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The way you hold your baby or position them will affect how easy it is for them to breastfeed effectively. You can breastfeed your baby in many different positions, so it's good to try different ones. This helps you find what's most comfortable for you and allows your baby to get just the right mouthful of breast to feed effectively and easily.

Breastfeeding positions for newborns

When you first start breastfeeding, you and your baby may take a while to master this new skill. Patience and trying different positions will help you find a position that works for you both.
Our video has some great tips on different ways to hold your baby.
If you're having problems breastfeeding, or with latching or attachment, do call our infant feeding support line on 0300 330 0700 to talk to a breastfeeding counsellor. Your midwife or health visitor may know about local breastfeeding support groups.

Getting some support with breastfeeding can help you to get comfortable in one or more of the breastfeeding positions that we describe in this article.

Here's how to get started...

Preparing to feed

Your baby will be happier and will latch more easily if you can identify and respond to their early feeding cues. If they are crying or upset, they need to be calmed before they are ready to feed.

Holding them against you, talking to them, walking around or gently rocking might help if they need to be calmed. Most babies like to have their hands free to touch and stroke your breast; this helps to reassure them that they are in the right place.

Read more about getting started with breastfeeding in our article here.

Laid-back position

Sitting upright

Lying down

Underarm or rugby ball

Holding your baby under your arm may be suggested to women who have given birth by caesarean, to avoid pressure on the wound. This position might also be suggested to mothers of twins. However, it can be difficult to maintain this position as the baby's weight is being taken by the mother's hand. Babies soon outgrow this position, and it doesn't allow them to use their instincts and reflexes to attach on to the breast (NHS, 2020; La Leche League, 2022).

Breastfeeding positions for a fast milk flow

If you have a fast milk flow, this could be due to a large supply of breast milk. A fast milk flow can make your baby cough, splutter and come off the breast, which is sometimes similar to reflux symptoms. If they're having problems, it could be that the baby needs more control when they're feeding. If this is the case, laid-back feeding, where the baby is more in control, could be useful as it helps your baby to attach better and pull back if they need to take a break.

Breastfeeding your baby as they grow

As your baby grows, they become more active in getting themselves into position, and they're longer and heavier. So you might need to adjust you and your baby's position to continue to feed comfortably and effectively.

A laid-back breastfeeding position could be useful with larger or older babies as you do not have to use your arms to hold their weight. You can always ask a breastfeeding counsellor for support with finding positions that suit you and your baby.

Breastfeeding position tips

Whichever breastfeeding position you choose, remember...

Get comfortable before you start.

Tuck your baby in closely to you.

Bring your baby to your breast or let them attach themselves rather than leaning towards them.

Avoid putting the breast in your baby's mouth; let them take it in themselves.

Check that their ear, shoulder and hip are all in a line - not twisted round.

If you are bringing your baby to your breast, make sure they are turned towards your breast, with your nipple level with baby's nose - they shouldn't have to turn their head.

Cushions, special breastfeeding pillows and other supports can prevent your baby's body from getting close enough to your body or may raise your baby's body too high for effective attachment. It's best to get your baby attached to the breast, then if support is needed tuck a pillow in under your arm at the point where you are feeling strain from the weight of the baby.

(UNICEF and NHS, 2022)

Many women and babies take a while to get used to breastfeeding and it can take a while to find the position(s) that work best for you. Experimenting with different positions can help you find the ones that work best for you and your baby.
Page last reviewed December 2022.
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.

For further information on how to breastfeed, including positioning and breastfeeding attachment, and a section on expressing your breastmilk by hand, visit Unicef's Baby Friendly Initiative support area for parents.

Bump to Breastfeeding DVD: available from your midwife or library - see more at www.bestbeginnings.org.uk

Coulson S. (2012) Biological nurturing: the laid-back breastfeeding revolution Midwifery today. 101. Available at: https://midwiferytoday.com/mt-articles/biological-nurturing/ [Accessed 7th November 2022]

La Leche League. (2022) Positioning. Available at: https://www.llli.org/breastfeeding-info/positioning [Accessed 7th November 2022]

Milinco M, Travan L, Cattaneo A, Knowles A, Sola MV, Causin E, et al. (2020) Effectiveness of biological nurturing on early breastfeeding problems: a randomized controlled trial. Int Breastfeed J. 15(1):21. Available at: https://doi.org/10.1186/s13006-020-00261-4

NHS. (2020) How to breastfeed. Available at: https://www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/how-... [Accessed 7th November 2022]

UNICEF; NHS. (2022) Off to the best start. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfe... [Accessed 25th November 2022]

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Breastfeeding positions: which are best for you? | Baby & toddler, Feeding articles & support | NCT

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Here we provide tips on breastfeeding positions, including laid-back, lying down, sitting upright and underarm positions.

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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].

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How often should I breastfeed my baby? | Baby & toddler, Feeding articles & support | NCT

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Read our tips on when to breastfeed your baby and how much milk they need.

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Continue to nurse your baby through coronavirus.

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Continue to nurse your baby through coronavirus.

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Media Release

MAGYAR NEDERLANDS 日本語 繁體中文 简体中文 ITALIANO ESPAÑOL DEUTSCHE ελληνικά български HEBREW Português Română ARABIC FRANÇAIS
Contact Information: zion@llli.org
Raleigh, North Carolina, USA
The novel Coronavirus (COVID-19) currently in the news is a rapidly evolving global medical situation with limited information available at this time. La Leche League International (LLLI) respects the efforts of international health and medical organizations and associations to maintain up-to-date information and recommendations as understanding of the virus is developed. LLLI will continue to track the development of the current global health crisis.

With over 60 years of breastfeeding experience, La Leche League International stands firm in encouraging all families to recognize the importance of breastfeeding in providing immunological protections to the breastfed child. Most often, babies who are being nursed remain healthy even when their parents or other family members fall ill with an infectious illness. There is a growing body of research showing babies benefit from multiple and diverse immunologic proteins, including antibodies, provided in human milk, particularly through direct breastfeeding.

Those who become infected shortly before giving birth and then begin breastfeeding, and those who become infected while breastfeeding, will produce specific secretory IgA antibodies and many other critical immune factors in their milk to protect their nursing infants and enhance their infants' own immune responses. At this time, these immunologic factors will aid their infants' bodies to respond more effectively to exposure and infection. Following good hygiene practices will also help reduce transfer of the virus.

If someone who is breastfeeding becomes ill, it is important not to interrupt direct breastfeeding. The baby has already been exposed to the virus by the mother and/or family and will benefit most from continued direct breastfeeding.

Disruption of breastfeeding may lead to several issues:

significant emotional trauma for the nursing baby or toddler,

a drop in milk supply due to the need to express milk,

later breast refusal by the infant due to the introduction of bottles,

a decrease in protective immune factors due to lack of direct breastfeeding and expressed milk not matching the infant's needs at a particular time, and

an increased risk of the infant becoming ill due to lack of immune support from direct breastfeeding.

The last point is of critical importance: when any member of the family has been exposed, the infant has been exposed. Hence, any interruption of breastfeeding may actually increase the infant's risk of becoming ill and even of becoming severely ill.

Anyone who believes they may have COVID-19 (also known as novel coronavirus; 2019-nCoV; SARS-CoV-2) is encouraged to follow good hygiene practices, such as thoroughly washing their hands and wearing a protective mask to prevent spread of the virus. If someone becomes ill enough to require hospitalization, the baby should be allowed to continue breastfeeding if at all possible, keeping in mind the above list of possible results from any separation or disruption of breastfeeding. In an extreme circumstance, if an interruption of breastfeeding is deemed medically necessary, hand expressing or pumping the milk is encouraged. In such cases, the expressed milk, which contains multiple immune factors, may be fed to the baby to help prevent the baby from getting the infection or to help reduce the severity and duration of an infection if the baby does get sick.

The World Health Organization (WHO) offers guidance and other information on coronavirus in multiple languages on the WHO website. UNICEF also provides information for breastfeeding through COVID-19 infection. Links are included in the references below.
All of the information above also applies to families at risk of or experiencing influenza and other respiratory viruses.

References

Centers for Disease Control and Prevention (CDC; 28 January 2020). About 2019 Novel Coronavirus (2019 - nCoV). Accessed 29 January 2020 and 12 February 2020 from https://www.cdc.gov/coronavirus/2019-ncov/about/index.html

Centers for Disease Control and Prevention (CDC; 17 February 2020). Frequently Asked Questions and Answers: Coronavirus Disease 2019 (COVID-19) and Pregnancy. Accessed 18 February 2020 from https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html

Centers for Disease Control and Prevention (CDC; 15 February 2020). Coronavirus Disease 2019 (COVID-19): Frequently Asked Questions and Answers. Accessed 19 February 2020 from https://www.cdc.gov/coronavirus/2019-ncov/faq.html

Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; published online Feb 12 2020 at https://doi.org/10.1016/S0140-6736(20)30360-3

China National Health Commission. Transcript of Press Conference on Feb 7, 2020 in Chinese. Available at http://www.nhc.gov.cn/xcs/s3574/202002/5bc099fc9144445297e8776838e57ddc.shtml

Lam, C.M., Wong, S.F., Leung, T.N., Chow, K.M., Yu, W.C., Wong, T.Y., Lai, S.T. and Ho, L.C. (2004), A case‐controlled study comparing clinical course and outcomes of pregnant and non‐pregnant women with severe acute respiratory syndrome. BJOG: An International Journal of Obstetrics &amp; Gynaecology, 111: 771-774.

