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A film showing what to look out for from feeding cues.

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Catriana I remember skipping over the section on breastfeeding after a C-section in The Womanly Art of Breastfeeding thinking it wouldn't apply to me but I'm glad I knew where to look when it did. My son was fairly sleepy in the first few days but we were able to stay together day and night after his initial checks so that I could offer to feed him whenever he showed the slightest sign of hunger.

When my daughter needed to be in special care for a while after her C-section birth, her big brother helped establish my supply and she seemed to know just what to do when we were reunited and we never looked back. Having someone to pass me the baby and do the heavy lifting in the early days of recovery was essential. It's hard to recover from major surgery while looking after one or more small people but breastfeeding gives you lots of excuses to put your feet up.

MarielleI've had two C-sections and exclusively breastfed both babies! Probably the hardest part was getting out of bed for night feeds in the early days, as it was very hard to go from lying down to sitting without help. With my first I slept sitting up on the couch and the baby was in a travel cot. With the second I got a big pillow I could use to sit up against and feed in bed, and I also brought the Moses basket into bed with me. You might need to get creative with sleeping arrangements!
( safe-sleep-the-breastfed-baby)

I fed both of mine pretty soon after the surgery. With my first I first fed in recovery and I was so numb I couldn't feel my breasts. With my second I was still getting stitched up when I noticed she was sucking on her swaddling blanket. The midwife helped me latch her on sideways because the sheet was still up, which was a very awkward position but she managed it anyway.

Fi I'm afraid to say mine wasn't a very positive experience, but what I've taken away from it, and what I'd want to share with any pregnant woman (not just any woman who knows she's going to have a Caesarean) is that it's really worth spending some time thinking through labour and delivery scenarios other than the one you hope for. It's all too easy to focus all your attention (as I did) on the lovely natural, active, drug-free birth you hope you're going to have, but babies have a way of writing their own stories and I wish I'd been a bit more prepared for other eventualities.

The midwife disappeared moments after my son was born by emergency caesarean and it was left to the sweet but childless anaesthetist to try to help me latch the baby. Cue one failed attempt. As a first-timer, I found latching a newborn on the flat of my back impossible, and I hadn't spent any time thinking or reading up on how this might work. The sister in charge of the recovery ward shooed away my mum and husband (it was just before dawn) and insisted the baby lie in his cot; which she left just beyond my reach. In shock from the op, I was very timid and British about all this. Now I'd be much more vocal about my baby's needs and insist that I have him in my arms for those first few hours. As it was, it was probably five hours from birth until we got a proper skin-to-skin cuddle/second attempt at breastfeeding.

We had a very difficult start to breastfeeding, the baby failed to put on weight, and I struggled with supply: though I'm sure they weren't the whole story, I think these factors didn't help. That said, I did manage to exclusively breastfeed my son from twelve weeks and we're still feeding now, at 16 months.

In terms of logistics, I didn't find the early weeks too tricky, but I had a LOT of help, which I think was crucial. Our bedside cot was invaluable. I used every cushion and pillow in the house for support. Now that I'm a hardened co-sleeper, I'd definitely be trying lying-down earlier as a way of feeding baby without putting pressure on the scar, though perhaps you need to wait until you're properly mobile, I don't know. That's another thing to read up/think about!

ZenaI had an emergency C-section after 13 hours of labour and am still breastfeeding at 21 months. I was out of theatre within 40 minutes of Henry being born. He had been skin-to-skin the whole time. My sister (midwife) weighed him when we got back to my room so that once he fed I could keep him skin-to-skin uninterrupted. He latched on with only a little help from me after 45 mins of being born. He then remained feeding for two hours and skin to skin for the next seven hours!

Feeding progressed as expected over the coming days: it was frequent and educational for both of us! The challenge with breastfeeding after a C-section for me were that I was too sore to lie down and feed. I felt more comfy sitting up, so the first few weeks were very tiring. It is also tiring recovering from major surgery without having sleep and a newborn to look after so it's important to get an extra pair of hands for a couple of weeks to do other chores so you can focus on resting, feeding and napping.

