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North Tees and Hartlepool NHS Foundation Trust

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Responsive feeding

A sensitive two way relationship between a mother and her baby. A mother responds to her baby when:

Baby shows feeding cues - rooting, moving their eyes, wriggling, waving sucking fists, blanket and making murmuring noises

Baby is distressed - tired or lonely

Her breasts are full

She simply wants to sit and cuddle

Confident feeding

Your midwife will listen to any concerns you may have about feeding your baby and support you to gain confidence by:

Making sure you understand what is responsive feeding

Showing you how to hold your baby for feeding

Informing you how to access help when at home

Breastfeeding

Feeding your baby frequently for food and comfort

That you know how your baby is getting enough milk

That you understand the value of exclusive breastfeeding

Teaching you to hand express and why this can be helpful

Responsive formula feeding

Observe feeding cues

Hold baby close

Encourage rooting

Invite baby to take teat

Pace the feed

Never force a full feed

Limit who feeds the baby

By following the above points, will make your baby feel safe

Formula Feeding

Advising for you or your partner to feed your baby

Informing you how to sterilise and make up feeds safely

Advising you to only feed your baby with first milks

Making up a formula feed safely

Boil kettle with at least 1 litre of fresh cold tap water

Leave to cool for no > 30 mins (70 degrees)

Clean and disinfect surface you are going to use.

Wash your hands thoroughly

Shake off any excess sterilising solution

Stand the bottle on a clean surface.

Keep the teat and cap on upturned lid of steriliser

Follow manufacturer's instructions

Pour correct amount of water into bottle within 30 mins

Loosely fill scoop with formula and level off (Using flat edge of clean dry knife or leveller provided)

Hold the edge of the teat and put it on bottle

Screw the retaining ring onto bottle

Cover teat with cap and shake until powder dissolves

Before feeding baby

Cool holding bottom half of bottle under cold running water

Move bottle about under tap to ensure even cooling

Test temp on inside of your wrist before giving to baby

It should be body temperature

Discard any left over formula after one hour

How does a baby communicate?

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A sensitive two way relationship between a mother and her baby.

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A breastfeeding mother with a thrush infection of the nipple, areola and/or breast can experience pain in these areas both during and between feeds. If a baby's mouth is infected it can be sore, making him fussy during feeds.

Women describe the pain of thrush as severe, even excruciating. They dread feeds, even though they want to nurse their babies, and have real worries about how they will continue breastfeeding. Without appropriate help and support, many mothers give up breastfeeding before they are ready. The good news is that appropriate treatment can protect mother and baby from stopping breastfeeding before they are ready.

Signs and Symptoms
Research about thrush and its treatment
Eliminating other possibilities
Treatment
Hygiene
Diet
Supplements and complementary therapies
Thrush medication
Topical medication for the mother
Medication for baby
Applying ointments or creams
Oral medications
When treatment doesn't work as hoped
Eliminating thrush

Signs and symptoms

Symptoms of thrush in a baby
Your baby may have one or more of the following symptoms:

White patches inside his cheeks or on his tongue or gums. These look like left over milk. When wiped off they leave red sore areas which may bleed.

Your baby's mouth may be uncomfortable or painful, making him fussy during and between feeds. He may slip on and off the breast and may make a clicking sound.

Symptoms of thrush in a mother
Having two or more of these symptoms makes it more likely that thrush is involved, especially if these include shiny or flaking skin:

Burning nipple pain

Flaking skin on the nipple or areola

Shiny skin on the nipple or areola

A loss of colour in the nipple or areola

Painful breasts without tender spots or sore lumps

Stabbing pains in the breasts behind the areola.

Nipple thrush is more likely when:

A mother has thrush affecting any other part of her body - such as vaginal thrush.

Any other family member has a candida infection, for example athlete's foot, nappy rash or jock itch.

Mother or baby has been treated with antibiotics or corticosteroids, or mother takes the contraceptive pill.

Thrush is also associated with:
Research about thrush and its treatment

Researchers have conflicting views on the diagnosis and treatment of thrush. This is not helped by the fact that thrush can be associated with bacterial infection. It has been suggested that thrush cannot spread in milk ducts. However, some practitioners believe thrush may enter milk ducts by tracking back from skin at the nipple, causing stabbing pains in the front of the breast.

Eliminating other possibilities

Try adjusting your nursing position and your baby's latch-on before assuming pain is due to thrush. This is especially important if:

Breastfeeding has always been painful.

Your nipples are flattened, wedge-shaped or appear white after feeds.

An LLL Leader can help with this. Sudden onset of pain after a period of comfortable breastfeeding may suggest a thrush infection. Visiting your GP for a diagnosis is important as other skin diseases, including eczema, dermatitis, psoriasis, impetigo, herpes and bacterial infection can have similar symptoms to thrush. A mother may also experience breast pain for other reasons, e.g. engorgement, blocked ducts, mastitis, circulatory problems (Raynaud's syndrome) or if her baby is sucking incorrectly.

Treatment

With appropriate treatment, many women and babies overcome thrush and continue their nursing relationship. There are practical, effective steps you can take to combat thrush alongside any medication you use. Thrush spreads easily and spores linger on anything they touch ready to infect the next contact. Therefore, a fourfold approach to treatment may be needed:

Hygiene

Diet

Dietary supplements and complementary therapies

Medication.

Hygiene

Careful hand washing by all family members is essential, particularly after nappy changing or using the toilet. Wash your baby's hands too.

Keep a separate towel for each person in the family, or at least for you and your baby. Wash towels frequently at 60ºC. Or use paper towels for drying hands and dispose of them immediately.

Keep your nipples as dry as possible between feeds and, ideally, avoid breast pads. If you use breast pads choose disposable ones and wrap and dispose of them immediately after use, or wash re-usable ones immediately at a high temperature.

Wash anything that comes into contact with the affected area, immediately after use at a high temperature.

Wear a clean cotton bra every day and wash all clothes in hot water, at least 50ºC if possible. Hang in the sun to dry or dry them at a hot temperature. A hot iron can also kill yeasts.

Use sterilising fluid to regularly clean any items that could carry thrush: toys, pump equipment, bottles, teats, dummies. Or boil feeding and pump equipment for 20 minutes and replace teats and dummies weekly.

Replace toothbrushes, toiletries and cosmetics as they may have become infected.

Thrush cannot thrive in acidic conditions. Add 120 - 240ml (½ - 1 cup) distilled white vinegar to baths and in final rinses in washing machines.

Diet

When fighting any infection, eating a balanced diet and drinking enough water is a good idea. Limit sugar and other refined carbohydrates as they seem to make thrush symptoms worse. This can be a challenge as those with thrush often crave these foods. Many processed foods contain refined carbohydrates, so read food labels carefully. Note that fruits and juices contain sugar in the form of fruit sugar.

Some mothers have found that particular foods exacerbate their thrush and decide to limit them. These can include yeasty foods (such as bread, alcohol and mushrooms), dairy products or artificial sweeteners. If you decide to make major changes to your diet, you may find it helpful to consult a dietician.

Avoid giving your baby infant formula

Research has shown that bottle-fed babies are more likely to develop thrush.2 Although yeasts can grow in breastmilk, your breastmilk contains substances that help limit thrush growth. Formula, on the other hand, has high levels of added iron, which may encourage the growth of yeasts.

Avoid storing expressed milk

when you and your baby have a thrush infection. Freezing does not kill yeast cells so it's possible to reinfect your baby with thrush in stored milk.

Supplements and complementary therapies

Thrush is more common in mothers who are run down or under stress. Sweetened and processed foods are low in nutrients. So try to eat a varied diet of vitamin and mineral rich foods instead. Although scientific evidence is lacking, some mothers decide to try the following alongside prescribed medication:

Nutritional supplements from health food stores and chemists.

Therapies from registered homeopaths or naturopaths.

Altering the relative acidity (pH) of your nipple skin may reduce itching. Rinse your nipples with:

5 - 10 ml (1 - 2 tsp) of distilled white vinegar in 160 ml (1/4 pint) of water four times a day

Or 5 ml (1 tsp) of sodium bicarbonate in 240 ml (1 cup) of water once or twice a day Herbal products and essential oils should not be applied to your nipples, as it is not clear how safe they are for your baby.