Scientific American (12 February 2020). Disease Caused by the Novel Coronavirus Officially Has a Name: COVID-19. Accessed 12 February 2020 from https://www.scientificamerican.com/article/disease-caused-by-the-novel-coronavirus-officially-has-a-name-covid-19/

Shek CC, Ng PC, Fung GP, et al. Infants born to mothers with severe acute respiratory syndrome. Pediatrics 2003; 112: e254.

UNICEF (February 2020). Coronavirus disease (COVID-19): What parents should know. Accessed 18 February 2020 from https://www.unicef.org/stories/novel-coronavirus-outbreak-what-parents-should-know

Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004; 191: 292-97.

World Health Organization (WHO; 20 January 2020). Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts: Interim guidance 20 January 2020. Accessed 29 January 2020 from https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

World Health Organization (WHO, 2020). Novel coronavirus (2019-nCoV). Accessed 12 February 2020 from https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; published online Feb 10 2020. DOI:10.21037/tp.2020.02.06.

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Continuing to Nurse Your Baby Through Coronavirus (2019-nCoV; COVID-19) and Other Respiratory Infections | La Leche League International

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Media Release MAGYAR NEDERLANDS 日本語 繁體中文 简体中文 ITALIANO ESPAÑOL DEUTSCHE ελληνικά български HEBREW Português Română ARABIC FRANÇAIS Contact Information: zion@llli.org Raleigh, North Carolina, USA The novel Coronavirus (COVID-19) currently in the news is a rapidly evolving global medical situation with limited information available at this time.

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Breastfeeding and good attachment: how-to-guide

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This article explains why good attachment is important when breastfeeding your baby. Read about tips to 'latch your baby on' when breastfeeding.

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The NCT infant feeding line is there for you every day, 8am - midnight: 0300 330 0700

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The NCT infant feeding line is there for you every day, 8am - midnight: 0300 330 0700

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Why call the support line?

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

Please do call with any questions or worries you have. Watch the video below to see one of our lovely breastfeeding counsellors, Fran, answer the five most common questions we get calls about, including ' Am I doing this right?' and 'How long should I feed for?'

Who will you speak to?

By calling 0300 330 0700 (option 1), you'll speak to one of our amazing breastfeeding counsellors. They've had extensive training and will use their person-centred counselling skills to support you. This includes listening to you without judging or criticising and offering relevant information and suggestions - whether you're breastfeeding, formula feeding or a bit of both.

NCT breastfeeding counsellors can also provide new mums with face-to-face support. You can find them at breastfeeding support groups, such as Baby Cafes, and the breastfeeding session if you attend an NCT antenatal course.

What do parents say about our feeding line?

This is what mums who called the infant feeding line have said about the support and information they received.
"She was open and listened in a relaxed environment. She helped me understand that what was right for one woman and their baby was not necessarily right for another." "Approachable, kind and friendly. Gave common sense advice and increased my confidence as a new mum. What a brilliant woman doing an essential job. Can't believe I found such a wonderful, free, non-judgemental service." "She was decisive and clear in the way she spoke. She is obviously hugely knowledgeable and was able to reassure me and give me practical hands-on advice. She spent a good amount of time with me explaining and making sure I was confident and happy before moving on." "The breastfeeding counsellor was so helpful. Her kind, caring manner really helped me not to worry. She is a true gem and I can't thank her enough."
Call us if you have any questions about feeding: 0300 330 0700 (option 1)

The line is open everyday from 8am to midnight, including bank holidays.
* A call to an 0300 number costs the same as a call to a normal home or business landline. If your phone includes free calls to landlines, calls to 0300 numbers will be part of this.
Further information

You'll find lots more information and support about feeding your baby our website here.

For sources of breastfeeding support, visit this page.

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Support with breastfeeding or bottle feeding: our infant feeding line

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

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Peterborough and surrounding areas Breastfeeding support 

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Peterborough and surrounding areas Breastfeeding support 

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Get support from experienced Breastfeeding Counsellors in Peterborough.

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Peterborough Breastfeeding Support, Peterborough, United Kingdom. 1,619 likes · 6 talking about this. Welcome. Peterborough Breastfeeding Counsellors have extensive training and are able to offer...

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The benefits of being skin to skin with your baby...

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The benefits of being skin to skin with your baby...

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Bonding with your baby, and helping them adapt to life outside the womb, skin to skin contact is good for babies, and parents too!

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Meeting baby for the first time video - Baby Friendly Initiative

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

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As you get to know your new baby, you will start to recognise the signs that they are ready to feed...

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However you feed your baby, here's what you can expect to see in their nappy...

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Newborn baby poo in nappies: what to expect

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Your baby’s nappy can tell you a lot - find out more here.

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There is a drop in clinic on a Friday at the Galletly practice (see link below) and there is a support group of local mums called 'Boobie buddies' - see Facebook link below. They also run a drop in group twice a month, on every 1st and 3rd Tuesday at Abbey church hall 1-2.30pm).

https://www.facebook.com/groups/BourneBreastfeedingSupportPage/

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Dr Alex Mickleburgh is a GP at the Galletly Practice. She is a fully qualified breastfeeding peer supporter. Come along to the Galletly Practice and meet other breastfeeding mums, get advice on feeding, troubleshoot or just drop in for a chat. You do not need to be a registered patient to come.

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Dr Alex Mickleburgh is a GP at the Galletly Practice. She is a fully qualified breastfeeding peer supporter. Come along to the Galletly Practice and meet other breastfeeding mums, get advice on feeding, troubleshoot or just drop in for a chat. You do not need to be a registered patient to come.

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We are a group of local mothers who offer advice, information and support to breastfeeding mothers and pregnant women in the Rutland area. We have a wealth of personal experience and are trained La...

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Watch purified YouTube videos. Just for teachers, professors, social influencers, homeschoolers, and parents...like you.

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Step 3: The Bookmarklet will take you to the "purified" page on ViewPure.com to watch your video...free of YouTube distractions. Yeah!

Why are there still ads?

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Watch purified YouTube videos. Just for teachers, professors, social influencers, homeschoolers, and parents...like you. Let's use the actual video below to see the differences. We have always felt that videos speak louder than words. See below. As you have seen, ViewPure removes all distracting comments and side-bar related videos.

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Lincoln Breast start has 799 members. for support and information about breast feeding and group meetings times and contact details. Support Group

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Peterborough and Fenland breastfeeding support

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Peterborough and Fenland breastfeeding support

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Get support from peer supporters

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Peterborough and Fenland Breastfeeding Support

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Peterborough and Fenland Breastfeeding Support, Peterborough. 163 likes · 110 talking about this. NCT is jointly funded by Peterborough City Council and Cambridgeshire County Council to provide...

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positioning at the breast

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Information on Alcohol, Smoking and Medications
https://www.breastfeedingnetwork.org.uk/wp-content/pdfs/BfN_how_safe_is_leaflet_2009.pdf
Medications and breastfeeding
https://www.breastfeedingnetwork.org.uk/drugs-factsheets/
content/dibm/BFN%20Mastitis%20feb%2016.pdf

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Rhythms and routines for you and your baby

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Rhythms and routines for you and your baby

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

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

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

Difficulties with routines

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

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

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

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

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

Lengthy feeds.

A fussy baby.

Engorgement, blocked ducts or mastitis.

Expressing milk (pumping) can cause problems

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

Breastmilk: a balanced meal, a drink, a snack

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

Breastfeeding: comfort and connection too

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

Frequent breastfeeds: day and night

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

One breast or two

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

Breastfeeding patterns adjust

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

Finding your own rhythms: a sense of freedom

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

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

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

Think of breastfeeds as minor events

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

Expect the unexpected

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

Establishing helpful patterns

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

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

Babies are little for such a short time

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

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

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

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

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

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

Updated June 2022

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Rhythms and Routines - La Leche League GB

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

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My baby just wants to feed all evening. Is this normal?

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My baby just wants to feed all evening. Is this normal?

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Cluster Feeding

Is your newborn cluster feeding and fussy? The following cluster feeding tips have been written to help new mothers cope with the exhausting days and fussy evenings when their baby wants to cluster feed.

Newborn cluster feeding

To help you quickly access what you want to read the most, here's a list of what you need to know about cluster feeding:

What is cluster feeding?

So, what is cluster feeding exactly? Cluster feeding (also known as bunch feeding) is when babies cluster feeds close together at certain times of the day or night. Usually this means your baby may have some really fussy evenings... and you might end up confused and wondering if your baby is getting enough milk.

Rest assured, many babies will cluster feed during the early months. It's not a reflection of low milk supply and it's likely your baby is getting enough milk.

Why do babies cluster feed?

It's normal for newborn babies to cluster feed around 8-12 times per day, so your baby may feed quite frequently already. However, nights can feel like one big feeding session when you have a cluster feeding newborn!

The exact reason for cluster feeding is unknown. However, experts assume cluster feeding is a way for babies to boost milk supply during growth spurts.

Your baby's stomach grows rapidly during the first few months of life, and your body must produce more milk to meet the increased demand.

Babies also need more nutrition to support developmental changes such as rolling, crawling or talking.

Cluster feeding may be natures way of kick-starting this process.

Also, see our article, 3 reasons why your baby needs to feed so often.

Why do babies cluster feed at night?

Evenings and nighttimes with an unsettled newborn can be trying. Newborns can be fussy at night due to hunger, but they can also be fussy for a range of other reasons. For example, your milk flow might be too fast or too slow.

Here are 7 reasons why babies fuss at the breast.

However, some experts believe babies cluster feed at night because they're filling up on milk before a big sleep.

Although it's unlikely your baby will sleep through the night during these first few months, you may notice a long stretch of sleep following an evening of cluster feeds.

How long does cluster feeding last?