Emilia I had an emergency C-section. With hindsight, there are lots of things I could have done which would have helped to get breastfeeding established. I could have had skin-to-skin on the operating theatre or the recovery room, I could have tried biological nurturing. For various reasons none of that happened, so establishing breastfeeding in the early days was a bit difficult. However, with support, we went on to breastfeed exclusively for six months, and combined with other food, for many months after that.

Helen I knew I was going to have to have a C-section for medical history reasons. So I read Caesarean Birth - a Positive Approach to Preparation and Recovery, went to my local Children's Centre for one pre-natal visit, and made absolutely sure that my obstetrician and the whole surgical team were on board for a Natural Caesarean. Most of all I made myself BELIEVE that having a Caesarean was absolutely no reason why I shouldn't have a successful breastfeeding relationship.

I educated myself about what I was told were common pitfalls, and thought of ways of avoiding them. So, I wouldn't wait too long for a feed whilst in recovery, thereby letting my baby's blood sugar drop until she was too tired to feed and would need formula; I wouldn't let her be taken away for weighing and Vitamin K so that her temperature dropped and they insisted that she be kept away from me etc. I would demand adequate pain relief so that I could put her to the breast as often as necessary, so that my milk would come in strong and fast. Having thought it all through, and been pretty firm with the staff at the hospital about how we were going to do this procedure, it all went swimmingly.

She latched on within 20 minutes of being born, whilst I was still in theatre being stitched up. She lay on me from the moment they lifted her out, vernix and all, and she started to bop her head up and down like a chicken searching for nipple within minutes. I made it plain that the first hour was mine and mine alone and all box ticking and medical procedure stuff could wait. We spent the next two days more or less constantly attached, and by day three my milk came in. We've been breastfeeding ever since (she turns 2 in January).

Edited by Emma Gardner, send your thoughts to us at editor@laleche.org.uk
This column was originally published inBreastfeeding Matters issue 211 (Jan/ Feb 2016)
Copyright LLLGB

Further reading
Caesarean birth and breastfeeding
Birth and breastfeeding

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Mothers on ....breastfeeding and C-section - La Leche League GB

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We asked mothers how their C-section affected their start to breastfeeding Catriana I remember skipping over the section on breastfeeding after a C-section in The Womanly Art of Breastfeeding thinking it wouldn't apply to me but I'm glad I knew where to look when it did.

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As those who know me will testify, the subject of infant reflux (or gastrointestinal oesophageal reflux GOR) is one that launches me on to my soapbox at a rate Dick Fosbury would have been impressed with. So I thought a blog piece might save me repeating myself quite so often...

Reflux has to be one of the most over diagnosed and yet least understood conditions of the 21st Century. Ask anyone above about forty and they look puzzled when you toss the term about - yet seemingly every other baby at a group now suffers from this rapidly spreading problem. It seems to have replaced "colic" at the doctors surgery - new mother, baby crying a lot, back arching; ah that will be reflux. Gaviscon prescription please! I would love to know just how much Gaviscon's profits have increased since this new trend.

On the flip side, infants with moderate to severe reflux (which can cause serious issues from aspiration to oesophageal damage) seem to really struggle to get anyone to take their problem seriously, beyond Gaviscon!

What is infant reflux?
As those listening at Chemistry class might remember, the term "reflux" (from medieval Latin reflūxus) means "flowing back". So, when you tell your doctor your baby is frequently being sick (sometimes copious amounts) and he tells you the baby has "reflux"; he is simply repeating back to you what you told him, using a more impressive sounding word.

If he adds "gastrointestinal oesophageal" he is telling you what is refluxing and where, ie contents from the stomach, into the oesophagus. If the amount of sick isn't sufficient to be termed reflux - it's considered normal "posetting". Generally reflux is forceful vomitting, whereas posetting is the effortless mouthful of milk infants can bring up after a feed (which can still look an impressive amount at the time, but isn't comparable to projectile).

If baby isn't vomiting, but is very unsettled for long periods (read as screaming!), arching their back and displaying unusual feeding behaviour such as fussing, refusing or feeding very frequently - this is termed "silent reflux".

At the most extreme end of the scale the condition is termed GORD (gastrointestinal oesophageal reflux disease or Pathogenic GOR). Babies with GORD suffer from excessive reflux which if not appropriately managed leads to complicationd such as; inadequate growth, failure to thrive, feeding aversions and oesophagitis, or atypical complications such as wheezing, pneumonia and chronic sinusitis. It is more common in children with neurological impairments or physical abnormalities, and it is estimated around 3 in 1000 infants display symptoms of GORD.