Lactobacillus acidophilus tablets

Follow dosage on the packet until you are free of symptoms for 2 weeks

Grapefruit seed extract

250mg daily or 5 - 15 drops in 150 ml water 2 - 5 times daily

Garlic

3 triple strength deodorized tablets, 3 times daily

Zinc acetate or zinc gluconate

45mg daily

B vitamins

100 mg of each daily (avoid nutritional yeast)

Thrush medications

Prescribed medication

Complete the course of medication

Even if symptoms improve earlier, certain medication needs to be used for a particular period of time to clear the infection. Follow the guidelines provided with the specific medication or ask your doctor or pharmacist for more detailed guidance.

Treat both mum and baby

Thrush spreads easily, so both you and your baby need simultaneous treatment to avoid reinfecting one another - even if one of you is symptom free. Research has shown that mothers often test positive for thrush before symptoms appear.

Topical medications for the mother

When deciding whether to use medications you will want to weigh the potential benefit against the possible side effects. Treatment will depend on whether there is any inflammation or an associated bacterial infection. You can discuss this with your GP and health care team. You may find it helpful to share this page with your doctor. Doctors may prescribe one of the following creams or ointments when thrush is diagnosed. See Applying creams or ointments for information on application and oral treatment.

NYSTATIN

Nystatin

Some strains of thrush are becoming resistant to nystatin. Use for at least 14 days.

CLOTRIMAZOLE

Canestan

Risk of contact dermatitis. Clotrimazole is less effective for topical infections of the breasts than miconazole

NYSTATIN Tri-adcortyl Contains a corticosteroid. Used occasionally for persistent with triamcinolone

Tri-adcortyl

Contains a corticosteroid. Used occasionally for persistent with triamcinolone eczema-like inflammation associated with a thrush infection. Ask your doctor about safe use while breastfeeding.

Medications for baby

Treatments for thrush in a baby's mouth are in the form of liquids or gels. To work effectively, they need to be applied to all the nooks and crannies in a baby's mouth as directed by your doctor or pharmacist. Always wash your hands before and after application.

* MICONAZOLE (Daktarin Gel) is recommended as first-line treatment in children under two years.7 Due to risk of choking, manufacturers recommend it is not used for babies under 4 months of age and used only with care from 4 to 6 months. Divide each dose before applying and keep away from your baby's throat to avoid choking. If applying using a finger, keep your fingernails short.

* NYSTATIN (Nystan) oral suspension is recommended as the second-line of treatment where miconazole is ineffective or causes side-effects. The easiest way to apply this is to pour the correct dose onto a measuring spoon and apply with a dropper or swab. Discard the swab after use. If the dropper has been in contact with your baby's mouth, sterilise it before replacing in the bottle. Some strains of thrush are becoming resistant to nystatin.

Please note: Oral gel applied to your breast is unlikely to be effective; it has not been formulated for this use in this way, so will not have effective topical properties.

Applying ointments or creams

Unless your doctor states otherwise, creams (usually water-soluble) or ointments (usually oily) need to be applied after feeds several times a day for the recommended period of time and until you've been free of symptoms for at least two days. Take care to wash your hands before and after application. Wipe away any excess cream or ointment before nursing your baby. A water-soluble cream is more likely to have been absorbed by the skin. An oily ointment is best avoided as it may need removing with warm water and mild soap. Vigorous washing can cause further soreness.

* As you will be feeding your baby more often than you apply the medication, ask your doctor how often and how much to apply.
* You may find it helpful to use the cream after your baby nurses to sleep, especially if he is likely to sleep for a while.
* Resistant yeasts can replicate themselves every 30 minutes, so if thrush is persistent, ask your GP about applying the above medications in smaller more frequent doses while using the same amount in 24 hours.
* Be aware that symptoms may get worse as the thrush starts to die off, before you notice any improvement.
* Always taste a topical medication yourself as your baby will be tasting it. Some medications used for athletes foot (eg Timodine) are foul-tasting and should be avoided at all costs!

Oral treatments

Oral fluconazole (Diflucan) is usually only used when there is a definite diagnosis of thrush and topical treatments have been ineffective. A loading dose of 150-200mg followed by 100mg daily is required for up to 2 weeks. If things do not improve within this time, seek help for other causes. Although it is licensed to be given to babies in neonatal units, fluconazole is not licensed in the UK for use by breastfeeding mothers of babies under 6 months. It is only available for mothers of younger babies at the discretion of the GP.

When treatment doesn't work as hoped

Sometimes it can take time to find an effective treatment for your infection. If symptoms don't improve or get worse:
* Check for other sources of pain. An LLL Leader will be able to share information on other possible causes of nipple and breast pain.
* Check for possible sources of reinfection, especially if symptoms improved at the start of treatment. Treating any other candida infections in the family may help.
* Consider whether diet and hygiene need to be changed.

Let your doctor know if treatment was not effective or improved things only slightly:
* Another cream or ointment may be more effective if the diagnosis for thrush is certain.
* You and your doctor may need to investigate other possible causes of pain and skin changes.
* Other family members who have a candida infection may need treatment. In particular, if you have vaginal thrush, your partner may need treatment too.

If you are considering switching treatments, try the new preparation on just one side, while continuing on the other breast with the original treatment. You have two breasts so using them to experiment with treatments may help!

Eliminating thrush

It may take a little time and persistence to deal with a thrush infection and enjoy comfortable feeds once more. Sometimes it takes a little effort to find the right medication for your thrush. Many mothers have found using diet, hygiene, supplements and alternative therapies alongside any medication can make a great deal of difference and help prevent thrush returning.

Written by Sue Upstone and mothers of LLLGB

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Nipple pain

References
1. Francis-Morrill, J. Diagnostic value of signs and symptoms of mammary candidosis among lactating women. J Hum Lact 2004; 20(3): 288-94.
2. da Costa Zöllner, MSA et al. Candida spp. occurrence in oral cavities of breast feeding infants and in their mothers' mouths and breasts. Pesqui Odontol Bras 2003;17(2): 151-5.
3. Francis Morrill, J et al. Risk factors for mammary candidosis among lactating women. JOGNN 2005; 34: 37-45.
4. Francis Morrill, J et al. Detecting Candida albicans in human milk. J Clin Microbiol 2003; 41(1): 475-478. 5. Wiener,
S. Diagnosis and management of Candida of the nipple and breast. J Midwifery Womens Health 2006; 51(2):125-8.
6. Chetwynd, EM et al. Fluconazole for postpartum candidal mastitis and infant thrush. J Hum Lact 2002; 18(2): 168-71.
7. http://www.nhs.uk/chq/Pages/2448.aspx
8. Brent, NB. Thrush in the breastfeeding dyad: results of a survey on diagnosis and treatment. Clin Pediatrics 2001; 40(9): 503-6.
9. Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.
10. *Medications and Mothers' Milk. Hale, TW. TX: Hale publishing, 2010
11. Moorhead, AM et al. A prospective study of fluconazole treatment for breast and nipple thrush. Breastfeeding Review 2011; 19(3): 25-29.

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

Please note: Information is provided for educational purposes only. If you are concerned about your health, or that of your child, consult with your health care provider regarding the advisability of any opinions or recommendations with respect to your individual situation.

Copyright LLLGB 2016

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Thrush and Breastfeeding - La Leche League GB

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A breastfeeding mother with a thrush infection of the nipple, areola and/or breast can experience pain in these areas both during and between feeds. If a baby's mouth is infected it can be sore, making him fussy during feeds. Women describe the pain of thrush as severe, even excruciating.

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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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Mastitis symptoms usually develop quickly, with signs of inflammation normally appearing in one breast, often alongside feeling like you have flu. It's most common in women who are breastfeeding.

What is mastitis?

Mastitis causes a woman's breast to become swollen, painful, inflamed and it might appear red or darker, depending on skin colour. It usually occurs within the first three months after giving birth (NHS Start for Life, no date).

Mastitis symptoms

Mastitis usually occurs in one breast, but may affect both. Symptoms usually develop quickly and might include:

What causes mastitis?

Mastitis is often caused by excess milk in the breast leading to inflammation of the milk ducts and a disruption of the makeup of the breastmilk or microbiome.

You might get mastitis because:

you have an abundant supply of breastmilk

you are feeding your baby and also expressing as well

your baby is not attached well to the breast, and you need support to find a position that is comfortable for both of you

your baby is missing feeds, or you are delaying feeds, or maybe missing feeding cues (perhaps as a result of using a dummy)

you are weaning from the breast, (it's better to reduce breastfeeds gradually).

the kind of birth you have could also affect the chance of mastitis. This is because both caesarean surgery and the antibiotics received as a result of surgery disrupt the mother's microbiome.

something is putting pressure on the breast or has bruised it; for example, a tight bra or tight clothing, bag strap, seat belt, baby carrier

Using nipple shields has been associated with an increased likelihood of mastitis

In some cases, a large breastmilk supply can cause an imbalance in the breastmilk causing the growth of harmful bacteria. This is called infective mastitis and you might need antibiotics to treat it.