Cluster feeding sessions can last for several hours at a time, and is most common in the late afternoon and in the evening. But this may differ between babies ( 1, 2).

Although babies may leave a couple of hours between feeds most of the day, there will usually be a few hours of constant or close together feeds (often from 6 to 10 PM).

Cluster feeding ages

Cluster feeding is very common in young babies under 9 months of age. Many babies will start cluster feeding as soon as the first few days after getting home from the hospital, and can last for most of their first year.

However, some mothers notice cluster feeding returns with older babies who are approaching a growth spurt or developmental leap ( Wonder Week).

Cluster feeding and low milk supply

Cluster feeding is not a reflection of low milk supply. Cluster feeding is not a reflection of low milk supply. I said it twice, in case you didn't believe me the first time!

It's so easy to fall into the trap of thinking your baby isn't getting enough milk. Especially if you have a well meaning mother-in-law pressuring you to give your baby a bottle and a partner wondering why the baby is always hungry.

It's natural to start doubting yourself. However, this is simply nature's way of increasing milk supply. Unless you or your health care provider is worried about your baby's weight gain, and if you notice fewer wet and dirty nappies, your baby is likely getting enough milk.
Here are 3 reliable signs your baby is getting enough milk.
What about supplementing with formula?

Some mothers who worry about cluster feeding being due to low milk supply naturally turn their thoughts to formula.

However, if you supplement with formula during cluster feeding periods, your body won't receive the feeding cues that your baby needs more milk ( 3). As a result, your body will make less milk, due to the reduced demand. Soon enough, you'll find you're not producing enough milk to feed your growing baby.

Therefore the prophecy comes true, and you continue supplementing. Perhaps you might end up feeling bad about 'failing at breastfeeding' when you haven't.

Before supplementing with formula...

If your baby is producing a good amount of wet and dirty nappies, it's unlikely you have a breast milk supply problem. It's a good idea to make yourself familiar with the reliable signs that your baby is getting enough milk.

If you're concerned about cluster feeding or milk supply, please be sure to speak to a lactation consultant, or call a breastfeeding helpline before deciding to race out and buy formula.

7 Tips - How To Cope with Cluster Feeding

Here are our 7 cluster feeding tips to help make cluster feeding times a little more relaxing.

#1 - Acceptance

Babies usually develop a cluster feeding routine.

You may find that between 6 and 10 PM every evening, you're feeding the baby.

Once you know this, you can accept it and plan your evening around it.

That way you won't feel frustrated that your plans have gone awry and baby doesn't want to sleep.

#2 - Stay Hydrated

Producing breast milk is a thirsty business. You may find yourself particularly parched during periods of cluster feeding.

Make sure you have a big glass of water (even better with a slice of lemon!) next to you when you sit down to start breastfeeding.

Or perhaps you might like a nice warm cup of lactation tea.

You can buy teas especially for breastfeeding mothers, to help support milk supply. Herbal teas also help to keep you hydrated.

Another great option is electrolytes. Not those sugar-loaded sports lolly water drinks, but a quality electrolyte from a health food store.

#3 - Get Comfy

If you know you're going to be stuck somewhere for four hours, make sure you're comfortable.

Whether you're snuggled up in bed or propped up on the sofa, make sure you have your books, magazines, smartphone, TV remotes and DVD box sets nearby to keep you entertained. You might even like to try having some white noise or soft music on in the background, to help soothe your baby. Learn some nursing positions so you don't get tired or achy from being in the same position for a long period of time.

#4 - Eat First

If you know your baby may start cluster feeding at 6 PM, make sure you've eaten before then.

There's nothing worse than sitting hungrily while your baby slowly enjoys their three-course meal.

Hopefully, you have a stash of BellyBelly's delicious lactation cookies within your reach, at least!

#5 - Get A Breastfeeding Partner!

You've heard of a birth partner, now you need a breastfeeding partner too ( 4).

A willing volunteer to get you snacks, drinks and provide entertaining conversations to keep you amused during cluster feeds.

#6 - Look For Hunger Cues

If you tend to have a fussy, hungry and irritable baby in the evenings, act accordingly.

Instead of waiting for the crying to start (which is a late hunger signal), look out for hunger cues and offer the breast immediately.

#7 - Take Out In A Baby Carrier

By using a baby carrier, sling or wrap, your baby can enjoy nursing sessions on the go.

While feeding your baby in a sling, you'll have your hands free to get on with other things.

Slings also help to keep fussy babies content, because they feel safe and happy being close to you. The skin to skin contact can help soothe their nervous system which is still developing.

This KeaBabies Wrap Carrier (pictured) is a best seller on Amazon.

The wrap is made from a premium quality breathable cotton spandex blend, to keep you and your baby safe and comfortable.

...

Hopefully, you found our cluster feeding tips really helpful! If you're struggling or are worried about your baby, speak to an IBCLC (International Board Certified Lactation Consultant) or the Australian Breastfeeding Association (La Leche League in the US).
Recommended Reading: *This article contains affiliate links to quality products we recommend. Rest assured, it won't cost you extra. It just means we may be paid a commission if you decide to buy something. BellyBelly would never link to products we wouldn't use ourselves. We appreciate your support.

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Cluster Feeding Newborn? 7 Helpful Tips to Survive | BellyBelly

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Is your newborn cluster feeding and fussy? The following cluster feeding tips have been written to help new mothers cope with the exhausting days and fussy evenings when their baby wants to cluster feed. To help you quickly access what you want to read the most, here's a list of what you need to know about cluster feeding: So, what is cluster feeding exactly?

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Check out stylish,
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Most babies go through several growth spurts (also called frequency days) during the first 12 months.

What is a growth spurt?

During a growth spurt, breastfed babies nurse more often than usual (sometimes as often as every hour) and often act fussier than usual.

The increase in baby's milk intake during growth spurts is temporary. In exclusively breastfed babies, milk intake increases quickly during the first few weeks of life, then stays about the same between one and six months. As solids are gradually introduced after six months, baby's milk intake will gradually decrease.

Physical growth is not the only reason that babies may have a temporary need for increased nursing. Babies often exhibit the same type of behavior (increased nursing with or without increased fussiness) when they are working on developmental advances such as rolling over, crawling, walking or talking. Mom's milk is for growing the brain as well as the body!

When do babies have growth spurts?

Common times for growth spurts are during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months (more or less). Babies don't read calendars, however, so your baby may do things differently.

Growth spurts don't stop after the first year - most moms notice growth spurts every few months during the toddler years and periodically thereafter on through the teenage years.

How long do growth spurts last?

Growth spurts usually last 2-3 days, but sometimes last a week or so.

What is the best way to handle a growth spurt?

Follow your child's lead. Baby will automatically get more milk by nursing more frequently, and your milk supply will increase due to the increased nursing. It is not necessary (or advised) to supplement your baby with formula or expressed milk during a growth spurt. Supplementing (and/or scheduling feeds) interferes with the natural supply and demand of milk production and will prevent your body from getting the message to make more milk during the growth spurt.

Some nursing moms feel more hungry or thirsty when baby is going through a growth spurt. Listen to your body - you may need to eat or drink more during the time that baby is nursing more often.

See My baby is fussy! Is something wrong? for tips on comforting a fussy baby.

Additional Resources @ KellyMom

Additional Resources at other websites

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Most babies go through several growth spurts (also called frequency days) during the first 12 months. During a growth spurt, breastfed babies nurse more often than usual (sometimes as often as every hour) and often act fussier than usual. The increase in baby's milk intake during growth spurts is temporary.

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Common breastfeeding challenges in the early days..

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Common breastfeeding challenges in the early days..

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This page has links to the most common issues, and some suggestions for dealing with them. (Some mothers prefer to talk to someone on the phone or face to face - my contact details and NCT feeding line number are in the first column).

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Feeding should be comfortable for both you and your baby. If you experience any discomfort, or have concerns about your baby's feeding, talking to someone who can help could make all the difference.
Watch our video to find out about support for breastfeeding.
Common problems with breastfeeding include:
Sore nipples
Tongue tie
Sore breasts
Unsettled baby and frequent feeding
Baby refuses the breast

Sore nipples

An unfamiliar feeling of tingling, or pressure, without actual pain, is normal when you first start to breastfeed. But if breastfeeding hurts your nipples, then the most likely reason is that you and your baby need to change the way he latches on. Read about how to deal with sore nipples.

Tongue-tie

Some babies find a comfortable, effective latch hard to achieve because of tongue tie. Read our article on tongue-tie.

Sore breasts

When your baby is feeding, your breasts 'let down' milk. A few women find this sensation painful. You may also feel your womb contracting. It should pass quickly; try to relax and breathe through it and ask your midwife for tips. Find out more in our article here.

Unsettled baby and frequent feeding

If your baby seems unhappy, unable to sleep, or difficult to feed, do ask for help. Many women worry a great deal when their babies seem to need to breastfeed a lot, or for prolonged periods of time, and show by their crying they don't like being placed in a crib or cot for very long. Read about how to deal with frequent feeding here.

Baby refuses the breast

If your baby is very sleepy and doesn't seem interested in feeding, then do seek help. It could be that the after-effects of the birth or pain relief used during labour are affecting his responses. Other babies fight and struggle at the breast, and seem to resist it. Find out more here.

For problems that are more likely to affect your breastfeeding, as your baby gets older click here.

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) 0844 209 0920

NHS information on mastitis.

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

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

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Breastfeeding problems and concerns in the early days | Baby & toddler, Feeding articles & support | NCT

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Here we look at some of the problems and concerns that can make breastfeeding in the early days challenging.

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Can I drink alcohol whilst breastfeeding?

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Can I drink alcohol whilst breastfeeding?