Those who reflux without weight gain issues or apparent distress are labelled "happy spitters" and these babies are generally not medicated.

The vast majority of typical infants will outgrow reflux by around their first birthday - even those who suffer severely when younger.

So what's my problem?
A reason that is often given for around 60% of infants suffering from reflux, is that they have a weaker lower oesophageal sphincter (the muscular ring at the lower end of the oesophagus), making them more prone to refluxing stomach contents - but given the number now diagnosed with this condition, why are babies suddenly suffering en-mass from abnormally weak stomachs? I don't doubt there are some with an unusually weak valve, or other physical condition, but I do believe these are the minority.

Infants suffering with moderate to severe reflux can be naturally very distressed, there can be risk of aspiration as discussed and it can be a worrying and exhausting time for parents. Isn't just handing out mediction without investigation unfair?

Why?
Because several things are known to cause reflux - yet instead of looking at possible reasons why a baby is refluxing, the doctor (with little breastfeeding training or experience and likely pushed for time), deals with trying to stop the symptoms via medication.

Causes

Tongue Tie/High Palate - This in my experience almost always causes either reflux, wind or both. If you had problems feeding previous infants, have experienced nipple pain during your feeding experience (even if this has now ceased) have a baby that is fussy/unsettled/hates being put down/hates the carseat/feeds for a long period or feeds very frequently - rule this out before you start cutting things you love from your diet! Removing dairy in my opinion can potentially cause a reduction in symptoms - even if it's not the cause )more about dairy further down)... The tongue co-ordinates sucking/swallowing and breathing meaning any variation can cause further problems. ( Brian Palmer also has also linked a restricted frenulum to acid reflux). Baby may present just as an oversupply baby, ie milk running out of sides of mouth, loud audible gulping, spluttering. Secondly baby needs to maintain a seal to form a vacuum when feeding, extremely difficult if you're tongue is restricted - causing increased intake of air again and difficulty obtaining fatty milk. I'm halfway through a blog entry specifically focusing on this!

Gut Flora - Candida (thrush), antibiotics and various other triggers such as food intolerances are linked with a less healthy gut flora. Probiotic supplement has been found by some sources to reduce colic/reflux symptoms.

Milk over supply/fast letdown - Reflux caused by a large supply or fast letdown is typically mild to moderate, and will in my experience usually manifest itself from around 3 weeks onwards, with 6 weeks being a prime time. Mums often comment baby gulps, coughs, gasps, splutters, clamps down, pulls from the breast or guzzles. Some find baby will feed until letdown - then pull off, arching and fussing or if it's severe refuse to latch at all. Other babies just appear to be fast feeders and don't seem to suffer until later. If mums have a large over supply, baby may display symptoms similar to that of a secondary lactose intolerance, as the infant struggles to produce enough lactase to digest all the lactose rich milk. See foremilk/hindmilk and a lot of confusion, for further information about this. If you think this may be the case, contact your local Lactation Consultant or registered Breastfeeding Counsellor who can discuss this further with you.

Latch/attachment problems - If baby is not well attached he is unable to milk the breast effectively. This may prevent him from effectively releasing the fat and result in more lactose rich milk (along with perhaps several other issues). Supply may decrease longterm with incorrect attachment, therefore if you think this may be the case contact your local Lactation Consultant or registered Breastfeeding Counsellor who can discuss this further with you.

Long feed spacings - Whereas in many countries, babies are fed little and often (the optimum way for a human infant) Western feed spacings are quite different. Typically larger volumes or milk are transferred less frequently, because this fits with what women expect (based on a non breastfeeding culture). Whilst some infants adjust to this pattern, others struggle with this unexpected strain on their gut. The reason this problem may be increasing is also due to mum's diet becoming more calorific, which in turn may lead to larger volumes of milk per sitting. Combine with a larger gap and letdown can easily become overpowering - hitting the stomach before refluxing straight back up!

