.breastfeeding.asn.au/bfinfo/do-i-need-wake-my-baby-feeds [Accessed 1st October 2017].

Ballard O, Morrow AL. (2013) Human milk composition: nutrients and bioactive factors. Pediatric Clinics of North America. 60(1):49-74. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/ [Accessed 1st October 2017].

Crowther SM, Reynolds LA, Tansey EM (2009). The resurgence of breastfeeding, 1975-2000. Wellcome Witnesses to Twentieth Century Medicine. London: Wellcome Trust Centre for the History of Medicine at UCL. Available at: http://discovery.ucl.ac.uk/15855/1/15855.pdf [Accessed 1st October 2017].

Entwistle FM. (2013) The evidence and rationale for the UNICEF UK Baby Friendly Initiative standards. UNICEF UK. Available at: https://www.unicef.org.uk/babyfriendly/about/evidence-and-rationale-for-the-baby-friendly-standards/ [Accessed 1st October 2017].

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D. (2016) Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database of Systematic Reviews. (9):CD009067. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009067.pub3/full [Accessed 1st October 2017].

Hoddinott P, Craig, LCA, Britten J, McInnes RJ. (2012) A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open 2:1-14. Available at: https://bmjopen.bmj.com/content/2/2/e000504 [Accessed 1st October 2017].

World Health Organization. (2009) Session 2 The physiological basis of breastfeeding. In: Infant and Young Child Feeding. Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Available at: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 1st October 2017].

Jonas W, Woodside B. (2016) Physiological mechanisms, behavioural and psychological factors influencing the transfer of milk from mothers to their young. Hormones and Behaviour. 77:167-181. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26232032 [Accessed 1st October 2017].

Kent JC, Prime DK, Garbin CP. (2012) Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 41(1):114-121. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1552-6909.2011.01313.x [Accessed 1st October 2017].

Martin CR, Ling PR, Blackburn GL. (2016) Review of infant feeding: key features of breast milk and infant formula. Nutrients, 8(5):279. Available at: https://www.mdpi.com/2072-6643/8/5/279 [Accessed 1st October 2017].

NHS. (2016a) Breastfeeding: the first few days. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-first-days.aspx#building [Accessed 1st October 2017].

NHS. (2016b) Breastfeeding: is my baby getting enough milk? Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 1st October 2017].

NHS. (2017) Your breastfeeding questions answered. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 1st October 2017].

NICE (2015) Postnatal care up to 8 weeks after birth. CG37. Available at: https://www.nice.org.uk/guidance/cg37 [Accessed 1st October 2017].

NICE. (2017) Faltering growth: recognition and management of faltering growth in children. NG75. Available at: https://www.nice.org.uk/guidance/ng75/chapter/Recommendations#weight-loss-in-the-early-days-of-life [Accessed 1st October 2017].

UNICEF. (2010) Baby Friendly Initiative. Breastfeeding checklist for mothers - How can I tell that breastfeeding is going well? Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf [Accessed 1st October 2017].

World Health Organization; United Nations Children's Fund (2009). Baby Friendly Hospital Initiative: revised, updated and expanded for integrated care. Geneva: World Health Organization. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23926623 [Accessed 1st October 2017].
Further reading
Leurer MD, Misskey E. (2015) "Be positive as well as realistic": a qualitative description analysis of information gaps experienced by breastfeeding mothers. International Breastfeeding Journal. 10(10):2-11. Available at: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0036-7 [Accessed 1st October 2017].

# data[].attributes.attachment_link.description
As a rough guide, your baby will feed at least eight to 12 times (sometimes more) over 24 hours during the first few weeks (NHS, 2016a; UNICEF, 2010). That means they'll probably need to feed every two to three hours. Watch our video for tips on how often and how long to breastfeed your baby for.

# data[].attributes.attachment_link.readable_text
In the first few days, you and your baby will be getting to know each other. It may take time for both of you to get the hang of breastfeeding.
This happens faster for some women than others. But nearly all women produce enough milk for their baby.

Preparing to breastfeed before the birth

It's good to find out as much as you can about breastfeeding before you have your baby. It may help you feel more confident when you start breastfeeding your baby.

Antenatal classes usually cover the most important aspects of breastfeeding, such as positioning and attachment, expressing, and how to tackle common breastfeeding problems.

Find antenatal classes near you.

You can find out about breastfeeding from your midwife, family and friends, and useful helplines and websites.

There are lots of groups and drop-ins, some specially designed for pregnant women who want to know more about breastfeeding. You can find out more by asking your midwife, health visitor, local peer supporter or GP. Or visit your local Children's Centre.

Skin-to-skin contact

Having skin-to-skin contact with your baby straight after giving birth will help to keep them warm and calm and steady their breathing.

Skin-to-skin means holding your baby naked or dressed only in a nappy against your skin, usually under your top or under a blanket.

Skin-to-skin time can be a bonding experience for you and your baby. It's also a great time to have your first breastfeed. If you need any help, your midwife will support you with positioning and attachment.