(La Leche League GB, 2023; NHS, 2023; Mitchell et al, 2022)

For some women mastitis recurs every couple of weeks. This could be because:

Previous issues of attachment, position, or supply were not resolved.

Previous infectious mastitis was not resolved with antibiotics.

(Mitchell et al, 2022)

Continuing to breastfeed with mastitis

If you develop mastitis, continuing to breastfeed in response to your babies needs will help improve the symptoms and won't harm your baby. It has previously been thought that extra feeding or expressing was helpful along with breast massage, however there is now evidence this will not help and may make things worse.

(La Leche League, 2023; NHS, 2023; Mitchell et al, 2022)

Mastitis treatment

Mastitis is usually easy to treat, and most women recover well and quickly. Some self-help measures can be helpful, such as:

continuing to breastfeed in response to your baby's needs

getting lots of rest and relaxation

applying cold to the affected area

staying hydrated

using paracetamol or ibuprofen for relief from pain or fever

avoiding tight or restrictive clothes or bras until symptoms improve (see our article about maternity and nursing bras for more tips).

avoid nipple shields unless essential for feeding your baby. If using nipple shields seek support from a breastfeeding counsellor to use them without causing further issues

(NHS, 2023; Mitchell et al, 2022)

Continue with self-help measures, and if the inflammation has not cleared after 12-24 hours, or symptoms worsen (eg a fever and flu-like symptoms), you could see your GP (NHS, 2022).

You might need antibiotics to treat mastitis if there is an infection, however antibiotics will not be helpful if no infection is present. If you're breastfeeding, your GP will be able to prescribe antibiotics that are safe to use while breastfeeding.

You might also need to contact your GP if you:

continue to feel feverish or if your temperature rises above 38.4°C

see pus or blood in your milk

have a cracked nipple that looks infected

(NHS, 2023; Mitchell et al, 2022)

Some women with mastitis or recurrent mastitis can develop a breast abscess - a collection of pus, which might need to be drained surgically (Mitchell et al, 2022).

Preventing mastitis

If you find you have recurring mastitis, it's a good idea to seek breastfeeding support to help make adjustments to your baby's latch and to discuss ways to manage your breastmilk supply. It might also be helpful to check that your baby doesn't have any underlying medical conditions, such as a tongue-tie. Try to take these steps to help prevent mastitis:

If expressing as well as breastfeeding, build up the frequency slowly.

If you have infective mastitis, ask your GP about a breast milk culture to ensure the right antibiotics are being used.

When weaning from the breast, reduce breastfeeds gradually.

This page was last reviewed in July 2023
Further information

We support all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our support line on 0300 330 0700 (open 8am to midnight every day of the year), 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.

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

Sarah Oakley's parent-friendly explanation of 'The Mastitis Spectrum'

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

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 Postnatal Practitioner and other new parents in your area.

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

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Mastitis: symptoms and treatment | Baby & toddler, Feeding articles & support | NCT

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Mastitis is a painful breast condition. Here we discuss its symptoms, treatment, how to continue breastfeeding with mastitis and how to help prevent it.

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Reports on new research published in the American Journal of Public Health 1 have implied that breastfeeding may contribute to the development of rickets. 2 This is a condition that affects bone development in children, causing the bones to become soft and weak, potentially leading to bone deformities (in adults rickets is known as osteomalacia or soft bones).

The report from St Michael's Hospital, Toronto, claims that exclusive breastfeeding in the first year of life without vitamin D supplements is a known risk factor for rickets. It would seem to be difficult to draw conclusions on the relationship between the total length of time a child is breastfed and vitamin D levels, as a baby absorbs the vitamin from other food sources once complementary feeding starts.

From around the age of six months most babies will be having other foods introduced to their diets which can include vitamin D. Foods which include vitamin D are oily fish such as salmon, mackerel and sardines, as well as meat and eggs. It is also added to some breakfast cereals, soya products, dairy products, powdered milks and fat spreads. However, the changes in the way we live our lives, with less exposure to sunlight, and with the foods we eat, might mean that mothers may not have enough vitamin D in their own bodies to pass to their babies via breast milk.

Current recommendations that babies are not exposed to strong direct sunlight have also led to a decrease in their absorption of vitamin D. Breastmilk does not naturally contain high levels of Vitamin D as, in the past babies would absorb most of their Vitamin D from exposure to sunlight. However, when this is combined with a mother having low levels, it further reduces the amount that passes through breastmilk. 3

Breastfeeding and Vitamin D

How much vitamin D is acquired through sunlight also depends on skin colour and where a woman resides. Those living in northern climates do not have as much chance to absorb vitamin D.

The NHS website ⁴ says "Most people can make enough vitamin D from being out in the sun daily for short periods with their forearms, hands or lower legs uncovered and without sunscreen from March to October, especially from 11am to 3pm. A short period of time in the sun means just a few minutes - about 10 to 15 minutes is enough for most lighter-skinned people - and is less than the time it takes you to start going red or burn. Exposing yourself for longer is unlikely to provide any additional benefits. People with darker skin will need to spend longer in the sun to produce the same amount of vitamin D."

However, the NHS does suggest that pregnant and nursing mothers take supplements to ensure their breastmilk contains enough Vitamin D.

Do I need to take Vitamin D if I am breastfeeding?

La Leche League International says that breastfeeding mothers who have adequate amounts of vitamin D in their bodies can successfully provide enough vitamin D for their nursing children through breastmilk. However, LLLI agrees that lifestyle changes have led to some women not having enough vitamin D. They recommend that pregnant and nursing mothers obtain adequate vitamin D, or supplement as necessary. Women who aren't sure if they need a supplement can have a simple blood test before making a choice to supplement.

Some health care professionals now recommend that infants receive vitamin D supplements in the first few days of life, but many women find it preferable to take the supplement themselves rather than trying to give it directly to the baby.

Evidence from a recent study by Professor Bruce Hollis, PhD of the Medical University of South Carolina, supports the validity of this alternative. The study found that maternal vitamin D supplementation supplied breastmilk with adequate vitamin D to satisfy the nursing infant's requirement and offered an alternate to direct infant supplementation. 5 When asked by La Leche League GB if mothers should continue to take supplements once their babies were over six months old, Professor Hollis replied: "The mother should continue to take the vitamin D as long as she is lactating." He confirmed that part of the problem is that a lot of food does not have vitamin D in it.
Too much or too little?
If a baby is born with a deficiency in Vitamin D, due to the mother's own low levels, this may not be reversed by the mother taking supplements. ⁶

There is no risk of a woman's body making too much vitamin D from sun exposure, although the usual precautions should be taken to cover or protect skin before it turns red or starts to burn. However, taking too much Vitamin D as a supplement can be harmful and a health professional should be able to give up-to-date information on recommended doses.

Breastfeeding Continues to be of significance

Breastmilk remains the optimal choice for infant nutrition. The unique structure and functions of breastmilk cannot by replicated by infant formula. It continually adapts throughout the day to suit each individual baby. The composition of human milk also changes to meet the changing needs of the baby as he matures, and even from feed to feed.

There is also evidence that the longer a baby is breastfed the greater the protection from ill health and the more positive impact on their long-term health (UNICEF 2012). ⁷ Human milk still remains the best source of nutrition during the first year, with the appropriate introduction of complementary foods. It becomes a supplement to solids during the second year, but keeps nutritional value, as well as emotional benefits.

Low levels of Vitamin D may cause problems, not breastfeeding

While reports give the impression that breastfeeding is causing problems, the real issue is that in today's world women may not have enough Vitamin D themselves to pass into breastmilk.

The answer is to address any possible deficiencies in that area so that babies will receive the Vitamin D they need whether this is via Vitamin D supplements and/or regular, small amounts of exposure to sunlight. Some mothers may want to ask for a medical evaluation to measure vitamin D levels in their baby's blood. What meets the needs of one nursling may not meet the needs of another.

In January 2017 Unicef released a statement on vitamin D supplementation for breastfed babies, you can read it here.

This article was updated March 2017.