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Things to consider:

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Breastfeeding mothers often receive conflicting advice about whether drinking alcohol can have a negative effect on their baby. This can leave them feeling like they have more questions than answers. While women are often warned not to consume alcohol during pregnancy given the evidence that this could cause damage to an unborn child, the risks of consuming alcohol while breastfeeding are not as well defined.

Drinking while nursing is not against the law and mothers have enjoyed alcohol in moderation while breastfeeding throughout history. The effects of alcohol on the breastfeeding baby are directly related to the amount the mother ingests. When the breastfeeding mother drinks occasionally and limits her consumption, the amount of alcohol her baby receives has not been proven to be harmful. However, many mothers find themselves in situations where they want to drink, but have concerns about any possible effects on their baby.

Things to consider
How much alcohol passes into breastmilk?
Can alcohol affect milk supply?
Do I have to pump and dump after drinking alcohol?
Alcohol abuse affects the baby
Medical opinion
Summary

Things to consider

Your baby's age

A newborn has an immature liver, and will be more affected by alcohol

Up until around 3 months of age, infants metabolise alcohol at about half the rate of adults

An older baby can metabolise alcohol more quickly than a young infant

Your weight

A person's size has an impact on how quickly they metabolise alcohol

A heavier person can metabolise alcohol more quickly than a lighter person

Amount of alcohol

The effect of alcohol on the baby is directly related to the amount of alcohol that is consumed

The more alcohol consumed, the longer it takes to clear the mother's body

Will you be eating?

An alcoholic drink consumed with food decreases the absorption rate into the bloodstream

How much alcohol passes into breastmilk?

Alcohol is present in a woman's milk at the same level as in her blood: it rises and falls along with it. If you know your blood alcohol level, you know your milk alcohol level. Alcohol passes freely into breastmilk and has been found to peak about 30 to 60 minutes after consumption, 60 to 90 minutes when drunk with food.

Alcohol also freely passes out of breastmilk so there is rarely need to express milk and throw it away. If the alcohol has gone from her blood, it will have gone from the milk. It takes a 140 pound (10 stone, or about 63.5kg) woman about two to three hours to eliminate the alcohol in one serving of beer or wine from her body; the more alcohol that is consumed, the longer it takes for it to be eliminated. For example, if the same woman had four drinks, it would take nine to ten hours for her breastmilk to contain no alcohol. (1)

Maternal blood alcohol levels must attain 300 mg/100ml before significant side effects are reported in the infant. (80mg/100ml fails the police breath test).

Can alcohol affect milk supply?

Studies have found that babies nurse more frequently when their mother has consumed alcohol. However they don't metabolise alcohol nearly as well as adults do, and when there is alcohol in the milk they seem to take less milk than they would otherwise in the 3-4 hours after an alcoholic beverage is consumed. Compensatory increases in milk intake have been observed during the 8-16 hours after exposure when mothers refrained from drinking. (2,3,4,5)

When this is combined with the slowed milk release that can result from alcohol, an oxytocin inhibitor, milk supply and baby's growth can be compromised if a woman drinks substantial amounts regularly. Even though nursing right after a couple of drinks can temporarily decrease the baby's milk intake, a beer or a glass of wine a couple of times a week is unlikely to matter, and the effects decrease as your baby gets older.

Do I have to pump and dump after drinking alcohol?
You do not have to pump and dump after drinking alcohol when you're breastfeeding, except for comfort.
As alcohol leaves the bloodstream, it leaves the breastmilk. Since alcohol is not "trapped" in breastmilk (it returns to the bloodstream as mother's blood alcohol level declines), pumping and dumping will not remove it. Drinking a lot of water, resting, or drinking coffee will not speed up the rate of the elimination of alcohol from your body either.

Adult metabolism of alcohol is approximately 1 ounce in 3 hours, so mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal. If you want to minimise the alcohol your baby gets, you can try nursing right before having a drink and then wait until your body has metabolised all the alcohol (about two hours for each drink consumed).

Alcohol abuse affects the baby

If you are regularly consuming large amounts of alcohol, this could harm the baby. It would be a good idea for you to consult a health professional if you have any doubts about the compatibility of your drinking habits with breastfeeding. Nursing mothers who are drinking to the point of intoxication, or binge drinking, may be less aware of their baby's needs and they should not breastfeed until they are completely sober, at which time most of the alcohol will have left their blood.

If consumed in large amounts alcohol can cause drowsiness, deep sleep, weakness, and abnormal weight gain in the infant, and the possibility of decreased milk ejection reflex in the mother. (6) Mothers who have been drinking should not bed-share with their babies as their natural reflexes will be affected. Excessive drinking by the mother can result in slow weight gain or failure to thrive in her baby. Alcohol abuses can affect milk letdown and may result in not breastfeeding enough. The baby may sleep more and miss breastfeeds, or may not suck effectively, leading to decreased milk intake. The baby may even suffer from delayed motor development.

Medical opinion

Dr. Jack Newman MD, FRCPC and Thomas W. Hale, R.Ph. Ph.D both believe that a mother can drink some alcohol and continue breastfeeding as she normally does. Dr. Jack Newman says this in his handout More Breastfeeding Myths: "Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers."

Thomas W. Hale, R.Ph. Ph.D. says this in his book Medications and Mothers' Milk (18th ed.): "Alcohol transfers into human milk readily , with an average plasma/ milk of about 1. This does not necessarily mean the dose of alcohol in milk is high, only that the levels in plasma correspond closely with those in milk. The absolute amount (dose) of alcohol transferred into milk is generally low and is a function of the maternal level. Older studies, some in animals, suggested that beer (or more likely barley) may stimulate prolactin levels. While this may be true, we now know clearly that alcohol is a profound inhibitor of oxytocin release, and inevitably reduces milk letdown and the amount of milk delivered to the infant. Thus beer should not be considered a galactagogue. [...] Excess levels may lead to drowsiness, deep sleep, weakness, and decreased linear growth in the infant. Maternal blood alcohol levels must attain 300 mg/dl before significant side effects are reported in the infant. Reduction of letdown is apparently dose-dependent and requires alcohol consumption of 1.5 to 1.9 gm/kg body weight. (7) Other studies have suggested psychomotor delay in infants of moderate drinkers (2+ drinks daily). Avoid breastfeeding during and for at least 2 hours after drinking alcohol (moderate). Heavy drinkers should wait longer. [...] Adult metabolism of alcohol is approximately 1 oz of pure ethanol in 3 hours, so mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal. A good rule is 2 hours for each drink consumed. Chronic or heavy consumers of alcohol should not breastfeed."

Summary

When a breastfeeding mother drinks occasionally and limits her consumption to one drink, the amount of alcohol her baby receives has not been proven to be harmful. The absolute amount of alcohol transferred into milk is generally low, and while we constantly review research, existing studies indicate that occasional moderate drinking is not considered harmful for nursing babies.

If you want to drink but are concerned about the effect on your baby, expressed breastmilk could be stored to use for the occasion. Alternatively, you can wait for the alcohol to clear from your system. If your breasts become full while waiting, you can hand express or pump, discarding the milk expressed, but this will not speed up the elimination of alcohol from your body.

If consuming alcohol while breastfeeding is something that concerns you, then you may choose to enjoy non-alcoholic drinks instead. However, many mothers already worry that breastfeeding is something that will not be easy to fit into their lives. Feeling their choices will be restricted, especially if they feel they will be committing an offence to have an occasional drink while breastfeeding, could possibly deter women from breastfeeding, thus denying both themselves and their baby the many benefits they would get from it.

Compiled by Anna Burbidge

Further Reading
Safer sleep and the breastfed baby

LLLI articles
Alcohol and breastfeeding
Other resources
Dr. Thomas Hale Medications and Mothers' Milk, 2019
Dr. Jack Newman More Breastfeeding Myths
NHS: Breastfeeding and drinking alcoholHaastrup, M. B., Pottegård, A. and Damkier, P. (2014), Alcohol and Breastfeeding. Basic Clin Pharmacol Toxicol, 114: 168-173.

References
1. Koren, G. Drinking alcohol while breastfeeding. Motherisk Update. Canadian Family Physician 2002; 48:39-41

2. Mennella JA, Beauchamp GK. The transfer of alcohol to human milk: Effects on flavor and the infant's behavior. New England Journal of Medicine 1991;325: 981-985.

3. Mennella JA, Beauchamp GK. Beer, breast feeding and folklore. Developmental Psychobiology 1993;26: 459-466.

4. Mennella JA. The human infant's suckling responses to the flavor of alcohol in mother's milk. Alcoholism: Clinical and Experimental Research 1997;21:581-585.

5. Mennella JA. The transfer of alcohol to human milk: Sensory implications and effects on mother-infant interaction. In: Hannigan JH, Spear N, Spear L and Goodlett CR, eds. Alcohol and Alcoholism: Brain and Development . New Jersey: Lawrence Erlbaum Associates, Inc., 1999. pp. 177-198.

6. American Academy of Pediatrics. The Transfer of Drugs and Other Chemicals Into Human Milk. Pediatrics, September 2001, Volume 108, Issue 3.

7. Cobo E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women. Am J Obstet Gynecol 1973; 115(6):817-821.

Copyright LLLGB 2020

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Alcohol and breastfeeding - La Leche League GB

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There is no need to pump and dump after drinking alcohol. This article helps you consider the contradictory advice about breast milk & alcohol

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Practical ideas if you decide to maintain breastfeeding, and what you might want to discuss with your employer:

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Can I continue breastfeeding when I return to work?

Yes, of course. Lots of mums continue to breastfeed when they return to work or study. Depending on the age and nature of your baby, you can usually find ways to continue breastfeeding if you wish to.