In addition mums in the West are more like to do things we know contribute to the incidence of reflux; such as feed in positions which place baby laying down on their back fighting gravity, and then again in the cot, pram or moses basket after a feed. Compared to other cultures, Western infants spend a lot of time on their backs (hence the increasing rates of Plagiocephaly/Flat Head Syndrome, but that's one for another post!).

Residual Birth Trauma - Long births, C-Sections, extremely fast births, posterior pregnancies and labours can all impact. Baby takes immense forces through the sacrum and occipital area (back of head) during labour, which can compress the nerves linked with digestion. Furthermore if the diaphragm becomes distorted, it can compromise the ability of the gut to retain it's contents (ala reflux). Some mums note amazing results with Cranio-Sacral Osteopathy - Annalisa Barbieri wrote an article about birth and osteopathy when her daughter was diagnosed with reflux. A basic introduction well worth a read if the above describes your labour is this

Cow's Milk Protein Allergy - Unfortunately many paediatricians are still telling mothers if their baby doesn't have IgE mediated allergy (the typical hives, swelling etc) - it's not the cow's milk protein; absolutely not true. There are at least 30 antigenic primary proteins in milk, which can get through the digestive tract intact and cause reflux. These antigens can also be responsible for delayed immune responses, producing disease in any and all tissues.

Interestingly untreated allergy can lead to a litany of gastrointestinal, respiratory and/or dermatological problems; with increased rates of infection, particularly in the ears and sinuses. This can result in pain, recurrent illness, poor growth, delayed development and failure to thrive." Now read back up to the symptoms of GORD and compare the two - how many cases of allergy are misdiagnosed and mismanaged as severe reflux? Dairy can also hide in foods you would never expect, under various guises. Many infants allergic to dairy also display a similar reaction to Soy products. If you suspect milk protein may be an issue, look for information about "non IgE mediated allergy" and contact your location Lactation Consultant or Breastfeeding Counsellor and your Doctor.

Prematurity - Premature infants are more likely to reflux feeds than a term baby due to immature development and reduced muscle tone. Again our culture gives much larger feeds, more infrequently than experts suggest biologically normal.

Will stopping breastfeeding help?
No. Reflux is FAR more common in the non breastfed infant Those fed by bottle typically have longer feed spacings, increased volume and increased exposure to cow's milk protein. As discussed in this blog post, it's also a lot easier for bottle feeding mums to overfeed their baby causing reflux. For the majority of mothers, introducing bottles full-time, also results in formula usage. The impact of this on the health of the infant must therefore also be considered - the bacteria profiles of a breastfed and one receiving a breastmilk substitute are very different, some sources list overgrowth of bad bacteria as a reason in itself for reflux. If this is suspected, pro and prebiotic supplementation may help the non breastfed baby.

If allergy to cow's milk protein is suspected, eliminating from mum's diet (in all forms mentioned above) prevents baby receiving any!

Updated 2011

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Reflux - broken babies or profitable product?

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As those who know me will testify, the subject of infant reflux (or gastrointestinal oesophageal reflux GOR) is one that launches me on to my soapbox at a rate Dick Fosbury would have been impressed with. So I thought a blog piece might save me repeating myself quite so often...

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Zainab Yate explains the often complicated phenomenon of nursing aversion. To hear more, come along to BfN's annual conference on Saturday 2nd October, where Zainab will be giving a talk entitled, "Help! Breastfeeding Makes Me Feel Sad, Mad and Bad." Tickets for this virtual event are available here.
Many mothers and those who support them do not know that they can experience negative emotions associated with breastfeeding. In modern society breastfeeding is often used - problematically - to exemplify myths about motherhood and maternal love, and is bound up with ideas of what makes a 'good mother'. In this context nursing aversion and agitation - intense, distressing feelings that are experienced by the mother during breastfeeding - can be both unexpected and hugely upsetting, particularly when women may have already overcome significant challenges in order to breastfeed. In a new book on the subject, When Breastfeeding Sucks, Zainab Yate examines what we know about this poorly understood aspect of infant feeding. Here she sets out the 10 most common misconceptions...