1. Darmawikarta D et al: "Total Duration of Breastfeeding, Vitamin D Supplementation, and Serum Levels of 25-Hydroxyvitamin D.", Am J Public Health, 2016 Apr; 106 (4): 714-9.
2. Express article, "Bottle vs breast debate: Breastfed children at risk of RICKETS, says study".
3. Vitamin D Council Website "Vitamin D during pregnancy and breastfeeding"
4. NHS Choices website "How to get vitamin D from sunlight".
Bruce W Hollis et al: "Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial", Pediatrics 2015, 136 (4): 625-34
5.Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial
6. Breastfeeding Network"Vitamin D and Breastfeeding"
7. Unicef"Preventing disease and saving resources:the potential contribution of increasing breastfeeding rates in the UK"

For more information:
Vitamin D and Breastfeeding - from LLL International's online magazine Breastfeeding Today
Vitamin D - from the NHS

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Breastfeeding and Vitamin D - La Leche League GB

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Reports on new research published in the American Journal of Public Health1 have implied that breastfeeding may contribute to the development of rickets.2 This is a condition that affects bone development in children, causing the bones to become soft and weak, potentially leading to bone deformities (in adults rickets is known as osteomalacia or soft ...

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Hemel Breastfeeder Facebook Group

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Log into Facebook to start sharing and connecting with your friends, family, and people you know.

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*More information on this topic can be found in my NEW BOOK on breastfeeding and tongue ties, "All Tied Up! How To Keep On Boobin' Through A Tongue Tie". Available here.
Most babies will latch on the best when they are supported to self-attach on their own, with the mother in the "laid-back" breastfeeding position, or self-attachment in the "koala" hold. Here is a video to show what this process looks like. It's an amazing thing to see (and experience yourself!)...

But what about the babies who cannot latch on well by themselves? What about the babies with tongue ties or other physical issues going on that inhibit their ability to keep enough of the areola in their mouth while breastfeeding? This is where the "flipple" technique can really help. In the following video I discuss how this little breastfeeding trick can work even better if the mother does this while her baby is in the "koala" position which looks like this:

Step 1. Try to get your knees lower than your hips as this can make it easier for some mothers.

Step 2. Put your baby's mouth right at your nipple.

Step 3. Use the "flipple" technique to get as much of your breast tissue into your baby's mouth as possible. Point your nipple very high towards their nose, try to get as much of the bottom part of your areola into your baby's mouth and use your finger to flip their top lip up after they have latched on.

*You may need to use this "flipple" technique before AND after you get a laser or scissor tongue/lip tie revision done. Some mothers find that they need to use this for quite some time as their baby get's the hang of using their new tongue!

Step 4: Watch this video to see it in action!

And here is another video demonstrating the flipple in an upright position but baby is supported from behind by both a pillow and their mother's arm...

Have you used the flipple and/or the koala hold? Share your experiences below! If you need some help getting your baby to latch on or have questions about tongue ties please CLICK HERE.

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How to get a better latch! The exaggerated latch or "flipple" breastfeeding technique... - The Milk Meg

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And here is another video demonstrating the flipple in an upright position but baby is supported from behind by both a pillow and their mother's arm... Have you used the flipple and/or the koala hold? Share your experiences below! If you need some help getting your baby to latch on or have questions [...]

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Breastfeeding Attachment - Breastfeeding Series

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Hemel Hempstead East Children's Centres - Home

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Please contact Delivery Team on 0113 3200 750 if you have any queries.

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We call on UK governments to take four key steps to enable mothers to breastfeed for as long as they wish and to protect all babies from commercial interests.

In the UK breastfeeding is a highly emotive subject because so many families have not breastfed, or have experienced the trauma of trying very hard to breastfeed and not succeeding. No parent should have to feel the pain of any implication that they have not done the best for their child, but the UK context has become so fraught that conversations about breastfeeding are shut down.

Powerful new evidence about the benefits of breastfeeding provides a compelling case to alter prevailing attitudes and practices. Three ground-breaking pieces of research funded by the Gates Foundation highlight the practical, emotional and cultural barriers that still stand in the way of women breastfeeding and underline the importance of breastfeeding in improving health, saving lives and reducing costs in every country in the world, rich or poor.

We need to change the conversation around breastfeeding; it is time to stop laying the blame for the UK's low breastfeeding rates in the laps of individual women and instead acknowledge that this is a public health imperative for which government, policy makers, communities and families all share responsibility. We are calling on UK and devolved governments to implement four key actions to create a supportive, enabling environment for women who want to breastfeed, and to protect all babies, whether breast or formula fed, from harmful commercial interests.

Read the Call to Action

We call on UK governments to:

1. Develop a National Infant Feeding Strategy Board in each of the four nations, including members from all relevant government departments and tasked with developing a comprehensive National Infant Feeding Strategy and implementation plan.

2. Include actions to promote, protect and support breastfeeding in all policy areas where breastfeeding has an impact.

3. Implement evidence-based initiatives that support breastfeeding, including the Unicef UK Baby Friendly Initiative, across all maternity, health visiting, neonatal and children's centre services.

4. Protect babies and their families from harmful commercial interests by adopting, in full, the International Code of Marketing Breastmilk Substitutes ("the Code").

Together, these four steps can help normalise and support breastfeeding, and enable parents to make informed choices about infant feeding.

Campaign updates

In December 2017, Unicef UK hosted an event for MPs to pledge support for the Call to Action. This was highly successful, with 45 MPs attending. Read more about the event.

Our 2017 survey of Infant Feeding Leads highlights worrying cuts to infant feeding support. See the survey results.

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Call to Action on infant feeding in the UK - The Baby Friendly Initiative

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In the UK breastfeeding is a highly emotive subject because so many families have not breastfed, or have experienced the trauma of trying very hard to breastfeed and not succeeding. No parent should have to feel the pain of any implication that they have not done the best for their child, but the UK context has become so fraught that conversations about breastfeeding are shut down.

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Dad and Breastfeeding

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When it comes to breastfeeding, you might wonder what you can do to support your partner and baby. The truth is you can make a huge difference.

Did you know that a mum is more likely to choose to breastfeed if she's sure her partner is positive about it? And if she does decide to breastfeed, she's much more likely to have a good experience and manage any difficulties if her partner supports her decision (Tohotoa, 2009; Rempel, 2011). A partner's emotional support is so important for helping mums to breastfeed for longer too (Tohatoa et al, 2009; Su, 2016).

Why is breastfeeding important?

If your partner is breastfeeding your baby - or planning to - that's fantastic because breastmilk has so many benefits for babies. For instance, breastmilk can help to reduce the risk of your baby getting infections and diseases (NHS, 2017). It also contains hormones that help your baby's development (Victora et al, 2016).

Overall, breastfeeding will have a positive impact on your baby's health. What's more, it can influence their health as an adult too (Victora et al, 2016).

Is breastfeeding hard or will my partner just know what to do?

Many parents see breastfeeding as a natural process but it can take time for mum and baby to learn this new skill together. It might take around six weeks to get the hang of it fully (NHS, 2016).

The good news is that with the right support, your partner can overcome any challenges and continue breastfeeding if she wants to. If you think your partner needs more information, support or just someone to talk to, why not give one of our trained breastfeeding counsellors a call on our support line: 0300 330 0700. The line is open every day from 8am to midnight, including bank holidays.

You might find it helpful to read up about breastfeeding and attend a breastfeeding session before your baby is born. This can help you know what to expect and perhaps give you a little more confidence. It can also help you both talk about feeding your baby and raise any questions or worries you might have.

What do I need to know about breastfeeding?

You might find it helpful to know how breastfeeding works and what normal behaviour is for breastfed babies. Here are a few quick and handy facts:

Babies are happier if they're fed as soon as they show signs of being hungry.

Babies usually feed frequently (anything from eight to 12 times or more in 24 hours) in the early weeks, especially during the evenings.

Some babies are slow feeders at first, but they get quicker as they get older.

The more a baby feeds, the more milk their mum makes because it's the removal of milk that drives the production of it.

The Department of Health recommends exclusive breastfeeding for at least your baby's first six months. Breastfeeding is also beneficial for toddlers because it gives them a health boost every time they feed. So your partner can breastfeed your baby for as long as they both want to.

Nipple soreness or pain during feeding might be a sign that a baby needs some adjustment to their attachment at the breast. If there is soreness or pain when breastfeeding, talking to a healthcare professional or breastfeeding counsellor can help.

Women enjoy feeding more when they are comfortable and relaxed.