How you do this will depend on your individual circumstances. Some mums might arrange their baby's childcare close to their work or place of study. They can then visit them to breastfeed when they can during the working day (NHS, 2018). Alternatively, your partner, childminder, friend or relative might bring your baby to your workplace so you can breastfeed them.

Some mums express milk during working hours to maintain their milk supply and so that their baby can be fed this expressed milk from a bottle while they're at work (NHS, 2018). Some parents opt for mixed feeding, also called combination feeding. This means continuing to breastfeed and offering suitable alternative milk when you're not able to breastfeed.

What are my legal rights around breastfeeding at work?

Before returning to work, it helps to let your employer know in writing that you are breastfeeding (NHS, 2018; HSE 2018). They can then complete a risk assessment and consider whether there are any specific risks to you for as long as you are breastfeeding (ACAS, 2014; HSE 2018).

There are few direct risks to breastfeeding but you should seek advice if you work with dangerous substances, such as organic mercury (HSE 2018).

Employers are legally required to provide a space for mums who are breastfeeding to lie down and rest if they need to (ACAS, 2014; NHS, 2018).

There is no legal right, however, for your employer to provide breastfeeding breaks at work. But they must meet their obligations to employees who breastfeed under health and safety law, flexible working law and discrimination law. (Maternity Action, 2017) This means your employer should make sure you don't feel unfairly treated because you are breastfeeding.

Can I express milk for my baby at work?

You should be able to express milk at your workplace if you wish. You can request that your employer provides you with a suitable private space where you can do this.

Guidelines recommend that you have access to a private, clean and comfortable room with a lockable door - not a toilet - in which to express. However, there is no legal obligation for your employer to provide this space (HSE 2018).

It's also recommended that you have use of a fridge to store your breast milk. (HSE 2018).

Can I change my hours to suit breastfeeding?

You might find that you'd like to make changes to your hours or working pattern to accommodate breastfeeding and/or expressing. Some parents share parental leave, some new mums choose to return part-time and others change their working hours. Have a think about what might suit you best and discuss different options with your employer.

One thing that could support your case is outlining the many benefits of employing and supporting mums who breastfeed, including fewer absences from the workplace and greater staff retention (Maternity Action, 2014; Steurer, 2017). There is also a long-term public health impact of continued breastfeeding and workplaces should be encouraging women to breastfeed (Rojjanasrirat, 2010). You could ask your employer to read Maternity Action's employer leaflet about this.

Your options may be partly determined by your financial situation and how flexible your workplace is. There are lots of sources of support and information to help you with this, such as Maternity Action (see Further information below).

My employer is not supportive of breastfeeding, what should I do?

Your employer must not refuse to allow you access to training or stop you returning to work because you're breastfeeding. If they refuse to act to protect your health and safety, you may have a claim under the Equality Act and you should seek advice.

If you feel like you are being discriminated against in the workplace contact Maternity Action.

This page was last reviewed in February 2019

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.

Maternity Rights Advice Line: 0808 802 0029.

Maternity Action is a UK charity committed to ending inequality and improving the health and well-being of pregnant women, partners and young children - from conception through to the child's early years.

Maternity Action's employer leaflet.

Health and Safety Executive information on breastfeeding and returning to work.

ACAS. (2014) Accommodating breastfeeding in the workplace. Available from: http://www.acas.org.uk/media/pdf/b/s/Acas-guide-on-accommodating-breastfeeding-in-the-workplace.pdf [Accessed 1st Oct 2017].

Borelli JL, Nelson SK, River SL, Birken SA, Moss-Racusin C (2017) Gender differences in work-family guilt in parents of young children. Sex Roles; 76(5-6): 356-368. Available from: https://link.springer.com/article/10.1007/s11199-016-0579-0. [Accessed 1st September 2017].

Gatrell CJ (2007) Secrets and lies: Breastfeeding and professional paid work. Soc Sci Med. 2007;65(2):393-404. Available from: http://www.sciencedirect.com/science/article/pii/S0277953607001487. [Accessed 1st September 2017].

HSE. The Health and Safety Executive Expectant Mothers - FAQs. Available from: http://www.hse.gov.uk/mothers/faqs.htm [Accessed 20 February 2019]

Maternity Action. (2014) Accommodating breastfeeding on return to work. Available from: https://www.maternityaction.org.uk/wp-content/uploads/2014/11/BORTW-employer-leaflet-FINAL.pdf [Accessed 1st Oct 2017].

Maternity Action. (2017) Continuing to breastfeed when you return to work. Available from: https://www.maternityaction.org.uk/wp-content/uploads/2014/03/Continuing-to-breastfeed-when-you-return-to-work-2017.pdf [Accessed 1st Oct 2017].

NHS Choices. (2018) Breastfeeding and going back to work. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-back-to-work/ [Accessed 1st Oct 2017].

Rojjanasrirat W, Sousa VD (2010) Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA. J Clin Nurs. 2010;19(13-14):2014-2022. DOI 10.1111/j.1365-2702.2009.03152.x Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2009.03152.x/full [Accessed 1st September 2017].

Steurer LM (2017) Maternity Leave Length and Workplace Policies' Impact on the Sustainment of Breastfeeding. Public Health Nurs. 34(3):286-294. DOI: 10.1111/phn.12321. Available from: http://onlinelibrary.wiley.com/doi/10.1111/phn.12321/full [Accessed 1st September 2017].
Further reading
Dettwyler KA (2017) A Time to Wean: The Hominid Blueprint For the Natural Age of Weaning in Modern Human Populations. In: Dettwyler KA, Stuart-Macadam P Breastfeeding: Biocultural Perspectives. Chapter 6. Available from: https://books.google.co.uk/books?hl=en&lr=&id=_8s3DwAAQBAJ&oi=fnd&pg=PT56&dq=+benefits+of+breastfeeding+beyond+two+years&ots=KPM3VOOAYR&sig=F0157OTEF3SC2SzIOsTKKkDfg6E (Accessed 1st October 2017).

Grether T, Wiese BS (2016) Stay at home or go back to work? Antecedents and consequences of mothers' return to work after childbirth. Research perspectives on work and the transition to motherhood Soc Sci Med. 65(2): 105-128. Available from: https://link.springer.com/chapter/10.1007/978-3-319-41121-7_6 [Accessed 1st September 2017].

La Leche League GB. (2016) Working and Breastfeeding. Available from: https://www.laleche.org.uk/working-and-breastfeeding [Accessed 1st Oct 2017].

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Yes, of course. Lots of mums continue to breastfeed when they return to work or study. Depending on the age and nature of your baby, you can usually find ways to continue breastfeeding if you wish to. How you do this will depend on your individual circumstances.

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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

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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.

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Hand expression is a useful skill - this video shows how to do it, and discusses when it might be helpful:

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This video guides mothers on how to hand express and talks about the times when hand expression might be useful.

See the Breastfeeding Network website for FAQs and a leaflet all about expressing and storing breastmilk.

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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This video guides you through how to hand express, and talks about the times when hand expression might be useful for you.

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Step-by-step instructions on safe preparation of formula milk:

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A video following 3 mothers who are breastfeeding twins:

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Follow three mothers as they share their tips on the joys and challenges of feeding twins.

The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole:

From Bump to Breastfeeding

From Bump to Breastfeeding extra films

Latest

The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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Follow three mothers as they share their tips on the joys and challenges of feeding twins. Vimeo Video http://www.vimeo.com/11739595 The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole: From Bump to Breastfeeding 1.

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A leaflet giving practical information on various aspects of breastfeeding more than one baby:

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Peer support from NCT-trained mothers who have breastfed twins:

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Peer support from NCT-trained mothers who have breastfed twins:

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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The Sling Library and The Nappy Library are back on 19th May.

How it works

You book your 15min slot here and come along to The Place Stamford where Katie (slings) and Charlotte (nappies) will be able to help you. You then pay the hire fees directly to Katie and Charlotte. You can pay these through the till at The Place Stamford or by paypal.

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Sling Library and Nappy Library - The Place Stamford

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The Sling Library and The Nappy Library are back on 19th May. How it works You book your 15min slot here and come along to The Place Stamford where Katie (slings) and Charlotte (nappies) will be able to help you. You then pay the hire fees directly to Katie and Charlotte.

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By Kelly Bonyata, BS, IBCLC

Babies should be fed when they indicate hunger. Crying is a late indicator of hunger - breastfeeding is much easier for both mom and baby if mom is able to pick up on baby's earlier hunger cues.

Common infant hunger cues include:

Early

Smacking or licking lips

Opening and closing mouth

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

Active

Rooting around on the chest of whoever is carrying him

Trying to position for nursing, either by lying back or pulling on your clothes

Fidgeting or squirming around a lot

Hitting you on the arm or chest repeatedly

Fussing or breathing fast

Late (calm baby before feeding)

Moving head frantically from side to side

Crying

"My newborn wants to sleep all the time! Should I wake him to nurse?"

Yes, if he doesn't wake on his own. Many newborns are very sleepy in the early days or weeks and may not exhibit hunger cues as often as they actually need to eat. Newborns should be nursed anytime they cue hunger, but at least every 2 hours during the day and at least once during the night. Once your baby has established a good weight gain pattern (at least 4 ounces per week, for babies under 4 months), you can stop waking baby to nurse and let him set his own pattern.

"My baby just started sleeping longer at night. Do I need to wake him to nurse?"

If your baby is younger than 4 weeks, then it is a good idea to wake baby at least every 4-5 hours at night to nurse if he does not wake on his own. If your child is older than 4 weeks, you can allow baby to sleep as long as he wants at night as long as he is peeing, pooping, and gaining weight within normal parameters.