1. Breastfeeding mothers who experience aversion do not always want to stop breastfeeding!

Breastfeeding or Nursing Aversion (aversion) is when breastfeeding appears to trigger particular negative emotions like anger and agitation, skin-crawling sensations and an overwhelming urge to de-latch. You can also feel like a prisoner when breastfeeding or have thoughts of pushing your nursling off you and running away. Although it creates an emotional burden for mothers, and a strain on their breastfeeding relationship, mothers do not often want to 'just stop breastfeeding'. What most of them desperately want is for aversion to go away.

2. Aversion can strike at any point in any breastfeeding mothers journey.

Whilst many in the infant feeding and mothering world knew that aversion can strike when a mother is breastfeeding while pregnant or when she is feeding an older nursling, it can actually happen at any point in a breastfeeding journey - with some mothers experiencing it at the newborn stage. Even though there is a strong argument that aversion is a natural biological trigger to start the weaning process in older nurslings, if you experience aversion and your nursling is under 12 months old, milk is their main source of nutrition so it is best to seek advice from an infant feeding specialist.

3. One reason for aversion could be oxytocin!

In some mothers, it is possible that they have a negative association to breastfeeding, whether it is due to being a survivor of previous sexual abuse, childhood trauma or simply because the start of their breastfeeding journey was very painful or challenging for many weeks, even months. I argue that these can cause a stress response due to the oxytocin, instead of loving, calming feeling it is well known for when breastfeeding. This is because oxytocin actually plays a role in stress regulation, and can cause fear and stress in negative experiences as it activates a part of the brain that intensifies the memory.

4. Some mothers self-harm in order to continue to breastfeed through aversion if they find breastfeeding painful.

This is known as the gate control method, a scientific theory that asserts the activation of nerves which do not transmit pain signals can stop or interfere with signals from pain fibres. So digging your nails into your thighs or biting down on your hand can inhibit the perception and therefore the sensation of pain in your nipple when breastfeeding. Many mothers in this predicament seem to instinctively do this. This would be a particularly severe level of aversion, as aversion can be experienced on a spectrum. If you feel like this, please seek advice from a health care professional or infant feeding specialist.

5. Aversion is different from Dysphoric Milk Ejection Reflex (D-MER)

D-MER is a medical condition that can be diagnosed in a breastfeeding mother when her letdown causes her to feel negative emotions like despair, despondency and hopelessness. It lasts a few minutes and is dissimilar to aversion as the latter can last throughout a whole feed, whether it is 2 minutes or 2 hours - like the breastfeeding-to-sleep-marathon that can happen at night. Mothers can, however, experience both, and I believe if you struggle with D-MER you are more likely to experience aversion due to the added difficulty you experience when breastfeeding.

6. Misdiagnosis can occur with aversion.

Some mothers have sought help and advice from their doctors about their aversion when breastfeeding, but because some of the symptoms of negative emotions are similar to post-natal depression, and because they have just had a baby, health care professionals had wrongly assumed they must be post-natally depressed. If you are otherwise managing fine in day to day life and your emotions, and your difficulty with breastfeeding is just when your nursling is latched, or if anti-depressants the doctor prescribed you do not help your aversion, return back to your doctor and asked for proper screening, assessment and support.

7. Weaning and stopping breastfeeding can be just as hard as carrying on!

Breastfeeding cessation can be very difficult for mothers with aversion because of compounded guilt and shame that they experience in the aftermath of their negative emotions. Even if breastfeeding mothers who experience aversion do decide to wean, many can be surprised at how difficult it is to wean, both practically (if they have a particularly boob-attached nursling), and emotionally, as mothers have to process the feelings of guilt and shame around the negative emotions, and separate that with the guilt of stopping. Understanding that aversion is actually a reasonable response to an intolerable situation, what can alleviate or lessen aversion, and what the weaning process entails can help you get through it.

8. Mothers with aversion fear they are harming their nurslings

So many mothers I support are concerned about having aversion when breastfeeding - that it will harm their nurslings because of the nature of the emotions - but there is no evidence to show this happens. Whether it is feeling stressed or angry when breastfeeding, or even weaning earlier than you or your nursling want due to severe aversion, there is no evidence to indicate there is any long term harm caused to your nursling due to this. We all know the benefits of breastfeeding both mentally and physically as there is a lot of research about this, but we must understand these facts in the context of the research. These studies and statements are about when breastfeeding is going well. With severe aversion and breastfeeding challenges, it is questionable whether all the benefits of breastfeeding and bonding remain, and we know the research shows that when breastfeeding is hard or painful mothers are actually more at risk of post-natal depression.