Skin-to-skin contact is good at any time. It will help to comfort you and your baby over the first few days and weeks as you get to know each other. It also helps your baby attach to your breast using their natural crawling and latching-on reflexes.

You'll still be able to bond with and breastfeed your baby if skin-to-skin contact is delayed for some reason, for example if your baby needs to spend some time in special care.

If necessary, your midwife will show you how to express your breast milk until your baby is ready to breastfeed. They can also help you have skin-to-skin contact with your baby as soon as it's possible.

Skin-to-skin after a caesarean

If your baby is delivered by caesarean, you should still be able to have skin-to-skin contact with your baby straight after delivery.

Colostrum: your first milk

The fluid your breasts produce in the first few days after birth is called colostrum. It's thick and usually a golden yellow colour. It's a very concentrated food, so your baby will only need a small amount, about a teaspoonful, at each feed.

Your baby may want to feed quite often, perhaps every hour to begin with. They'll begin to have fewer, but longer feeds once your breasts start to produce more "mature" milk after a few days.

The more you breastfeed, the more your baby's sucking will stimulate your supply and the more milk you'll make.

Your let-down reflex

Your baby's sucking causes muscles in your breasts to squeeze milk towards your nipples. This is called the let-down reflex.

Some women get a tingling feeling, which can be quite strong. Others feel nothing at all.

You'll see your baby respond when your milk lets down. Their quick sucks will change to deep rhythmic swallows as the milk begins to flow. Babies often pause after the initial quick sucks while they wait for more milk to be delivered.

Occasionally this let-down reflex can be so strong that your baby coughs and splutters. Your midwife, health visitor or breastfeeding supporter can help with this, or see some tips for when you have too much breast milk.

If your baby seems to be falling asleep before the deep swallowing stage of feeds, they may not be properly attached to the breast. Ask your midwife, health visitor or breastfeeding supporter to check your baby's positioning and attachment.

Sometimes you'll notice your milk letting down in response to your baby crying or when you have a warm bath or shower. This is normal.

How often should I feed my baby?

In the first week, your baby may want to feed very often. It could be every hour in the first few days.

Feed your baby as often as they want and for as long as they want. They'll begin to have fewer, but longer feeds after a few days.

As a very rough guide, your baby should feed at least 8 to 12 times, or more, every 24 hours during the first few weeks.

It's fine to feed your baby whenever they are hungry, when your breasts feel full or if you just want to have a cuddle.

It's not possible to overfeed a breastfed baby.

When your baby is hungry they may:

get restless

suck their fist or fingers

make murmuring sounds

turn their head and open their mouth (rooting)

It's best to try and feed your baby during these early feeding cues as a crying baby is difficult to feed.

Building up your milk supply

Around 2 to 4 days after birth you may notice that your breasts become fuller. This is often referred to as your milk "coming in".

Your milk will vary according to your baby's needs. Each time your baby feeds, your body knows to make more milk for the next feed. The amount of milk you make will increase or decrease depending on how often your baby feeds.

Feed your baby as often as they want and for as long as they want. This is called responsive feeding. In other words, responding to your baby's needs. It's also known as on-demand or baby-led feeding.

In the beginning, it can feel like you're doing nothing but feeding. But gradually you and your baby will get into a pattern and the amount of milk you produce will settle down.

It's important to breastfeed at night because this is when you produce more hormones (prolactin) to build up your milk supply.

In the early weeks, before you and your baby have become comfortable with breastfeeding, "topping up" with formula milk or giving your baby a dummy can lower your milk supply.

Speak to a midwife or health visitor if you are worried about breastfeeding or you think your baby is not getting enough milk.

They might suggest giving your baby some expressed breast milk along with breastfeeding.

Find out more about how to tell if your baby is getting enough milk and tips for building up your milk supply.

Dealing with leaking breasts

Sometimes, breast milk may leak unexpectedly from your nipples.

Wearing breast pads will stop your clothes becoming wet with breast milk. Remember to change them frequently to prevent an infection.

Expressing some milk may also help. Only express enough to feel comfortable as you do not want to overstimulate your supply.

If your baby has not fed recently, you could offer them a feed as breastfeeding is also about you being comfortable.

Help and support for breastfeeding

Find out more about positioning and attachment, including how to get comfortable and make sure your baby is properly attached.

If you are having difficulties with breastfeeding, take a look at breastfeeding problems.

Ask a midwife or health visitor for help. They can also tell you about other breastfeeding support available near you.

Search online for breastfeeding support in your area.

Call the National Breastfeeding Helpline on 0300 100 0212 (9.30am to 9.30pm daily).

Got a breastfeeding question?

Use the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

Get Start4Life pregnancy and baby emails

Sign up for Start4Life's weekly emails for expert advice, videos and tips on pregnancy, birth and beyond.