"My baby frequently sucks on his hands. Does this always mean that he's hungry?"

After the newborn period, hand sucking is not as reliable an indicator of hunger. Starting at around 6-8 weeks, baby will begin to gain more control over his hands and will soon begin to explore his hands and everything else using his mouth. It is also common for babies to suck on their hands when their gums become tender in preparation for tooth eruption. Symptoms of teething can sometimes occur weeks and even months before the first tooth erupts. More here on teething.

More information:

Signs That Your Baby Is Hungry, a video from baby gooroo's Amy Spangler, RN, MN, IBCLC

Newborn hunger cues video from janellevideo

Baby feeding cues (great photo handout here), from Queensland Health

Infant Hunger Cues, from Lactation Education Resources

Feeding Cues, from the Australian Breastfeeding Association

The Clock and Early Breastfeeding, by Nancy Mohrbacher, IBCLC, FILCA

Nursing your newborn - what to expect in the early weeks @ KellyMom

Should baby be on a schedule? Links @ KellyMom

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

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Hunger Cues - When do I feed baby? * KellyMom.com

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Babies should be fed when they indicate hunger. Crying is a late indicator of hunger - breastfeeding is much easier for both mom and baby if mom is able to pick up on baby's earlier hunger cues. Common infant hunger cues include:...

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Breastfeeding after Breast surgery

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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.

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Tongue-tie in babies | Baby & toddler, Feeding articles & support | NCT

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Tongue-tie (ankyloglossia) in babies can affect both breastfeeding and bottle-feeding. Here we explain about tongue-tie symptoms and treatment.

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a brief guide to the law and what to do if you are treated unfavourably because you are breastfeeding in a public place.

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Remember to sterilise expressing equipment too.

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How to sterilise your baby’s bottles and other feeding equipment safely and effectively, whether you’re using boiling, steam or cold water sterilising equipment.

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Looking for an IBCLC International Board Certified Lactation Consultant near to you? Find an IBCLC by using our 'Find an IBCLC' map search.

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Steph Westacott: Pregnancy, Birth, Postnatal

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An earlier version of this piece was first published on the blog for Growing Families ahead of their conference in Manchester in October 2016. This current piece has been amended and updated as new information has been made available, and to the best of our abilities we will continue to amend and update where new evidence is produced which materially changes the content.
This year's big thing in the infant feeding related products world seems to be the Haakaa silicone breast pump. Coming from New Zealand, the company information on Facebook says they are a "baby brand that provides parents with Safe, Natural, Non-toxic, Eco-friendly baby products" http://www.haakaa.co.nz/ The 'buzz' around this product is so strong that people all over the UK have been importing from the other side of the world so they can get their hands on this item, and leaving rave reviews! I have been hearing a lot about them and wanted to provide a good discussion of what the fuss is all about.

This new-ish product is essentially a clever combination of two items which have been around for a long long time - breast shells and breast relievers.

Breast shells are designed to be tucked into the bra of a lactating woman, and the hole goes around the nipple so that any leaked milk is caught in the 'shell'. The shape of the part which touches the breast, and the size and placing of the hole, creates gentle pressure on the lactiferous ducts behind the areola and actually encourages milk flow and so stimulates leakage.

Two examples here

Breast relievers are designed to pump milk from the engorged breasts of lactating women when the baby they have been feeding baby cannot or does not wish to be fed. They rely upon a combination of suction (creating a vacuum which draws the milk out), rhythm (which might stimulate the 'let-down' reflex) and pressure on the lactiferous ducts, which stimulates milk flow. These devices have been around for well over 100 years and are still used today. See this one in the British Science Museum which was apparently in production between 1870 and 1901, although many like this were used much more recently - but also this one which is one of many similar ones available online now.

Where these have been promoted as breast 'pumps' in the past I have been a little concerned as this suggests the milk is being saved for use in feeding baby, and I'm never sure how one would effectively clean the 'bulb' - which both gets squeezed to create the vacuum / pumping, and also serves to store the collected milk. Nor whether the plastics or rubberised materials used, might leech substances into the milk - which is a worry if this is to be used for feeding baby, but of less concern of course if it is purely used to relieve engorgement and the resulting milk is discarded. However I don't know many lactating women who are happy about the idea of discarding breastmilk!!

So when I first saw the Haakaa in a breastfeeding group online I was impressed by the simplicity of the design and the ethos behind it - namely that it's simple to care for, and non-toxic!
How does it work?
For this we can turn to the company's own website: "Simply suction to your breast and let the pump do the work for you as it draws your milk using suction". It's true - the reports I have had tell me that the flange is placed on the breast, nipple lined up with the 'neck' of the device, and then the bulb is squeezed to compress which expels air from the bulb and creates a vacuum around the flange on the breast, securing it to the breast. Mums tell me that they then feed their baby on the other breast and while they are feeding the device fills up with their milk! The device has a scale on the side up to 90ml but I suspect it would accommodate 100ml - whether it could do this without falling off the breast as the vacuum reduces and the device itself becomes heavier with milk, is another matter - but you could hold it on.
How is it different from other pumps?
Most breast pumps work in a similar way - there's a flange or funnel which sits on the breast, a hole and tube which accommodates the nipple, and then something on the other side to provide the vacuum in a rhythm so that it does actually pump the breast. Usually there's some sort of valve so that the milk once removed from the breast is released into a bottle via some sort of 'one way' affair and cannot come back out again into the body of the pump. Whether hand pump or electric, whether double or single, costing £10 or £200 - all the same basic design. So there are at least 4 parts, of which at least 2 are moving. Usually many more than 4, and first time assembly for the exhausted new parent is akin to completing a passport application using only your mouth to hold the pen! But the Haakaa is just one piece of silicone and not really a 'pump' at all - no valve, no pumping required - though the manufacturers do say that you COULD squeeze and release the 'bulb' at the bottom, which contains any milk, if you choose to - it isn't necessary. Because it involves no 'pumping', in spite of the dictionary definition of pump only meaning to move liquid through suction or pressure, for some reason I'm a little uncomfortable calling it a 'pump' and am finding myself using the word 'device' to describe it!
How can it be cleaned?
Unlike any of the more complicated 'moving part' pumps there's only one piece to this device which makes it far simpler to wash inside and out (in hot soapy water) and of course no assembly required. Unlike its predecessors the breast reliever, Haakaa's device is also dishwasher safe (not sure how to position it so that it would definitely get washed and rinsed thoroughly, however - dishwashers tend to send small light things like this spinning around inside the machine during the cycle, in my experience), and because we don't want any nasty things leeching into baby's milk they are made from 100% food grade silicone and certified BPA, PVC and Phthalate free. So it's as simple as it looks.

Which brings us to a troubling issue with these devices:
Copycat pumps.
Since these devices have become popular, almost inevitably some copycat devices have spring up on the internet - some in China, some in Malaysia. Examples here

Some look identical to the Haakaa, some do not, and are not. The authentic Haakaa pumps were originally available only from New Zealand, costing $27NZ (about £15) and it was not possible to buy them from the UK without relatively high transport costs. The main (New Zealand-based) websites selling them would charge around £27 to sell and deliver one to an address in the UK, within about 2 weeks. UPDATE: at the bottom of this piece we have included a link for purchasing in the UK, updated 28th August.

However, the copycat pumps are available through amazon and other mainstream retailers, claiming prices from as little as £3 delivered! From the families I have spoken with who have ordered these copycat pumps, I know that the very cheap ones often do not turn up at all, and sometimes the refunds have been impossible to secure, also that even the £12-20 ones have been arriving without proper packaging - this is one example given to me by a local mum

As you can see - the packaging isn't quite as sophisticated!

These copycat pumps are often more 'solid' than the authentic Haakaa, made from a material that feels more rigid to the touch, and weighs more - 100g compared to 74g. This suggests they are not made to the same standards as the authentic Haakaa. Reviews on some of the copycat pumps on eg Amazon.com suggest that this thicker silicone actually causes pain when it is suctioned onto the breast, and there have been reports of burns to the skin, like chemical burns, from users - the reviews on some of the third party selling sites containing these damning claims have now been removed as far as I can see.

Interestingly the copycat pump shown above donated by a local mum has a different pattern on the silicone to the Haakaa, but the design is identical and it's just as squishy - even came shrink- wrapped squished in the post as you can see above! BUT it weighs LESS than the authentic Haakaa - so the copies are getting more sophisticated but still are not the real thing. The copycat pumps sometimes have Chinese lettering on them, whereas the authentic Haakaa one, a representative from the company tells me, have the word HAAKAA written down the side.

The authentic Haakaa pumps are certified BPA free. BPA is Bisphenol A - an industrial chemical used in the production of polycarbonate which is a hard, clear plastic, used in many consumer products. BPA is also found in epoxy resins, used as a protective lining on the inside of some metal-based food and beverage cans. It also leeches into liquids and is now thought to be carcinogenic, to which end it has been banned from the production of baby bottles since 2011 in the EU.
Buyer Beware!
Copycat pumps make some claims on the advertising and packaging but we cannot of course be sure if these are true. One mother I spoke to was concerned about these copycat pumps and, fearful she had bought one, she emailed the seller to ask if they were safe and what testing they had had. The response she received was that they had no idea, they were just selling and sending them out. In the UK/EU the importer actually has the responsibility for the safety and conformity of imported products, the 'CE markings', so if a UK resident is importing things from abroad then as the importer, THEY are responsible for checking that the products are appropriately CE marked for conformity to required standards.
Are they any good?
Assuming we're now talking only about the authentic Haakaa silicone pump, what most families will want to know, I imagine, is are they any good?