9. Aversion can lessen or even go away for some mothers

For mothers who figure out their triggers, make lifestyle changes, improve their sleep hygiene, eating habits or use supplements like magnesium, aversion can abate and for some, it disappears as quickly as it reared its ugly head. There is always something you can try, and accessing our free online structured support course on www.breastfeedingaversion.com, or our peer-to-peer support group 'Aversion Sucks' on Facebook to get tips and tricks from other mothers struggling can instantly help you deal with aversion.

10. You don't get aversion with every nursling.

Sometimes mothers worry that because they experienced aversion with their first nursling they will automatically get it again, but this isn't always the case. As I outline my biopsychosocial theory of the phenomenon of aversion in my book 'When Breastfeeding Sucks', I cover why some physiological, psychological and societal causes can mean you experience aversion. I believe forewarned is forearmed, and the second or third time around as a breastfeeding mother you know more and are more empowered to protect yourself against things that can compromise your physical and mental health and therefore to protect you against aversion.
This blog was originally published on www.breastfeedingaversion.com, and is reproduced here with the permission of the author. Zainab Yate BSc, MSc (Medical Ethics & Law, Imperial College London, UK) is a biomedical ethicist, clinical hypnotherapist, independent researcher and campaigner. Zainab is vice-chair and named qualitative lead of a London Research Ethics Committee, with the Health Research Authority (HRA) and has a background in public health and commissioning with the National Health Service (NHS). She published the first peer-reviewed study looking specifically at breastfeeding/nursing aversion and agitation in 2017 and has published the only book on the topic with specialist publishers Pinter & Martin, London. Zainab has been a breastfeeding peer supporter with the NHS for a number of years and is the owner of the only resource site for mothers and healthcare practitioners on aversion (www.breastfeedingaversion.com), she has helped tens of thousands of women and families when breastfeeding triggers negative emotions - both Dysphoric Milk Ejection Reflex and aversion, through her advocacy, free structured support course and peer-to-peer support groups.
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#BfNConf21 Guest Blog: 10 Things You Don't Expect About Nursing Aversion - The Breastfeeding Network

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Zainab Yate explains the often complicated phenomenon of nursing aversion. To hear more, come along to BfN's annual conference on Saturday 2nd October, where Zainab will be giving a talk entitled, "Help! Breastfeeding Makes Me Feel Sad, Mad and Bad." Tickets for this virtual event are available here.

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When can my baby have water?

Young babies under six months won't usually need to have any water or extra drinks, other than their usual milk (NHS Choices, 2017).

I breastfeed my baby so do they need extra water in hot weather?

Babies who are breastfed won't need water until they're around six months old (NHS Choices, 2017).

"When you breastfeed your baby and they've started eating solid foods, you can offer them water out of a cup as well as breastfeeding frequently."

Even in hot weather, you won't usually need to offer your baby water if you feed them breastmilk. They will just breastfeed more frequently if they need to. Babies who are breastfed can feed more frequently because the energy content of breastmilk changes according to their feeds.

I feed my baby formula milk so do they need extra water in hot weather?

If you feed your baby formula milk, you might need to offer them water in hot weather as well as the milk. Make sure you boil and cool the water before you give it to them (NHS Choices, 2017).

How do I know my baby's getting enough to drink?

In hot weather, it's important to offer your baby frequent milk feeds, whether you are breastfeeding, formula feeding or both. In very hot weather, it's important babies drink plenty of fluids to prevent dehydration.

In general, your baby is getting enough to drink if they have at least six heavy, wet nappies every 24 hours. This should be the case from when your baby is five days old, as long as they're happy and alert, and they're feeding frequently. You can find out more in our how can I tell my baby is feeding well article.

When can my baby drink tap water?

Babies under six months should only drink tap water that has been boiled and cooled down. Water straight from the tap is not sterile so is not suitable for younger babies.

Once your baby is six months old, you can offer them water straight from the tap in a beaker or cup. They'd have this as well as their usual milk (NHS Choices, 2017; Oral Health Foundation, 2017).

Can my baby or toddler drink bottled water?