(Department of Health, 2011; La Leche League, 2016; NHS, 2016)

What can I do to help support my partner with breastfeeding?

There are lots of things you can do to support and encourage breastfeeding.

Here are 10 tips:

1. Boost your partner's confidence by encouraging her and being positive about her progress. As with learning any new skill, reassurance and praise are a massive help.

2. Listen and talk honestly about how you each feel about finding your way with your new baby.

3. Be involved with your baby in other ways so that the caring is shared (see below).

4. Help to reduce the household chores so your partner can feed your baby for as long and as often as they need.

5. Try to help your partner to relax by giving them a massage.

6. Women don't need to eat anything special while breastfeeding, but it's a good idea to encourage your partner to eat and drink regularly.

7. Help her get specialist support if she's struggling with breastfeeding. As mentioned above, you can both talk to one of our breastfeeding counsellors on 0300 330 0700.

8. Help out by bottle feeding your baby expressed milk once your partner and baby have got the hang of breastfeeding (see below).

9. Accept your partner's decision on when to stop breastfeeding.

10. Try to remember that with your support, breastfeeding can quickly become just another part of your family life.

(Rempel et al, 2010)

What practical support can I give to my baby if my partner is breastfeeding?

You might expect to feel like a bit of a spare part with feeding but it's good to remember that each parent plays a different and vital role. The decision on how you feed your baby is certainly a joint one (deMontigny et al, 2018). It might take a while to get used to the different parts you play though.

Whatever you decide to do, you might actually find feeding is less important to you than you expected anyway. Especially if you're hands-on with your baby in different and rewarding ways.

Tips for being a hands-on partner with your baby

Changing nappies and generally caring for your baby - it's great if you can spend time with your baby and interact (see below) with them while you're looking after them.

Bathing your baby - you could bath your baby or even have a bath with your baby. You'll both enjoy the bonding benefits of skin-to-skin contact and one-to-one time together (NHS, 2018).

Talking and playing - babies enjoy hearing gentle sounds. They even recognise the muffled tones of people talking from their time in the womb and they'll be aware of familiar voices like yours (Lee and Kisilevsky, 2013). So a chat with your baby might be a little one-sided but rest assured, they know it's you. Socially interacting with your baby through their senses helps to stimulate their brain development; for example, you could pull some different expressions (Boucenna et al, 2010).

Baby carrying - this means taking your baby out and about in a sling. It can be a rewarding and comforting experience for both you and your baby (Miller, 2019).

For more ideas on being a hands-on parent, see our article about bonding with and getting to know your baby.

How can I share feeding our baby?

If you're keen to feed your baby, you could give them expressed breastmilk from a spoon, syringe, cup or a bottle. But only introduce your baby to a bottle once breastfeeding is going well. For more on expressing, see our 10 bottle feeding tips for breastfed babies article.

And once your baby's moved on to solid food, there are so many ways you can get involved with that...chopping, mashing, cleaning up all the food that ends up on the floor...

I want to support breastfeeding but will it affect our sex life?

Possibly, but tiredness - and your partner's birth experience and recovery - is more likely to affect their sex drive rather than breastfeeding (Rowland et al, 2005). See our article about breastfeeding and sex for more details.

What if I feel uncomfortable about my partner breastfeeding in public?

If you're feeling uncomfortable or nervous about your partner breastfeeding in public, have a chat with her so you can talk it through. Maybe you're worried about your partner showing her breasts in public? Yet in reality, very little breast actually shows when a baby is feeding. You might have even seen a mum breastfeeding before without realising it.

It might also help to talk to other families where the mum is breastfeeding and find out about both partners' experiences of it. The chances are, you'll change your mind as you get used to seeing breastfeeding.

It's good to know that breastfeeding in public is protected by the law under the Equality Act 2010. That means providers of any services or facilities open for the public are not allowed to discriminate against women who are breastfeeding (Maternity Action, 2019).

Many places now welcome breastfeeding and have special facilities for mums if they'd prefer to feed in private.

Some mums might feel uncertain themselves about feeding in public at first and may appreciate the reassurance of having their partner with them.

At the end of the day...

Don't underestimate the huge difference you can make if your partner is breastfeeding. With you both on board, breastfeeding can quickly become an everyday part of your lives (Rempel, 2011).
This page was last reviewed in October 2017.
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.

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.

Visit our breastfeeding support contacts page.

NHS Choices breastfeeding information.

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

Health Talk has some interesting videos about different people's experiences of breastfeeding, click here to view them.

Boucenna S, Gaussier P, Andry P, Hafemeister L. (2010) Imitation as a communication tool for online facial expression learning and recognition. 2010 IEEE/RSJ International Conference on Intelligent Robots and Systems, Taipei: 5323-5328. Available at: https://ieeexplore.ieee.org/abstract/document/5650357 (Accessed 1st July 2018)

deMontigny F, Gervais C, Larivière-Bastien D, St-Arneault K. (2018) The role of fathers during breastfeeding. Midwifery. 58:6-12. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29272696 (Accessed 1st July 2018)

Department of Health. (2011) Breastfeeding. Available at: http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Publichealth/Nutrition/Nutritionpregnancyearlyyears/DH_127625 (Accessed 1st July 2018)

La Leche League. (2016) Still nursing? Available at: https://www.laleche.org.uk/still-nursing/ (Accessed 1st July 2018)

Lee GY, Kisilevsky BS. (2013) Fetuses respond to father's voice but prefer mother's voice after birth. Dev Psychobiol. 2014 Jan;56(1):1-11. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23817883 (Accessed 1st July 2018)

Miller R. (2019). Babywearing education in the neonatal intensive care unit. The International journal of childbirth education: the official publication of the International Childbirth Education Association. 34. 43-47. Available at: https://www.researchgate.net/publication/334151320_Babywearing_Education_in_the_Neonatal_Intensive_Care_Unit (Accessed 1st July 2018)

NHS. (2016) How to combine breast and bottle feeding. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/combining-breast-and-bottle/ (Accessed 1st July 2018)

NHS. (2017) Benefits of breastfeeding. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/benefits-breastfeeding.aspx (Accessed 1st July 2018)

NHS. (2018) Washing and bathing your baby. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/washing-your-baby/ (Accessed 1st July 2018)

Rempel LA, Rempel JK. (2010) The breastfeeding team: the role of involved fathers in the breastfeeding family. J Hum Lact. (2):115-21. Available at: http://journals.sagepub.com/doi/abs/10.1177/0890334410390045 (Accessed 1st July 2018)

Rowland M, Foxcroft L, Hopman WM, Patel R. (2005) Breastfeeding and sexuality immediately post partum. Can Fam Physician. 2005 Oct;51:1366-7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479788/ (Accessed 1st July 2018)

Su M, Ouyang YQ. (2016) Father's role in breastfeeding promotion: lessons from a quasi-experimental trial in China. Breastfeed Med. 11:144-9. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26836960 (Accessed 1st July 2018)

Tohotoa J, Maycock B, Hauck Y, Howat P, Burns S, Binns C. (2009) Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. Int Breastfeed J. 4:15. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788531/ (Accessed 1st July 2018)

Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC; Lancet Breastfeeding Series Group. (2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 387(10017):475-90. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26869575 (Accessed 1st July 2018)

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How can dads and partners support breastfeeding?

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When it comes to breastfeeding, you might wonder what you can do to support your partner and baby. The truth is you can make a huge difference. Did you know that a mum is more likely to choose to breastfeed if she's sure her partner is positive about it?

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Making up a bottle

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What if I need to formula feed my baby away from home? | Baby & toddler, Feeding articles & support | NCT

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Here we explain how to prepare a bottle for going out and how to make up formula safely when you are out...

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Colic

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You've checked everything and all is as it should be. You've tried all your soothing methods (and other people's) and your baby is still upset.

If you just simply cannot work out why they're crying, it could be colic. It could also be the Period of PURPLE Crying - developmental crying in healthy babies, which is often mistaken for colic (NCSBS, 2018).

Only 11% of babies get true colic in their first six weeks, and this drops to 0.6% of babies by 10 to 12 weeks (Wolke et al, 2017). Knowing what to look for and how to help your baby through colic can make everyone feel a little less desperate.

What is colic?

The medical definition of colic (or infantile colic) is repeated episodes of excessive and inconsolable crying in an infant that otherwise appears to be healthy and thriving (NICE, 2017; Patient, 2018). These episodes last for more than three hours a day, for more than three days a week, for at least one week (NICE, 2017).