If you go online and search for Haakaa reviews, a few clicks will bring you many many positive stories, lots of five star feedback, youtube videos and so on. The point is it's a simple idea, and it works. Gentle pressure on the lactiferous ducts, plus gentle vacuum as the bottle expands, plus feeding baby or active pump on the other breast to create a 'let-down', will elicit a flow of milk into the device. Some women find they could completely fill it, others just an ounce - but as many mothers have told me - they have always failed at expressing, they are no good at it, and this device gives them an ounce they would never otherwise have had! Mothers who have trouble with leakage while feeding on the other breast and so use lots of breast pads, are finding this saves them lots of breast pads and leakage AND gets them some milk to store.

A word of caution though - a quick search of reviews online shows that some babies think it's a great game to knock them off the other breast as they are feeding, and because of the design, a knocked Haakaa pump can spill ALL the milk collected - up to 4 ounces - all over the place. So now you have been warned about that, there's no use crying...!

Lots of rave reviews however, and little images sent in of milk collected in them!

From the Haakaa Facebook page
Are there any drawbacks?
However because they apply the gentle pressure on the lactiferous ducts AND a gentle suction too, they will encourage continued leaking and can exacerbate the issue for anyone for whom leaking is already an issue; so as breasts are really supposed to work individually - assuming you are feeding only one baby! - if you have a problem with leaking from one side when the other is 'working', or perhaps a slightly different but related issue such as an over-supply, perhaps it's better to manage that rather than encourage more of the same by collecting the milk in a device like this. See someone qualified and experienced in supporting mothers with breastfeeding issues - perhaps from the voluntary sector (ABM, BfN, LLL or NCT) or an IBCLC www.LCGB.org/Find-An-IBCLC has a list of local practitioners.
Nutritional content of milk collected
One final potential drawback of these devices which should be noted before going ahead and using or encouraging their use, is that used as described above, ie simply attached to the breast and left to gather milk which is spontaneously ejected from the 'other' breast while feeding or expressing on the first breast, they may basically collect 'drip milk' which is not suitable for use exclusively as a full feed for baby, as it's the watery carbohydrate-rich milk, not the fattier richer milk. Fat soluble nutrients will be contained in the fattier richer milk in greater quantities. Babies feeding directly at the breast of course access the full spectrum of milk which the breast is capable of making, via a combination of variations in pressure, suction and mum's letdown.

If milk collected by the Haakaa or any other collection device is used as an occasional drink to be left when mum isn't able to feed, then probably the only negative issue would be baby being slightly less satisfied or needing slightly more volume to become satisfied - not a big deal. However if you fed nothing but 'drip milk' to a baby it would not do so well. In milk banking 'drip milk' is not suitable for donation because it is not whole milk, essentially it's skimmed milk.

A very quick search for evidence to corroborate my assertion about 'drip milk' when chatting online about the potential drawbacks of this device, brought me this from 1978 http://www.ncbi.nlm.nih.gov/pubmed/571325 - the author of that piece Alan Lucas does take money from the infant formula industry (though this was long ago so not sure whether this pre-dates the industry money) and so some may pooh-pooh the impartiality of his work, but we cannot dismiss everything he does on that basis alone - he has come up with some interesting stuff! And industry-funded work is often extremely informative too - no sense throwing the baby out with the bath water so to speak!

I know too from my experience working withthe UK Association for Milk Banking UKAMB for these past many years, and as a member of the 2009/2010 Development Group for NICE Guidance on Milk Banking, that the donation or collection of 'drip milk' is not recommended within milk banking as it is not suitable for fully-feeding growing vulnerable babies in the NNU, because of the nutritional shortfalls it may have. However, as an antidote, of course one could hand express a little of the much fattier richer milk from the breast after a feed, to even up the nutritional composition, and make it more suitable for using as a full milk feed. The best 'how to' guide I have seen online for massage before pumping and for expressing by hand is to be found here.

Because of the vacuum, it's likely to be slightly less 'drip milk' than milk which is REALLY dripping out, but not much more than the milk elicited by the breast shells which apply pressure to the areola. In some of the photos posted online, the colour of the milk is suggestive of higher water / carbohydrate content and lower fat content - but of course composition of breast milk will be slightly different from mum to mum and from one session to another, and it's impossible to judge nutritional content from a photo posted online! Haakaa confirm that there are no studies to determine the nutritional quality of the milk elicited as yet, and as a non-clinical researcher I'm certainly not in a position to provide this evidence myself.

It's worth pointing out too, that though Haakaa's website says "simply suction to your breast and let the pump do the work for you as it draws your milk using suction", apparently the instructions inside the box that comes with the genuine Haakaa also state that milk can be elicited by 'pumping' the bulb of the device.
Other online blogs about this product
Most of the blogs I found - a quick google search brings up loads! - seem to be rave reviews about the product, or akin to an instruction manuals, rather than a look at how they work and why it's so important to get an authentic one and not a copycat: however in this FB post from May, Ellen from New Zealand, who is a midwife, compares the 'China Cheapie' to the authentic Haakaa pump, and shows that they cheaper one is less flexible and much heavier.

Taken from Breastfeeding Illawarra's post about the Haakaa and the 'China Cheapie'!

As reported above however, newer copycat pumps are now on the market which look much more like the authentic pump, and behave in a similar manner - the pattern on the pump is different on the one I have (authentic Haakaas have a bamboo pattern - this one is flowers!), but the shape, feel and function are almost identical. The main factors pointing to a copycat pump rather than an authentic Haakaa device are the packaging - this one arrived in the shrink-wrap shown earlier, and stuffed into a plastic mailing envelope, not the cardboard tube of the Haakaa pump - and the weight is just 5g less. So we have no idea what it is made from or where it was made.

As with everything, Buyer Beware - and in this case, you definitely get what you pay for - so if the Haakaa is the pump for you then be sure you order a genuine Haakaa!
One final note - I have, at time of writing, not seen a genuine Haakaa pump - and I have not trialed it as I am an IBCLC and researcher, not a lactating mother anymore, so this is all theoretical and historically based and gathered from currently available evidence. I would welcome new evidence or experience on anything related with which to update this piece.
Haakaa have updated me that the pump is now available direct in the UK, via Amazon at £16.10 including delivery via Amazon Prime - and since I have heard that people importing from overseas have been billed for import duty in some cases, this seems like the best way to buy now!

AUGUST 2016

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By Shel Banks, Chair of LIFIB, Infant Feeding Information Specialist and IBCLC An earlier version of this piece was first published on the blog for Growing Families ahead of their conference in Manchester in October 2016. This current piece has been amended and updated as new information has been made available, and to the best of our abilities we will ...

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Inflammation of the milk ducts (also known as blocked ducts) | Baby & toddler, Feeding articles & support | NCT

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What does an inflamed milk duct feel and look like? And what’s the best way to treat it? Find out everything you need to know here. 

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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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Video transcript

Narrator: Getting a good attachment is an important step towards getting breastfeeding working for you and your baby. Becoming skilled at it can take time. Having you and your baby calm and relaxed is the first key step towards getting a good attachment to the breast. One thing that can help is to recognise the things your baby does to tell you he's ready for a feed, like turning his head from side to side with his mouth open.

To start the feed, hold your baby in close, along your forearm so that her chest is touching yours. Remember to bring your baby to your breast and not your breast to your baby.

Narrator: Bring your baby's nose directly opposite your nipple. As your baby tips her head back, her top lip brushes over your nipple. This encourages her to open her mouth wide. When her mouth is wide open, hug your baby to your breast and she can take your breast into her mouth with her chin leading. When your baby attaches well, she will have a large mouthful of breast in her mouth and your nipple will be positioned far back in her mouth, towards her soft palate. Breastfeeding will more likely feel comfortable and she can get the milk she needs.

So here is how it will look to you. Bring your baby's nose directly opposite your nipple. Allow your baby's head to tip back. As it does, her top lip will brush over your nipple. This encourages her to open her mouth wide. Sometimes it can take a few goes to get the timing right. So you can encourage her to open her mouth wide again by brushing your nipple over her top lip.

When her mouth is open wide, quickly hug her onto your breast directing your nipple towards the roof of her mouth. This helps achieve a deep attachment where your nipple is deep inside your baby's mouth towards her soft palate.

When your baby is attached well to your breast, her chin will be touching your breast and her nose is clear or only just touching your breast. Her lips are flanged out, not sucked in. There will be more of your areola showing above your baby's top lip, as compared to her lower lip.

You also know you have good attachment if there is no pain, although it is common for some mums in the early weeks to feel some nipple pain that ceases after the initial attachment.

At the start of the breastfeed, your baby sucks will be fast and shallow as she gets the milk flowing, by triggering the reflex that allows the milk to flow. After this, she will do groups of deeper, slower, suck and swallows.

Swallowing can be identified by a soft tick sound and also by a pause in her chin when it drops down to its lowest position when she has a mouthful of milk. The longer the pause in her chin, the bigger the mouthful. Rest periods between sucking are a normal part of breastfeeding too. As the breastfeed continues, the groups of sucks and swallows gradually become shorter and the rest periods longer.

Most of the time a baby will come off on her own accord when she is finished with that breast.

If you feel nipple pain beyond the initial attachment, you can try attaching your baby again. To break the attachment, avoid pulling your baby away from your breast. This could cause more pain and damage your nipple. Instead, break the attachment by inserting a clean finger into the corner of your baby's mouth between her gums. Gently but firmly press down on her lower gums and remove her from the breast.

Every mother and baby have slightly different ways of attaching to the breast. Doing what works best for you and your baby is important. So long as breastfeeding is comfortable and your baby is getting enough milk, exactly how you position and attach your baby doesn't matter. You can find out more about whether your baby is getting enough milk in our common questions video.