Community content from HealthUnlocked

# data[].attributes.attachment_link.description
In the first few days, you and your baby will be getting to know each other. It may take time for both of you to get the hang of breastfeeding. This happens faster for some women than others. But nearly all women produce enough milk for their baby.

# data[].attributes.attachment_link.title
Sore nipples when breastfeeding | Baby & toddler, Feeding articles & support | NCT

# data[].attributes.attachment_link.description
Sore nipples can be a problem in the early days of breastfeeding and beyond. This article discusses causes of sore nipples and how to ease the pain.

# data[].attributes.attachment_link.readable_text
What is a tongue-tie (ankyloglossia)?

Most people have a frenulum - a piece of tissue under their tongue that stretches from the underside of the tongue to the floor of the mouth. Tongue-tie occurs if the frenulum either extends forwards towards the tip of the tongue, is attached close to the lower gum, or is short and tight so it interferes with normal tongue movement (Oakley, 2021).

What problems does tongue-tie cause for babies?

If a baby has a tongue-tie, they may not be able to extend or lift their tongue or move it from side to side. Some will be able to lift the sides, but not the tip (v-shaped tongue). Some will be unable to lift the posterior of the tongue (bowl-shaped tongue). In babies where they frenulum extends all the way to the tip, the tongue may look heart-shaped.

Tongue-tie can affect both breastfeeding and bottle-feeding. For some babies, the effects will be quite mild. For others, tongue-tie can make feeding extremely challenging or even impossible.

In order to breastfeed, a baby needs to be able to open their mouth wide, extend their tongue over their bottom lip and scoop the breast into their mouth. Then the tongue needs to massage the breast in a wave-like motion to remove milk from the breast (Oakley, 2021).

If your baby has a tongue-tie and you are breastfeeding, you might experience one or more of the following in your baby:

difficulty in latching

difficulty in maintaining a latch, with your baby frequently coming off the breast or slipping back to the nipple

a shallow latch

clamping down on the breast

clicking noises while feeding

unsettled behaviour during feeds

frequent or long feeds

poor weight gain or excessive early weight loss

colic/wind/hiccups/reflux.

If you are breastfeeding your baby and they have tongue-tie, you might find your nipples are sore and appear squashed after a feed, often appearing ridged, lipstick-shaped, flattened or blanched. If your baby isn't draining your breasts adequately, this can lead to engorgement, blocked ducts and mastitis. It can also have a negative effect on your milk supply. Feeds which are long or frequent can be very tiring (NHS, 2020; Oakley, 2021).

If you are bottle-feeding your baby, you might notice one or more of the following - your baby:

is very slow to take a bottle

chomps on the teat

needs to be fed very often in order to get enough milk

dribbles a lot during feeds

tends to push the bottle teat out

gags on feeds even when you slow the feed down

can only manage a teat that has a very slow flow.

(Oakley, 2021)

How is tongue-tie diagnosed?

Can I tell if my baby has a tongue-tie?

If you look in your baby's mouth, you might be able to see if they:

are unable to extend their tongue fully

have a tongue with a heart-shaped appearance at the tip

have difficulty lifting their tongue or moving it from side to side.

Tongue-tie is not just about how your baby's tongue looks. A tongue can look completely normal to an untrained eye yet still cause substantial problems with feeding (Young, 2011).

A tongue-tie is diagnosed by the baby's tongue function too - what they can do with their tongue. It can only be diagnosed by a qualified tongue-tie practitioner (NHS, 2020).

Tongue-tie types

Tongue-ties can be described as anterior (where the frenulum extends towards the front of the tongue) or posterior (towards the back of the mouth).

Tongue-ties might also be described using a percentage or a number (type I, II, III and IV). This percentage or number describes how far along the underside of the tongue the frenulum comes. So 100%, or type I, would indicate that the frenulum comes all the way to the front of the tongue.

A posterior tongue-tie, which may be described as a 10% tongue-tie, can restrict tongue function just as much as an anterior one. That means these anatomical descriptions of how the tongue looks don't always relate to how severely a tongue-tie will affect tongue function and your baby's feeding (Oakley, 2021).

Tongue-tie diagnosis

Some babies have a visible frenulum that doesn't cause problems with feeding (UNICEF, no date). Tongue-tie shares many of the symptoms of other breastfeeding problems, so it's not always easy to determine whether these problems are caused by a tongue-tie or something else.

A full feeding assessment should be done before or as part of a tongue-tie assessment (Oakley, 2021). If you and/or your baby are experiencing feeding difficulties, a feeding assessment and some breastfeeding support from a breastfeeding counsellor or trained breastfeeding professional is recommended. Support to improve your baby's attachment to the breast may resolve the problem (UNICEF, no date).

A baby's inability to open their mouth widely and extend their tongue may also be caused by tension around the mouth and neck, resulting from birth tensions or interventions during labour. This might be resolved by manual therapy, such as osteopathy or chiropractic from a registered practitioner (ATP, no date; Oakley, 2021).