"Colic is most common in babies from a few weeks old to around four months of age, but it can still happen up to six months."

There are no long-term effects. Beyond coping with the crying, there's nothing to worry about.

What causes colic?

There's no definitive cause of colic. Although it might be caused by abdominal pains, changes in hormone levels in the gut, food intolerance, trapped wind or sensitivity to milk protein (Patient, 2018). Yet this is only relevant to 5% to 10% of babies (Hogg, 2015). Others think it's just the extreme end of crying, while others say it is evolution making sure babies always have an adult around to protect them (Batlivala, 2017).

Some parents can be so desperate to have a cause for their baby's crying, they'll assume it's the result of a treatable medical condition or digestive problem (i.e. colic) (Hogg, 2015).

What are the symptoms of colic?

Each baby behaves in a completely unique way, but colic is usually characterised by all or some of the following:

Crying for more than three and a half hours a day .

Crying that's inconsolable and almost continuous - this can be intense and sound different from your baby's other cries.

The crying reaches a peak in the late afternoon and early evening.

Their face becomes red and flushed.

They clench their fists, bringing their legs up to their tummy or arch their back.

(Wolke et al, 2017; Patient, 2018)

If you're worried it might be something more serious than colic, visit your GP or talk to your health visitor. This way you can rule out any illness.

What to do if your baby has colic

Unfortunately, there's no cure for colic and each baby responds differently to attempts to soothe them (Patient, 2018). But here we've put together some of the more common methods that people say might help soothe a baby with colic.

Positions:

Holding your baby, wrapping them snugly in a blanket or putting them in a baby sling.

Holding your baby in different positions, such as on your shoulder, cradled in your arms, or lying with their tummy faced down along your forearm.

Swaddling: some people say swaddling their baby - wrapping them snugly in a blanket - can make them feel safe and secure.

Gently swaying your baby.

Sitting or holding your baby upright during feeding, to prevent them swallowing air.

Burping your baby after feeds or gently bringing their legs into their tummy.

(NHS, 2018; Patient, 2018)

Feeding and supplements:

Some people say using a fast-flow teat if you're bottle-feeding helps your baby to not swallow air.

Burping your baby after feeds.

Do not change your baby's formula unless your GP or health visitor advises this.

Anti-colic drops or supplements are not recommended as there's insufficient evidence they work.

(NHS, 2018; Patient, 2018)

Surroundings:

Some people say avoiding overstimulating your baby by repeatedly picking them up and putting them down can help. Gently comforting your baby in a quiet, darkened room might be better.

Pushing them around in their pram or driving - babies like movement.

Using white noise: a washing machine, vacuum cleaner or radio static will do the job.

Gently rubbing their stomach or back or giving them a warm bath.

(NHS, 2018; Patient, 2018; Sezici et al, 2018)

Your diet if you're breastfeeding:

It's not recommended that you change your diet if you're breastfeeding (NHS, 2018). Yet some women find drinking too many caffeinated drinks, eating spicy food and alcohol can aggravate colic.

When to seek medical advice

If your baby is displaying any of the following symptoms, get medical help straight away:

has a weak, high-pitched, or continuous cry

seems floppy when you pick them up

isn't feeding

vomits green fluid

has blood in their poo

has a fever of 38°C or above (if they're less than three months old) or 39°C or above (if they're three to six months old)

has a bulging fontanelle (the soft spot at the top of a baby's head)

has a fit (seizure)

turns blue, blotchy, or very pale

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

Keeping yourself calm through excessive crying

Trying and failing to soothe a baby who is crying inconsolably can be very stressful. It's important to remember your baby's colic is not your fault and you're not a bad parent because you can't get them to stop crying.

If you're feeling stressed, we suggest you check out our article about how to cope and keep calm when looking after your baby. You could also try out one of the many free meditation apps to help you feel more calm.

If you're becoming overwhelmed or feel like you can't cope, it's OK to put your baby somewhere safe and have 10 minutes of time out. Make sure you're asking loved ones for support and don't hesitate to reach out for help. A support line like that NCT offers on 0333 252 5051 can also provide help and advice to parents with babies that cry excessively.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0333 252 5051.

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.

Watch our coping with crying film.

The Purple Crying website looks in detail at the stage in your baby's life when they cry more than at any other time.

Understanding childhood also have a range of resources available online and to download, developed by child psychotherapists, including a leaflet on crying.

There's also useful information on the NHS website.

The NSPCC helpline provides help and support to thousands of parents and families.

The Lullaby Trust has lots of useful information and support for parents about safe sleep.

Alexander CP, Zhu J, Paul IM, Kjerulff KH. (2017) Fathers make a difference: positive relationships with mother and baby in relation to infant colic. Child Care Health Dev. 43(5):687-696. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28271578 [Accessed 2nd October 2018]

Arikan D, Alp H, Gözüm S, Orbak Z, Cifçi EK. (2008) Effectiveness of massage, sucrose solution, herbal tea or hydrolysed formula in the treatment of infantile colic. J Clin Nurs. 17(13):1754-1761. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18592627 [Accessed 2nd October 2018]

Batlivala SP. (2017) Colic: an evolutionary selective pressure for good parents? Clin Pediatr (Phila). 56(8):705-706. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28589761 [Accessed 2nd October 2018]

Hogg S. (2015) Understanding and responding to excessive crying. Int J Birth Parent Education. 2(4):7-11. Available at: https://ijbpe.com/images/pdf/vol2iss4/IJBPEcol2iss4_understandingandres... [Accessed 2nd October 2018]

NCSBS. (2018) What is the period of PURPLE crying? Available at: http://www.purplecrying.info/what-is-the-period-of-purple-crying.php [accessed 18th October 2018].

NHS. (2015) Colic. Available at: https://www.nhs.uk/conditions/colic/ [accessed 18th October 2018].

NICE. (2017) Clinical Knowledge Summaries. Colic - infantile. Available at: https://cks.nice.org.uk/colic-infantile [accessed 18th October 2018].

Patient. (2018) Baby colic. Available at: https://patient.info/health/baby-colic-leaflet [accessed 18th October 2018]

Sezici E, Yigit D. (2018) Comparison between swinging and playing of white noise among colicky babies: A paired randomised controlled trial. J Clin Nurs. 27(3-4):593-600. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28618052 [Accessed 2nd October 2018]

Wolke D, Bilgin A, Samara M. (2017) Systematic review and meta-analysis: fussing and crying durations and prevalence of colic in infants. J Pediatr. 185:55-61.e4. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28385295 [Accessed 2nd October 2018]

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My baby won't stop crying - coping with colic symptoms

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You've checked everything and all is as it should be. You've tried all your soothing methods (and other people's) and your baby is still upset. If you just simply cannot work out why they're crying, it could be colic.

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Reflux

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What is baby reflux?

It's something many parents talk about but what is baby reflux? It's basically when a baby brings milk back up during, or just after, a feed (NHS start4life, 2019).

Babies get reflux when the ring of muscle between the oesophagus (food pipe) and stomach is not fully developed. Food or milk can leak out and travel back up the food pipe (NHS, 2019). Other potential causes for reflux can include an intolerance to cow's milk protein or other allergies (La Leche League 2017).

Baby reflux affects at least four in ten newborns and it isn't usually cause for concern (NICE, 2015). Most of the time, it gets better on its own - often by the time a baby is one (NICE, 2015; NHS, 2019). That's because over a baby's first 12 months their digestive system naturally develops and they spend more time upright as they start to sit up (Tighe et al, 2014; NICE, 2015; NHS, 2019).

Is baby reflux just vomiting?

Baby reflux is effectively the same thing as posseting, which is when babies bring up a small amount of milk (usually a teaspoonful) without seeming to mind (NHS start4life, 2019). Reflux is common in babies under six months for completely normal physiological reasons and doesn't need medication. Baby reflux is also different from gastro-oesophageal reflux disease (GORD), which is when reflux symptoms become troublesome or cause complications (NICE, 2019).

Baby reflux signs and symptoms

Many of the common signs of baby reflux can also be signs that a baby is distressed for any number of reasons; for example, they're hungry, need a cuddle or they're cold. So it's good to remember that while there are some recognisable signs of baby reflux, this isn't necessarily a disease that needs medicated. Nonetheless, signs can include:

A baby arching their back and turning their head.

Crying for long periods and becoming irritable during and after feeds.

Choking or coughing during a feed or seeming to have a sore throat.