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Breastfeeding: getting a good attachment

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Good attachment is key to successful breastfeeding, but how do you make it happen? This video shows you how to do mother-led attachment to the breast.

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Feeding should be comfortable for both you and your baby. If you experience any discomfort, or have concerns about your baby's feeding, talking to someone who can help could make all the difference.
Watch our video to find out about support for breastfeeding.
Common problems with breastfeeding include:
Sore nipples
Tongue tie
Sore breasts
Unsettled baby and frequent feeding
Baby refuses the breast

Sore nipples

An unfamiliar feeling of tingling, or pressure, without actual pain, is normal when you first start to breastfeed. But if breastfeeding hurts your nipples, then the most likely reason is that you and your baby need to change the way he latches on. Read about how to deal with sore nipples.

Tongue-tie

Some babies find a comfortable, effective latch hard to achieve because of tongue tie. Read our article on tongue-tie.

Sore breasts

When your baby is feeding, your breasts 'let down' milk. A few women find this sensation painful. You may also feel your womb contracting. It should pass quickly; try to relax and breathe through it and ask your midwife for tips. Find out more in our article here.

Unsettled baby and frequent feeding

If your baby seems unhappy, unable to sleep, or difficult to feed, do ask for help. Many women worry a great deal when their babies seem to need to breastfeed a lot, or for prolonged periods of time, and show by their crying they don't like being placed in a crib or cot for very long. Read about how to deal with frequent feeding here.

Baby refuses the breast

If your baby is very sleepy and doesn't seem interested in feeding, then do seek help. It could be that the after-effects of the birth or pain relief used during labour are affecting his responses. Other babies fight and struggle at the breast, and seem to resist it. Find out more here.

For problems that are more likely to affect your breastfeeding, as your baby gets older click here.

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) 0844 209 0920

NHS information on mastitis.

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

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

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Breastfeeding problems and concerns in the early days | Baby & toddler, Feeding articles & support | NCT

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Here we look at some of the problems and concerns that can make breastfeeding in the early days challenging.

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College of Human and Health Sciences, Swansea University

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What's important to think about?

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A nipple shield is a thin, silicone teat that can be placed over a mother's nipple and may help a baby who is having difficulty learning to breastfeed. Holes in the tip allow milk to flow into the baby's mouth. A nipple shield can be used temporarily to help establish breastfeeding or in some cases to help ensure that breastfeeding continues. A shield provides a firm stimulus at the roof of a baby's mouth where the soft and hard palate meet. This can help him suckle more effectively.

If your baby is not nursing at all, or is nursing ineffectively despite improving attachment and increasing milk flow, a nipple shield may help by providing a firmer stimulus in your baby's mouth. A nipple shield may be a useful tool in some situations. When nothing else works, it can be a temporary way to establish and maintain breastfeeding.

A nipple shield may be helpful if

Your baby is struggling to learn how to breastfeed

You have flat or inverted nipples, or very soft breasts as it can help maintain nipple shape

Your baby thrusts his tongue, has a retracted tongue or has neurological problems

Your baby was born prematurely

Your baby needs extra stimulus to prompt sucking

In these situations, a nipple shield can

Give a baby the opportunity to learn to breastfeed

Allow a baby who breastfeeds ineffectively to take more milk directly at the breast. This can be particularly helpful for premature babies

Avoid or reduce the need to express milk and use cups or bottles

Help keep breastfeeding going

Not a magic solution

It is very important to seek skilled help with positioning, attachment and any other problems if you are planning to use nipple shields or are already using them. Helping your baby get a deep latch at the breast is the key to effective and comfortable nursing with or without a nipple shield. A shield cannot correct underlying problems, especially those of sore and damaged nipples or low milk production. And if your baby is not attached well he may compress your nipple, causing damage and intense pain. When your baby latches on deeply at the breast he gets plenty of milk. Also, as you wean from the shield he will be able to adapt to breastfeeding effectively and comfortably without it.

Even with a nipple shield, your baby may still need help to learn to breastfeed well. Sometimes just a small adjustment to the way you hold your baby makes a big difference. You may find the suggestions and pictures in Comfortable Breastfeeding helpful. If you cannot get comfortable or breastfeeds are taking an hour or more, seek help from an LLL Leader who can give you personalised suggestions.

Holding your baby in skin-to-skin contact can make a big difference too. With or without a shield, laid back or 'natural' breastfeeding positions (see above) can be a great help in encouraging your baby to latch on effectively, as well as being comfortable for you. You can either lie down or recline with your baby on top of you and with his whole front against you and his body completely supported by yours. Such positions also leave both your hands free to shape your breast and help him latch.

If your baby won't breastfeed

Don't panic! Some babies take time to learn. However, babies will often latch on and suckle spontaneously if they can snuggle up close to their mother's bare chest for periods of time. Try letting your baby lie on your body as you recline so that both his chest and tummy are against you. This kind of contact, known as Biological Nurturing ™, or laid back breastfeeding usually stimulates a baby's instinct to attach and suckle well at the breast. In such positions, babies can also latch on when sleepy or even asleep. Watch for signs your baby is stirring and gently encourage feeding. If he is not breastfeeding effectively or at all you will need to express your milk for him. This will help maintain your milk production while he learns to breastfeed. An LLL Leader can give you tips for effective milk expression.

Is he getting enough milk?

Offer frequent feeds and monitor wet and dirty nappies for evidence your baby is getting plenty of milk. His weight will need checking regularly-as often as every three days for premature babies. For more information see Is My Baby Getting Enough Milk?

Check your breasts

Areas that aren't being drained well may appear swollen, sore or red. Treat early signs of localised engorgement to avoid a blocked duct or mastitis.

Practicaliti es
Type and fit
Modern nipple shields are made of clear ultra thin silicone. Different makes vary in flexibility. Some shields have a cut out section, but these may not stay in place as well as a full nipple shield. Full nipple shields do not bother babies or affect their breathing. Nipple shields come in different sizes but choice is limited. Both the width of the tip section and the shape of the flat part vary and you may need to experiment to find which size and shape you prefer. A comfortable fit is very important and some mothers need more than one size of nipple shield due to differences between their breasts.

Applying
Stretching the shield onto the breast can help it stay in place. You can also moisten the shield's edges or warm it with hot water to help prevent it moving. Turn the nipple shield almost inside out before applying it. Smooth it onto the breast, starting well away from the nipple in the area where your baby's lower jaw will latch on. Stretch the shield over your breast, with the tip centred over your nipple. The nipple shield should be tight against your breast with your nipple extending into the tip. If necessary, you can express milk into the tip or drip expressed milk onto the outside to encourage your baby to latch on.

Cleaning
If you and/or your baby are in hospital, wash the nipple shield thoroughly in hot soapy water and sterilise it before each use. If you have a healthy, full-term baby and are at home, cleaning with hot soapy water or washing in a dishwasher on a hot cycle will be sufficient. Shields should be dried thoroughly before use and stored in a clean, sealed container or bag.

A faster flow
Swallowing encourages sucking, which will help keep milk flowing. A baby who has become used to a continuous fast flow from a bottle may need help to persist with breastfeeding. Hand expressing for a few minutes can encourage a good flow of milk before your baby latches on. You can even hand express milk into your baby's mouth to encourage him to latch on or keep him nursing when your milk flows more slowly.

Try breast compression

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

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

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

Use a shield with a nursing supplementer

If your baby needs extra milk, a nursing supplementer can be used to deliver this through a tube as your baby breastfeeds. This avoids the need to bottle feed. The end of the supplementer tube can be placed either inside or outside the shield. Consult an LLL Leader if you think a nursing supplementer may be helpful.

Giving up the shields

Nipple shields are intended to be a temporary solution until your baby learns to breastfeed without them. When using a shield, help your baby to latch on by himself with a wide open mouth. This will help him to learn to breastfeed without a shield. Offer your baby some time in skin-to-skin contact every day without a nipple shield so he has the opportunity to latch on if he is able. It can take time to wean from shields but do keep gently trying. Try at times when you and your baby are most comfortable and relaxed and there are fewest distractions. You can try different methods to see what suits your baby.

Start with skin-to-skin next to breast without the nipple shield before nursing with the shield.

Start a feed with a shield, removing it part way through nursing from one breast or when switching breasts.

Gradually offer the breast without the shield.

DO NOT CUT a silicone shield as this could leave sharp edges that would hurt you and your baby.

Seek support

Whilst you may be relieved that a nipple shield is enabling your baby to breastfeed, it can be frustrating if he will not feed without it. However, given time and patience, it is usually possible for a baby to learn to breastfeed without the shield. An LLL Leader can be a useful source of support if you need to choose, use and wean from nipple shields.

Written by Karen Butler, Sue Upstone and mothers of La Leche League GB.

Further Reading

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

Positioning & attachment
Comfortable breastfeeding
Engorged breasts - avoiding and treating
Hand expression of breastmilk
Inverted nipples?
Is my baby getting enough milk?
My baby needs more milk
My baby won't breastfeed
Nipple confusion?
Nipple pain - why and what to do

References
The Breastfeeding Answer Book. Third edition. Schaumburg IL: LLLI, 2003.
Breastfeeding and Human Lactation. Fourth Edition. Sudbury, MA: Jones and Bartlett, 2010.
Supporting Sucking Skills in Breastfeeding Infants. Watson Genna, C. Sudbury, MA: Jones and Bartlett, 2008.
This information is available in printed form from the LLLGB Shop
Copyright LLLGB 2016

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how an when to use nipple shields to support successful breastfeeding