If the breastfeeding professional (breastfeeding counsellor, midwife or health visitor) suspects your baby has a tongue-tie, they will refer you to a local tongue-tie practitioner. Tongue-tie practitioners will do a formal assessment of tongue-tie based on how the tongue functions as well as how it looks (e.g. the Hazelbaker Assessment Tool for Lingual Frenulum Function). Most midwives and health visitors are not tongue-tie practitioners so are unable to make a diagnosis of tongue-tie themselves.

Tongue-tie treatment

What is tongue-tie division?

Your baby could have a tongue-tie division, which can release their tongue so it can move more freely. This involves cutting the frenulum (NICE, 2005).

Tongue-tie division is a safe procedure that can improve the breastfeeding problems that tongue-tie causes (NICE, 2005).

Does tongue-tie division hurt?

Tongue-tie division procedures are very quick and simple and are thought to be almost painless (NICE, 2005).

Does tongue-tie division resolve feeding problems?

Most parents say their baby's feeding improves after a tongue-tie division and many find it resolves the problem completely (Buryk et al, 2011; Berry et al, 2012). But a few babies do continue to have feeding difficulties even after a tongue-tie division.

Do I need to get my baby's tongue-tie treated?

The decision on whether to have a tongue-tie divided is a personal one and different parents will make different decisions. Every tongue-tie is different too and the range of issues it causes can vary from very mild to severe. So how much the tongue-tie is affecting feeding and your life with your baby might influence your decision.

You might find it helpful to talk things through with an NCT breastfeeding counsellor too. They can help you explore your thoughts and feelings plus find ways of coping if you decide not to have the procedure done.

What else might help with feeding difficulties due to tongue-tie?

For some babies, it may be possible to improve feeding without having a tongue-tie division.

If babies are fed in a laid back position, they are more relaxed, can open their mouth wider and get a bigger mouthful of breast. But some babies are unable to extend their tongue enough to scoop the breast into their mouth, so this position doesn't make feeding easier. A side-lying position or koala hold might also help.

Babies can also be helped by using an 'exaggerated latch'. This is where you hold your baby close to but below the breast, and use your forefinger to tilt your nipple upwards. That way, when your baby tips their head back and is brought into the breast, your nipple can be flipped towards the back of their mouth (Oakley, 2021).

Babies who are bottle-fed might find feeds easier if paced bottle feeding techniques are used. Occasionally, finger feeding can be a more comfortable option than using a bottle (Genna, 2013). A tongue-tie can make it difficult for babies to form a seal around the bottle teat. A high palate, often associated with a tongue-tie, can trigger the baby's gag reflex. Shorter, wedge-shaped or flatter teats may be easier for babies with a tongue-tie to drink from (Oakley, 2021).

How can I find tongue-tie division services near me?

Only registered healthcare professionals who have received proper training in tongue-tie division should perform this procedure. In many areas, the NHS provides a tongue-tie division service. But provision varies across the country and parents in some areas have to travel long distances to reach a tongue-tie division service.

It can be even harder to find a tongue-tie division service when a baby is having problems bottle-feeding. Unfortunately, some areas might have no service available (Wise, 2015).

The National Institute for Health and Care Excellence - also known as NICE - supports considering tongue-tie division. Yet there is no common agreement among tongue-tie dividers on how to carry out the procedure or how far the membrane should be divided (NICE, 2005). This means the service different health professionals offer varies.

Online, you can see a directory of both NHS and private tongue-tie practitioners on the Association of Tongue-tie Practitioners (ATP) website.

What can I expect after my baby's tongue-tie division?

Babies are often unsettled in the first day or two after a tongue-tie division and might need more cuddles and nurturing. After the procedure, you'll probably see a white patch under your baby's tongue; this takes 24 to 48 hours to heal but it won't bother your baby (UNICEF, no date).

Do I need to do anything after the tongue-tie division?

Some tongue-tie practitioners recommend some tongue exercises or wound massage after a tongue-tie division. The exercises involve encouraging the baby to move their tongue through finger sucking and tongue-poking games. Massaging the wound with a clean finger may help prevent the tongue division knitting together and re-forming but there is no evidence to suggest that this is safe or effective (Oakley, 2021).

Will my baby's feeding improve after their tongue-tie division?

Parents often expect that feeding will improve immediately after a tongue-tie division.

Feeding can be more difficult for the first day or two after a tongue-tie division because it takes time for your baby to adjust to their new, freely-moving tongue (Oakley, 2021).

Some babies might need further support even after a tongue-tie division. If things have not improved after a few days, you might find it helpful to get extra support to improve feeding - see below.
This page was last reviewed in March 2022.
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

Attending a Baby Cafe or other breastfeeding support drop-in can be a good way to access support with feeding your baby. You may also find other parents there whose babies have had a tongue-tie.

Pictures of babies with tongue-tie can be found on Catherine Genna's website.

The Association of Tongue Tie Practitioners has a list of locations where tongue tie can be divided.