Bottled water is not recommended for babies or toddlers as it may contain too much salt or sulphate.

Water and milk are good options

Older babies and toddlers who have drinks like squash or juice during the day may fill up on calories from these drinks. This reduces their appetite for milk or solids, and can make it difficult for them to get enough nutrients. It might also lead to deficiencies over time, especially a lack of iron, which can cause anaemia (NHS Choices, 2017; Oral Health Foundation, 2017).

It's a good idea to simply offer your baby water to drink, as well as their regular milk feeds.

Taking care of your baby's teeth

Squash and fruit juice are high in sugar and can contribute to tooth decay. Fruit juice is often seen as a healthy alternative to squash, but it still contains sugars and acids that can harm tooth enamel (Oral Health Foundation, 2017). Children under three years of age should not have anything with artificial sweeteners in it (Oral Health Foundation, 2017).

If you want to offer squash or juice to your child, only give it to them sparingly, well diluted, and as part of meal times. Whole fruit juice is a better option than squash. Find out more in our taking care of your baby's teeth article.

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.

NHS Choices has information on how you can look after your baby's teeth.

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Young babies under six months won't usually need to have any water or extra drinks, other than their usual milk (NHS Choices, 2017). Babies who are breastfed won't need water until they're around six months old (NHS Choices, 2017).

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While it seems unnatural to not provide water to your little ones early on, there's legitimate evidence as to why babies shouldn't have water until they're about 6-months old.

The World Health Organization (WHO) notes that babies that are breastfed don't need additional water, as breast milk is over 80 percent water and provides the fluids your baby needs. Children who are bottle-fed will stay hydrated with the help of their formula.

Assuming that your child is feeding well, either through breast milk, formula, or both, their hydration status shouldn't be a cause of concern.

Giving your baby water before six months isn't recommended for the following reasons.

1. Water feedings tend to fill up your baby, making them less interested in nursing. This could actually contribute to weight loss and elevated bilirubin levels.

2. Providing water to your newborn could result in water intoxication, which can dilute the other nutrient levels in the baby's body.

3. Too much water causes their kidneys to flush out electrolytes, including sodium, leading to imbalances.

When your little one is at the stage where you're introducing pureed solids, water could also be introduced.

According to the Children's Hospital of Philadelphia (CHOP), once solids are introduced around 4 to 6 months, a baby's milk intake reduces from a range of 30 to 42 ounces per day to around 28 to 32 ounces per day.

It all depends on how solids are introduced, what kinds of solids are introduced, and how often they're being consumed. The goal for babies between 6 and 12 months is to ensure adequate nutrition intake and overall growth.

In order to effectively achieve this, introduce solids slowly and in multiple exposures. It's acceptable to supplement with water at this time. However, assuming adequate formula or breast milk intake, your child may not need more than 2 to 4 ounces of water over a 24-hour period.

Water is traditionally introduced through a sippy cup. In this time period, as your child becomes more active, you may find that providing additional water in occasional instances is helpful.

Once your child is 12-months old, their milk intake will reduce, ideally to a maximum of 16 ounces per day.

At this stage, you may have established a routine involving breakfast, lunch, and dinner, while introducing a variety of new foods. Due to the increased activity of your child, the reduced milk intake, and the varied food intake, water intake will naturally increase.

The CHOC Children's hospital in Orange County, California recommends that a 1-year-old gets approximately one 8-ounce cup of water every day.

This amount increases each year. The number of 8-ounce cups an older child consumes each day should correspond with their age (up to a maximum of eight 8-ounce cups per day). For example, a two-year-old should consume two 8-ounce cups per day.

Staying hydrated can help your child have proper bowel movements and replenish any lost fluids.

For most children, all you need to do is provide frequent access to water and they will drink enough to meet their needs. If you seem to have trouble encouraging your child to consume water through a sippy cup, try these additional tips to ensure adequate hydration.

Encourage small, frequent sips

Offer small amounts of water throughout the day. Your child will be hydrated but not full from other fluids, which may affect their meal intake.

If you use diluted fruit juice, limit their intake to 4 ounces of pure juice per day.

Make fluids fun

Young kids seem to be intrigued by colors and shapes. You could use colorful cups and fun-shaped straws so that your little ones are excited about consuming water.