Spitting up milk during or after feeds several times a day, which upsets them.

Persistent hiccups.

Frequent ear infections.

Fighting feeding or refusing to feed.

Poor weight gain.

Waking very frequently at night.

Signs of pain or discomfort when feeding.

(NHS, 2016; La Leche League GB, 2017; Essential Parent, 2019)

Are some babies more likely to get reflux?

Reflux is more common among babies who are born prematurely and babies with low birth weight. It's also common in babies or children with some impairment of their muscles and nerves, such as cerebral palsy, or those with a cow's milk allergy (Patient, 2018).

When should you seek medical advice for reflux?

Baby reflux isn't usually a cause for concern if your baby is happy and is gaining weight. However, if reflux starts after six months of age, continues beyond a year or if your baby has any problems mentioned below, contact your midwife, health visitor or GP:

Spitting up feeds frequently or refusing feeds.

Coughing or gagging while feeding.

Frequent projectile vomiting (forceful vomiting that lands some distance away).

Green or yellow vomit (maybe bile), or blood in vomit.

Blood in poo or persistent diarrhoea.

Excessive crying or irritability.

Swollen or tender tummy.

High temperature of 38⁰C or above.

Not gaining weight or losing weight.

(NICE, 2015; NHS, 2016)

In a small number of babies, reflux might be associated with a more serious problem, such as gastro-oesophageal reflux disease (GORD). This is a form of long-term baby reflux where stomach contents are able to rise up and irritate the oesophagus (NHS, 2016).

Silent reflux in babies

Sometimes babies don't spit out what comes back up but swallow it instead. This is known as 'silent reflux'. Babies with silent reflux might gain weight normally but show some of the symptoms as reflux (NHS start4life, 2019).

How to ease your baby's reflux

You can help ease your baby's reflux by making small changes to the way you feed them. Talk to your midwife or health visitor who might suggest:

Gently burping your baby regularly throughout feeding.

Ensuring they take breaks during a feed.

Giving your baby shorter but more frequent feeds.

Keeping your baby's head higher than their bottom during feeds.

Keeping your baby upright for a bit after feeding.

Changing baby on their side to avoid any discomfort caused by lifting their legs up towards their stomach.

Using thickened 'anti-reflux' formula milk. You can buy these without a prescription but it's important to talk to a healthcare professional before you do. There is some caution about their use, such as the fact that they are made at a lower temperature than is currently recommended to get rid of harmful bacteria.

If your baby has a cow's milk allergy, your doctor might suggest using special formula milk that doesn't contain cows' milk.

(NHS, 2016 ; La Leche League GB, 2017; First Steps Nutrition Trust, 2018; Patient, 2018)

Some parents might be advised to raise the head end of their baby's cot slightly or place a rolled up towel under the mattress. It's important to say that there is no scientific evidence that this works and it might increase the risk of sudden infant death syndrome (SIDS) (Lullaby Trust, 2019).

Diagnosis and treatment

Usually, babies with reflux don't need any tests as the condition can be diagnosed based on their symptoms. But in rare cases and if a healthcare professional thinks they might be helpful, an endoscopy, pH monitoring or barium swallow test can be done (NICE, 2015; NHS, 2016).

Baby reflux usually doesn't need any specific treatment but the feeding suggestions above might be helpful. In severe cases, a GP or gastroenterologist can prescribe medicines that might help with pain and discomfort (Tighe et al, 2014). Surgery might also be recommended for a small number of babies who have underlying medical conditions, such as cerebral palsy (NICE, 2015; NHS, 2016).

If you have a baby with a reflux, it can feel stressful and worrying at times. There's lots of support and information to help you though. Read other parents' experiences here.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0333 259 6180.

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

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

Living with reflux is a UK non-profit for information and support for sufferers of GOR and GORD.

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What is baby reflux? Symptoms and support

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It's something many parents talk about but what is baby reflux? It's basically when a baby brings milk back up during, or just after, a feed (NHS start4life, 2019). Babies get reflux when the ring of muscle between the oesophagus (food pipe) and stomach is not fully developed.

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Bottle feeding breast fed babies

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Storing breastmilk

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Hand expressing

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There are plenty of reasons why, if you choose to do it, expressing milk is a useful skill to have for your new baby. It can help in medical situations that mean your baby or you is struggling to breastfeed (Becker et al, 2016).

When you're away from your baby expressing milk will keep up your supply (Becker et al, 2016). It can even be a good trick to boost your supply if it's low (Becker et al, 2016).

Another plus of expressing is that babies learn to take a bottle or cup. This gives you more freedom to go to work, appointments or even an evening out with friends. It also allows your partner or other members of your family to become more involved in the early months (Becker et al, 2016). Here are the ways that you can start expressing your milk.

Watch our video for tips on expressing breastmilk.

Electric breast pumps

Breast pumps are useful when you need or want to give your baby milk in a bottle or cup but want to continue breastfeeding. You have two options when it comes to using a pump to express your breast milk: manual or electric.

Electric pumps use mains electricity, batteries or sometimes both. They are more expensive than hand pumps but they are usually less exhausting - a big bonus in the early newborn weeks. Electric pumps are also great if you need to express often for a baby who is in special care.

If one type of electric pump doesn't work for you, try another one to explore the options. You could do this either by returning it for a refund or hiring a pump instead of buying from an NCT breastfeeding counsellor.

It's good to check the fit - no-one's nipples are the same and you may need a different-sized funnel (Becker et al, 2016). If you're keen on efficiency you could consider 'double pumping'. This uses a double electric breast pump so you can express from both breasts at once.

Top tip: If there are different suction settings on your pump, start on a low one. You won't win any prizes - especially not from your painful nipples - by going straight for the hardest level. So build it up gradually.

Manual breast pumps

For some women, hand-operated pumps can seem less intimidating than electric pumps. That might in turn mean you're more relaxed using them. If you're more relaxed you'll produce more milk (Becker et al, 2016). Most pumps have flanges that go over your nipple and areola (the coloured skin around the nipple) and fit the breast. This helps draw the milk out by suction as you collect it in a bottle-shaped container.

Use them when your breasts are full and you should hold your baby while you pump if possible. This helps because skin-to-skin contact makes you produce the hormones that will bring on the milk (UNICEF, 2015).

Top tip: Make sure you sterilise all parts of the pump and whatever you're using to store your milk before you start expressing (NHS, 2016a).

Hand expressing

Your milk reaches the nipple through many different ducts. So as you press and release the breast tissue, your fingers mimic the action of your baby's tongue and mouth, squeezing milk from these ducts. That's how hand expressing works.

You can also use hand expressing to ease engorgement. It's handy if you're out somewhere without your breast pump, like a private office at work. Here's how to do it:

Massage your breasts or put a warm flannel on them first.

Position your hands under your breast with your thumbs upwards. The exact position will differ between women and you may or may not be touching your areola. The idea is to put pressure on the milk ducts. You may need to experiment to feel where they are.

Try pushing in towards your ribcage before rolling your fingers inwards. Move around so you affect different areas.

As you start to squeeze, milk will appear. Work around each breast, releasing the milk from all parts.

Express from one breast until the milk flow slows down and then start massaging the other. You can switch from breast to breast until the milk flow stops.

At first you may not be able to produce much but usually the more you express the easier it becomes.

Ask your midwife, health visitor or nurse to show you how to hand express your milk (NICE, 2014; NHS Choices, 2016a).

Top Tip: Find a container like a jug that has a wide rim for catching your milk and make sure it's sterilised (NHS Choices, 2016b). Make sure you have some sterile storage containers for storing your milk, like bags, bottles or containers with lids (Breastfeeding Network, 2009).

This page was last reviewed in October 2017
Further information

Our helpline offers practical and emotional support in many areas of pregnancy, birth and early parenthood: 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.

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

UK Association of Milk Banking has information on its network of milk banks across the UK.

Best Beginnings: view video footage online from 'bump to breastfeeding'.

Healthtalkonline.org provides a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.

American Academy of Pediatrics. (2011) Practical bottle feeding tips. Available from: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Practical-Bottle-Feeding-Tips.aspx [Accessed 1st October 2017].

Becker GE, Smith HA, Cooney F (2016) Methods of milk expression for lactating women. Cochrane Database Syst Rev 29:9. doi: 10.1002/14651858. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006170.pub5/full [Accessed 1st October 2017].