# data[].attributes.attachment_link.title
Tongue-tie in babies | Baby & toddler, Feeding articles & support | NCT

# data[].attributes.attachment_link.description
Tongue-tie (ankyloglossia) in babies can affect both breastfeeding and bottle-feeding. Here we explain about tongue-tie symptoms and treatment.

# data[].attributes.attachment_link.readable_text
When should I feed my baby?

As a rough guide, babies need to feed at least eight to 12 times (sometimes more) over 24 hours during the first few weeks (NHS, 2019a; UNICEF, 2010). That means they'll probably need to feed every two to three hours.

Watch our video for tips on how often and how long to breastfeed your baby for.

It's best to feed babies responsively or in a baby-led way rather than sticking to a feeding schedule (WHO, 2009; Entwistle, 2013; Fallon et al, 2016). Letting your baby feed when they want will help them get the milk they need. It will also stimulate your milk supply (Infant and Young Child Feeding, 2009).

What if I'm struggling or worried about the number of feeds?

We know from the experiences of new mums that breastfeeding responsively can feel emotionally and physically challenging (Fallon et al, 2016).

A baby that breastfeeds frequently can give parents a sense of reassurance but it can also cause worry. Some people may think frequent feeding is a sign of insufficient milk, or that baby isn't getting enough breastmilk during feeds. This sometimes leads to women supplementing feeds with formula milk or deciding to stop breastfeeding (Leurer, 2015).

Try and keep in mind that a newborn baby's stomach is really small. They need to feed little and often (NHS, 2020). It's really common for babies to have a good feed and then appear to be hungry again quite quickly. This doesn't mean something is wrong or that they're not getting enough milk. It's just the way newborn babies feed (Kent et al, 2012).

All of this also means that newborn feeding is frequent. In fact, much of the time, it's not really a question of clearly-defined 'feeds' with clear beginnings and endings (WHO 1998).

Your baby knows your voice, your smell and your taste but they are much less familiar with the 'world' outside your womb. Staying close to you gives them a vital sense of safety and reassurance. This builds their confidence that they are loved and cared for (Crenshaw, 2007).

If you're worried, it can really help to talk through your concerns with a breastfeeding counsellor. So call our Infant Feeding Support line on 0300 330 0700.

Will I produce enough milk?

The more you breastfeed your baby, the more milk you will produce (Daly & Hartmann, 1995). If your baby is attached properly, and you're both comfortable and feeding them when they ask for it, you will make enough milk for them (Kent et al, 2012; WHO 2019).

How do I know when to feed my baby?

When your baby is hungry they may give you little signals, known as early feeding cues (NHS, 2019a,b). They might:

* get restless

* suck their fist or fingers

* make murmuring sounds

* turn their head and open their mouth (rooting).

Looking out for and responding to these cues is important. It can help prevent your baby from becoming upset and frustrated, which will make it more difficult to feed them (WHO, 2009). Here's what you might see...

How long should each feed last?

Every baby is different and they will go through different patterns of feeding as they grow (Kent et al, 2012). How much milk a baby needs per breastfeeding session will vary. It's best to be guided by your child (Kent et al, 2012).

Some feeds will seem to last a long time, with your baby dozing for short periods before wanting more. And more. And still more! It's normal for a young baby to be on the breast many times a day and night. 12-15 'visits' to the breast is well within a normal range (Entwistle, 2013).

As a general rule, babies who are feeding well will feed for between five and 40 minutes at each feed (UNICEF, 2010). Your baby will let you know when they've had enough milk. They will usually come off the breast themselves, look sleepy or calm, and look around (UNICEF, 2010).

During each breastfeed, your milk changes slightly. So the milk at the end of the feed is more creamy and filling than the milk at the beginning of the feed (Ballard and Morrow, 2013). Offer one breast and let your baby feed until they stop drinking. If they still appear hungry, offer the second breast - allowing them to drink as much as they want (NICE, 2015).

Should I wake my baby up to feed?

In most cases, healthy, thriving newborns will wake up for feeds and, provided they are well latched on, get all the milk they need (Australian Breastfeeding Association, 2017). But there might be reasons why a newborn might be more sleepy and therefore need to be woken up for feeds.

This includes medical reasons, such as jaundice, infection or a heart problem, or perhaps because the pain relief used during birth is still affecting them (Australian Breastfeeding Association, 2017). If you're worried your baby might be sleeping too much and this is affecting their feeding, talk to your health visitor or call our Infant Feeding Support line on 0300 330 0700.
This page was last reviewed in March 2021
Further information

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

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

Australian Breastfeeding Association. (2017) Do I need to wake my baby for feeds? Available at: https://www.breastfeeding.asn.au/bfinfo/do-i-need-wake-my-baby-feeds [Accessed 20 March 2021].

Ballard O, Morrow AL. (2013) Human milk composition: nutrients and bioactive factors. Pediatric Clinics of North America. 60(1):49-74. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/ [Accessed 20 March 2021].

Crenshaw J. Care practice #6: No separation of mother and baby, with unlimited opportunities for breastfeeding. Journal of Perinatal Education2007;16(3):39-43. Available at: doi:  10.1624/105812407X217147 (Accessed 26 Apr 21)

Daly SEJ, Hartmann PE (1995). Infant Demand and Milk Supply. Part 1: Infant Demand and Milk Production in Lactating Women. Journal of Human Lactation. 11(1):21-26. doi:10.1177/089033449501100119 Available at https://journals.sagepub.com/doi/10.1177/089033449501100119 [Accessed 13 April 2021]

Entwistle FM. (2013) The evidence and rationale for the UNICEF UK Baby Friendly Initiative standards. UNICEF UK. Available at: https://www.unicef.org.uk/babyfriendly/about/evidence-and-rationale-for-the-baby-friendly-standards/ [Accessed 20 March 2021].

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D. (2016) Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database of Systematic Reviews. (9):CD009067. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009067.pub3/full [Accessed 20 March 2021].

Kent JC, Prime DK, Garbin CP. (2012) Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 41(1):114-121. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1552-6909.2011.01313.x [Accessed 20 March 2021].

Leurer MD, Misskey E. (2015) "Be positive as well as realistic": a qualitative description analysis of information gaps experienced by breastfeeding mothers. International Breastfeeding Journal. 10(10):2-11. Available at: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0036-7 [Accessed 20th March 2021].

NHS. (2019a) Breastfeeding: the first few days. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-first-days.aspx#building [Accessed 20 March 2021].

NHS. (2019b) Breastfeeding: is my baby getting enough milk? Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 20 March 2021].

NHS. (2020) Your breastfeeding questions answered. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 20 March 2021].

NICE (2015) Postnatal care up to 8 weeks after birth. CG37. Available at: https://www.nice.org.uk/guidance/cg37 [Accessed 20 March 2021].

UNICEF. (2010) Baby Friendly Initiative. Breastfeeding checklist for mothers - How can I tell that breastfeeding is going well? Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf [Accessed 20 March 2021].

World Health Organization. (1998) Evidence for the Ten Steps to Successful Breastfeeding. Geneva: World Health Organization.

World Health Organization. (2009) Session 2 The physiological basis of breastfeeding. In: Infant and Young Child Feeding. Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Available at: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 20th March 2021].
Further reading
Hoddinott P, Craig, LCA, Britten J, McInnes RJ. (2012) A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open 2:1-14. Available at: https://bmjopen.bmj.com/content/2/2/e000504 [Accessed 20 March 2021].

Martin CR, Ling PR, Blackburn GL. (2016) Review of infant feeding: key features of breast milk and infant formula. Nutrients, 8(5):279. Available at:   https://www.mdpi.com/2072-6643/8/5/279 [Accessed 20th March 2021].

# data[].attributes.attachment_link.title
How often should I breastfeed my baby? | Baby & toddler, Feeding articles & support | NCT

# data[].attributes.attachment_link.description
As a rough guide, babies need to feed at least eight to 12 times (sometimes more) over 24 hours during the first few weeks (NHS, 2019a; UNICEF, 2010). That means they'll probably need to feed every two to three hours. Watch our video for tips on how often and how long to breastfeed your baby for.

# data[].attributes.attachment_link.readable_text
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]

# data[].attributes.attachment_link.title
Why is my baby refusing the breast? 8 tips that help | Baby & toddler, Feeding articles & support | NCT

# data[].attributes.attachment_link.description
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.

# data[].attributes.attachment_link.readable_text
There are a number of reasons why you may experience breast pain while you're breastfeeding.
"Usually the reason can be resolved fairly quickly if you get the right help," says Bridget Halnan, infant feeding lead in Cambridgeshire and Fellow of the Institute of Health Visiting.

"Never put off asking for help early. Persevering on your own, hoping it will get better, may make matters worse."

Here's how to deal with some of the most common reasons for breast pain while breastfeeding.

Breast engorgement

Breast engorgement is when, for whatever reason, your breasts become overly full. They may feel hard, tight and painful.

"In the early days, engorgement can be due to your milk coming in and your newborn not feeding as much as perhaps they need to," says Bridget Halnan.

Newborns need feeding little and often. It can take a few days for your milk supply to match your baby's needs.

If your baby isn't well attached to the breast, it may be hard for them to take your milk when your breast is engorged.

The nipple can become a little overstretched and flattened, and possibly painful.

Ask your midwife, health visitor or a breastfeeding specialist for advice immediately to help your baby relieve the engorgement and prevent it happening again.
Find out more about positioning and attachment
Engorgement can still happen once you have learnt the skill of positioning and attachment, usually when your baby hasn't fed for a while.

Your baby usually knows when they need a feed, for how long and from which breast.

Early signs (cues) that your baby is ready to feed can include:

moving their eyes rapidly

putting their fingers into their mouth

rooting (turning to 1 side with their mouth open as if seeking the breast)

becoming restless

Crying is the very last sign that your baby needs feeding. Feeding them before they cry often leads to a much calmer feed.