Breastfeeding Network. (2009) Expressing and storing breastmilk. Available from: https://www.breastfeedingnetwork.org.uk/wp-content/pdfs/BFNExpressing_and_Storing.pdf [Accessed 1st October 2017].

Healthy Children. (2011) Practical bottle feeding tips. Available from: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Practical-Bottle-Feeding-Tips.aspx [Accessed 1st October 2017].

NHS Choices. (2016a) Expressing and storing breast milk. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/expressing-storing-breast-milk/ [Accessed 1st October 2017].

NHS Choices. (2016b) Sterilising bottles. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/sterilising-bottles/ [Accessed 1st October 2017].

NICE. (2014) Breastfeeding recommendations. Available from: https://www.nice.org.uk/guidance/PH11/chapter/4-Recommendations#breastfeeding-3 [Accessed 1st October 2017].

UNICEF. (2015) Guide to bottle feeding. Available from: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2008/02/start4life_guide_to_bottle_-feeding.pdf [Accessed 1st October 2017].

UNICEF. (2018) Skin to skin contact. Available from: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/guidance-for-health-professionals/implementing-the-baby-friendly-standards/further-guidance-on-implementing-the-standards/skin-to-skin-contact/ [Accessed 1st October 2017].
Further reading
NHS. (2009) Breast milk ingredients and sleep. Available from: http://www.nhs.uk/news/2009/10October/Pages/Breast-milk-ingredients-and-sleep.aspx [Accessed 1st October 2017].

NHS Choices. (2017) Benefits of breastfeeding. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/benefits-breastfeeding/ [Accessed 1st October 2017].

NHS Choices. (2018) How to bottle feed your baby. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/bottle-feeding-advice/#how-to-bottle-feed-your-baby [Accessed 1st October 2017].

Peila C, Coscia A, Bertino E, Li Volti G, Galvano F, Barbagallo I, Gazzolo D (2017) Human milk adrenomedullin is unstable during cold storage at 4°C. Breastfeed Med. 12(9):561-565. doi: 10.1089/bfm.2017.0072. Available from https://www.ncbi.nlm.nih.gov/pubmed/28956619 [Accessed 1st October 2017].

Science News. (2015) Backwash from nursing babies may trigger infection fighters. Available from: https://www.sciencenews.org/blog/growth-curve/backwash-nursing-babies-may-trigger-infection-fighters [Accessed 1st October 2017].

University Hospital Southampton NHS Trust. (2014) Syringe and cup feeding your baby. Available from: http://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Pregnancyandbirth/Syringe-and-cup-feeding-your-baby-patient-information.pdf [Accessed 1st October 2017].

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Expressing milk: Which method is best? | Baby & toddler, Feeding articles & support | NCT

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You might have decided to express milk for your baby but are unsure which method is right for you. Here's what you need to know...

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Expressing

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How to tell my baby is thriving

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Whats in a nappy

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Off to the best start

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Skip to main content

Breastfeeding is a skill that takes time to get the hang of. Lots of mums wonder if their baby's feeding well and getting enough - especially in the first few days. But once you've mastered it, you'll probably find it's the easiest and most satisfying way to feed your baby.

Apart from the fact that breast milk is tailor-made for your baby, contains vitamins and minerals and is always available, it also offers protection from certain infections and helps improve your baby's long-term health. Breastfeeding reduces the risk of SIDS (Sudden Infant Death Syndrome), childhood diabetes and leukaemia.

We're here to provide lots of helpful information and advice on breastfeeding. If you have any breastfeeding worries or concerns, the best thing to do is speak to your midwife or health visitor, or join a local breastfeeding support group.

Any amount of breastfeeding is beneficial, but exclusively breastfeeding your baby for 6 months offers a lot more protection. There are benefits and advantages for you too - breastfeeding helps:.

your uterus get back down to size - after your baby is born, your uterus (womb) will gradually get smaller day-by-day, but breastfeeding will help speed this up

you bond with your baby - breastfeeding is a lovely way to feel close and strengthen the bond between you and your baby

release a hormone called "oxytocin" which helps you feel calm and connected to your baby

protect your health - breastfeeding lowers your risk of breast cancer, ovarian cancer, osteoporosis (weak bones), diabetes and cardiovascular disease (conditions affecting the heart or blood vessels)

burn off calories - if you are exclusively breastfeeding, this will help burn off about 300 calories a day

There are many benefits of carrying on breastfeeding after 6 months - your breast milk protects your baby from infections and there's some evidence it helps them digest solid foods.

Breastfeeding Friend from Start for Life

The Breastfeeding Friend, a digital tool from Start for Life, has lots of useful information and expert advice to share with you - and because it's a digital tool, you can access it 24 / 7.

For confidential breastfeeding information and support, call the National Breastfeeding Helpline on 0300 100 0212. Lines are open 9:30am to 9:30pm every day.

Sign up now for our pregnancy, baby and toddler guide

Get personalised emails for trusted NHS advice, videos and tips on your pregnancy week by week, birth and parenthood.
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Breastfeeding can take practice - read our guides on breastfeeding to find out what works best for you

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Skip to main content Breastfeeding is a skill that takes time to get the hang of. Lots of mums wonder if their baby's feeding well and getting enough - especially in the first few days. But once you've mastered it, you'll probably find it's the easiest and most satisfying way to feed your baby.

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Unicef UK Baby Friendly Initiative, introduced to the UK in 1995, is based on a global accreditation programme of Unicef and the World Health Organisation. It is designed to support breastfeeding and parent infant relationships by working with public services to improve standards of care.

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Below is a selection of videos from Best Beginnings' 'From Bump to Breastfeeding' DVD. Find out more on the Best Beginnings website.

If you have any problems viewing the videos, please contact us.

Baby-led feeding

This clip shows how baby-led feeding happens in practice.

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Best Beginnings videos - Baby Friendly Initiative

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If you have any problems viewing the videos, please contact us. This clip shows how baby-led feeding happens in practice.

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Helplines

National Breastfeeding Helpline – 0300 100 0212

Association of Breastfeeding Mothers – 0300 330 5453

La Leche League – 0845 120 2918

National Childbirth Trust (NCT) – 0300 330 0700Helplines

National Breastfeeding Helpline – 0300 100 0212

Association of Breastfeeding Mothers – 0300 330 5453

La Leche League – 0845 120 2918

National Childbirth Trust (NCT) – 0300 330 0700

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Children's centres

Your local children's centres provide support with responsive breastfeeding, responsive bottle-feeding and introducing solid food.

You can visit children's centres before your baby is born for support on becoming a parent.

Remember - pick up your free Healthy Start vitamins at your children's centre.

Support groups

Whether you're breastfeeding, bottle-feeding or introducing solid foods, there are support groups around Hertfordshire to help you.

Responsive feeding tips

When feeding your baby, there are some important things you can do to make sure you're closely responding to your baby's needs.

Skin to skin contact

This is when you hold your baby close, skin to skin, as soon as possible after birth. Your warmth, smell and heartbeat will make your baby feel safe and calm.

Skin to skin can continue for several weeks after birth.

Learning your baby's cues

Keeping baby close to you so that you can recognise feeding cues is helpful.

Most babies will "ask politely" in the first instance. This is a much easier time to feed than when crying.

Feeding at baby's pace

When breastfeeding your baby, feeds can be long or short. When bottle-feeding, feed at your baby's own pace. Like an adult, there will be times when they're hungrier than others.
More about feeding cues - signs baby is hungry
Bottle-fed babies may not finish every feed. Look for signs that they've had enough and avoid overfeeding.

Looking at and holding baby close

Babies need this for healthy brain development. There are simple things you can do to ensure you're enhancing baby's learning, both before and after baby is born.

Plenty of cuddles

You can't spoil a baby by picking them up and keeping them close. It helps your baby to feel secure and loved.

Remember, baby cries as a last resort and mostly wants to be close to you. If you're bottle-feeding, limit the number of people who give them a feed in the early days. Your baby is getting to know you and is still building up resistance to bacteria.

Breastfeeding out and about

You shouldn't feel uncomfortable when breastfeeding in public.

It's actually illegal for anyone to ask a breastfeeding woman to leave a public place.

All children's centres and libraries in Hertfordshire are already breastfeeding welcome venues.

For more information about breastfeeding out and about.

Bottle-feeding

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Your local children's centres provide support with responsive breastfeeding, responsive bottle-feeding and introducing solid food. You can visit children's centres before your baby is born for support on becoming a parent. Remember - pick up your free Healthy Start vitamins at your children's centre.