Keeping your baby close so you can watch and learn their early feeding cues will help.

How to ease breast engorgement

To ease the discomfort of engorgement, apart from your baby feeding, you could try expressing a little breast milk by hand.

"You don't need to strip the breast of as much milk as you can. This will only lead you to produce more," says Bridget Halnan. "But taking a little off can relieve the pressure."

Ask your midwife, health visitor or breastfeeding specialist to show you how.
Find out more about expressing breast milk
You may also find it helps to:

wear a well-fitting breastfeeding bra that doesn't restrict your breasts

put warm flannels on your breasts just before hand expressing if they're leaking

apply chilled cabbage leaves to your breasts after feeding or expressing to reduce the pain and swelling (the evidence on the benefits of this method is weak, but it may work for some women)

take some paracetamol or ibuprofen at the recommended dose to ease the pain (these are safe to take while you're breastfeeding)

Too much breast milk

Occasionally women make too much breast milk and their babies struggle to cope.

It's best to get your midwife, health visitor or breastfeeding specialist to watch a feed to see if they can spot why this is happening.

They can also suggest ways to decrease your supply.

"They may be able to help you pick up your baby's cues about how long they want to stay at 1 breast," says Bridget Halnan.

"Remember, it is your baby at the breast that makes the milk. Switching them too early can cause an oversupply."

Blocked breast milk ducts

The milk-making glands in your breasts are divided up into segments, rather like an orange.

Narrow tubes called ducts carry the milk from each segment to your nipple.

If one of the segments isn't drained properly during a feed (perhaps because your baby isn't attached properly), this can lead to a blocked duct.

You may feel a small, tender lump in your breast.

"This needs relieving as soon as possible, and your baby may be able to help," says Halnan.

"If possible, place them with their chin pointing towards the lump so they can feed from that part of the breast."

Avoid wearing tight clothes or bras so your milk can flow freely from every part of your breast.

Other things that may help include:

frequent feeding from the affected breast

warm flannels or a warm shower to encourage the flow

gently massaging the lump towards your nipple while your baby feeds

It's important to deal with a blocked duct quickly as, if left, it could lead to mastitis.

Mastitis

Mastitis (inflammation in the breast) happens when a blocked duct isn't relieved.

It makes the breast feel painful and inflamed, and can make you feel very unwell with flu-like symptoms.

If you don't deal with the early signs of mastitis, it can turn into an infection and you'll need to take antibiotics.

If you have mastitis, you'll probably have at least 2 of these symptoms:

a breast that feels hot and tender

a red patch of skin that's painful to touch

a general feeling of illness, as if you have flu

feeling achy, tired and tearful

a high temperature (fever)

"This can happen suddenly, and can get worse quickly," says Bridget Halnan. "It's important to carry on breastfeeding as this will help to speed your recovery."

If you think you're developing a blocked duct or mastitis, try the following:

Check your baby's positioning and attachment. Ask your midwife, health visitor or a breastfeeding specialist to watch a feed.

Carry on breastfeeding.

Let your baby feed on the tender breast first.

If the affected breast still feels full after a feed, or your baby can't feed for some reason, express your milk by hand.

Warmth can help the milk flow, so a warm flannel, or a warm bath or shower, can help.

Get as much rest as you can. Go to bed if you can.

Take paracetamol or ibuprofen to relieve the pain.

If you're no better within 12 to 24 hours or you feel worse, contact your GP or out-of-hours service.

You may need antibiotics, which will be fine to take while breastfeeding.

Stopping breastfeeding will make your symptoms worse, and may lead to a breast abscess.

Breast abscess

If a mastitis infection isn't treated, it can lead to a breast abscess, which may need an operation to drain it.

This can also develop if the mastitis doesn't respond to frequent feeding plus a course of antibiotics.

You can carry on breastfeeding after an abscess has been drained.
Find out more about breast abscesses

Thrush

If you experience pain in both breasts, often after a period of pain-free breastfeeding, and the pain lasts for up to an hour after a feed, you may have developed thrush.
Find out more about thrush and breastfeeding
Got a breastfeeding question?

Sign into Facebook and message the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice any time, day or night.

# data[].attributes.attachment_link.description
There are a number of reasons why you may experience breast pain while you're breastfeeding. "Usually the reason can be resolved fairly quickly if you get the right help," says Bridget Halnan, infant feeding lead in Cambridgeshire and Fellow of the Institute of Health Visiting. "Never put off asking for help early.

# data[].attributes.attachment_link.description
Find out about mastitis, including what the symptoms are, how to treat it and why it happens.

# data[].attributes.attachment_link.title
Natural Breastfeeding - Love to Love Breastfeeding

# data[].attributes.attachment_link.description
Theresa Nesbitt, MD is an Obstetrician-Gynecologist with special training in Maternal Fetal Medicine. Her interests today are promoting health and wellness for women with a focus on mothers. She also has an interest in brain growth and development.

# data[].attributes.attachment_link.readable_text
Expressing milk means squeezing milk out of your breast so you can store it and feed it to your baby later.

You might want to express milk if:

How to express breast milk

You can express milk by hand or with a breast pump. How often you express your milk, and how much you express, will depend on why you're doing it.

Sometimes it takes a little while for your milk to start flowing. Try to choose a time when you feel relaxed. Having your baby (or a photo of them) nearby may help your milk to flow.

You may find it easier to express if you cover your breasts with a warm towel first, or after you have a shower or bath.

Expressing breast milk by hand

Some find it easier to express milk by hand, especially in the first few days or weeks. It also means you can express without needing a pump, or an electricity supply.

Hand expressing allows you to encourage milk to flow from a particular part of the breast. This may be useful, for example, if one of the milk ducts in your breast becomes blocked.

Hold a sterilised feeding bottle or container below your breast to catch the milk as it flows.

These tips may help:

Before you start, wash your hands with soap and warm water.

Have something clean ready to collect the milk in.

Some find gently massaging their breasts before expressing helps their milk to let down.

Cup your breast with one hand then, with your other hand, form a "C" shape with your forefinger and thumb.

Squeeze gently, keeping your finger and thumb a few centimetres away from your nipple, just outside the darker area around it (areola). Do not squeeze the nipple itself as you could make it sore. This should not hurt.

Release the pressure, then repeat, building up a rhythm. Try not to slide your fingers over the skin.

Drops should start to appear, and then your milk usually starts to flow.

If no drops appear, try moving your finger and thumb slightly, but still avoid squeezing the darker area near your nipple.

When the flow slows down, move your fingers round to a different section of your breast, and repeat.

When the flow from one breast has slowed, swap to the other breast. Keep changing breasts until your milk drips very slowly or stops altogether.

Watch a video about expressing milk by hand on the UNICEF website

Expressing milk with a breast pump

There are 2 different types of breast pump: manual (hand-operated) and electric.

Manual pumps are cheaper but may not be as quick as an electric pump.

You may be able to hire an electric pump. Your midwife, health visitor or a local breastfeeding supporter can give you details of pump hire services near you.

The suction strength can be altered on some electric pumps. Build up slowly. Setting the strength to high straight away may be painful or damage your nipple.

You may also be able to get different funnel (the part that goes over your nipple) sizes to fit your nipples. The pump should never cause bruising or catch your nipple as it's sucked into the funnel.

Always make sure that the pump and container are clean and sterilised before you use them.

Find out how to sterilise baby bottles

Storing breast milk

You can store breast milk in a sterilised container or in special breast milk storage bags:

in the fridge for up to 8 days at 4C or lower (you can buy fridge thermometers online) - if you're not sure of the temperature of your fridge, or it is higher than 4C, use it within 3 days

for 2 weeks in the ice compartment of a fridge

for up to 6 months in a freezer, if it's -18C or lower

Breast milk that's been cooled in the fridge can be carried in a cool bag with ice packs for up to 24 hours.

Storing breast milk in small quantities will help avoid waste. If you're freezing it, make sure you label and date it first.

Defrosting frozen breast milk

It's best to defrost frozen breast milk slowly in the fridge before giving it to your baby. If you need to use it straight away, you can defrost it by putting it in a jug of warm water or holding it under running warm water.

Once it's defrosted, give it a gentle shake if it has separated. Use it straight away. Do not re-freeze milk that's been defrosted.

Once your baby has drunk from a bottle of breast milk it should be used within 1 hour and anything left over should be thrown away.

Warming breast milk

You can feed expressed milk straight from the fridge if your baby is happy to drink it cold. Or you can warm the milk to body temperature by putting the bottle in a jug of warm water or holding it under running warm water.

Do not use a microwave to heat up or defrost breast milk. This can cause hot spots, which can burn your baby's mouth.

Storing breast milk if your baby is in hospital

If you're expressing breast milk because your baby is premature or sick, ask the hospital staff caring for your baby for advice on how to store it.

Read more about breastfeeding a premature or sick baby

If you're having difficulty expressing breast milk

If you're finding it difficult or uncomfortable to express your breast milk:

Ask your midwife, health visitor or breastfeeding supporter for help. They can also tell you about other breastfeeding support available near you.

Search online for breastfeeding support in your area.

Call the National Breastfeeding Helpline on 0300 100 0212 (9.30am to 9.30pm daily).

The Bliss website also has advice about expressing milk for a premature or sick baby

Community content from HealthUnlocked

# data[].attributes.attachment_link.description
Expressing milk means squeezing milk out of your breast so you can store it and feed it to your baby later. You might want to express milk if: You can express milk by hand or with a breast pump. How often you express your milk, and how much you express, will depend on why you're doing it.

# data[].attributes.headline
Bottle Feeding How to Make up a Bottle Video

# data[].attributes.subject
Bottle Feeding How to Make up a Bottle Video