Be mindful of weather and activity

Kids aren't able to regulate their body temperature as easily as adults, so it's harder for them to recover and cool off. Encourage fluid intake before, during, and after activities.

As a guideline, encourage at least 4 ounces of fluid every 20 minutes, or whenever a break happens. An ounce of water is equal to about one "gulp" from your little one.

Incorporate water-rich foods

Foods such as soups or fruits such as watermelon, oranges, and grapes are rich in water. You can also flavor water with lemon, lime, cucumber, or oranges to make it fun and tasty.

Your baby may be ready take their first sip of water at six months. However, it's important to realize that newborns, infants, and toddlers have very different hydration than from adults.

What we'd expect ourselves to do in hot weather or during activity is quite different from what they would be encouraged to do. As long as you pay attention to your child's activity and give them plenty of access to water after age 1, you'll make appropriate decisions.
Anita Mirchandani, MS, RD, CDN, received a BA from NYU and an MS in clinical nutrition from NYU. After completing a dietetic internship at New York-Presbyterian Hospital, Anita became a practicing registered dietitian. Anita also maintains current fitness certifications in indoor cycling, kickboxing, group exercise, and personal training.

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Asking yourself when can babies drink water? Learn everything you need to know about hydration needs in newborns and toddlers. Discover why you should wait to give water to newborns. Also find out how much water your 1-year-old should be drinking, ways you can encourage kids to drink enough water, and more.

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Lactation Consultants of Great Britain - Charity

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LCGB is a registered charity working to improve the health and wellbeing of families through advocacy and expert IBCLC breastfeeding care

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NCT feeding helpline (support for breastfeeding, expressing, bottle feeding, formula milk)

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NCT feeding helpline (support for breastfeeding, expressing, bottle feeding, formula milk)

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0300 330 0700
8am til midnight every day

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Email us

If you can't find the information you need, please email us using the form below. The more information you provide the quicker we will be able to assist.

If you have a complaint or other comments about NCT or our services please email enquiries@nct.org.uk

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We provide practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers.

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Friendly Breastfeeding Support from Pregnancy onwards
​La Leche League (LLL) is a mother-to-mother breastfeeding support charity that was started in 1956 in Illinois, USA. They now have around 6,000 accredited Leaders across 70 countries, all of whom are volunteers (who have breastfed a baby for at least 12 months and undertaken a Leader Accreditation course) working from their homes around the needs of their own families.

LLL is recognized by UNICEF and WHO as a world expert in breastfeeding and is the largest women's health organisation in the world. They have their own medical liaison Leaders and Panel of Professional Advisors whom they can ask for additional information if need be.
The core of their work is their network of local mother-to-mother support groups, facilitated by LLL Leaders. The Derbyshire group has been running for over 30 years and the monthly meetings are open to all who are pregnant or breastfeeding. There is always some form of cake available, along with healthy snacks, a cuppa and a library of books covering various aspects of pregnancy, birth, breastfeeding and parenting.

Details of all LLL Derbyshire support group meetings, including occasional toddler meetings (for those who are feeding babies over 9 months & beyond) can be found on their facebook page (@lllderbyshire) which also has information and articles on all aspects of mothering and breastfeeding.

Leaders can be contacted between meetings via the facebook page, on the phone (a national helpline), by email or via the national website which has a wealth of supportive, accurate and evidence based information. LLL understand that when a mother needs support it can't wait until tomorrow.

The heart of LLL's work has always been mothering through breastfeeding and the foundation of their effectiveness has always been mother-to-mother support. So if you're pregnant, just starting your breastfeeding journey or want to meet other breastfeeding mums, bring your bump, baby or older child to a group and feel the lllove.
​
www.laleche.org.uk

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Friendly Breastfeeding Support from Pregnancy onwards ​La Leche League (LLL) is a mother-to-mother breastfeeding support charity that was started in 1956 in Illinois, USA. They now have around 6,000 accredited Leaders across 70 countries, all of whom are volunteers (who have breastfed a baby for at least 12 months and undertaken a Leader Accreditation course) working from their homes around the needs of their own families.

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Our core purpose is to work with people and lead communities in improving their mental and physical health and wellbeing for a better life; through delivering excellent and responsive prevention, diagnosis, early intervention, treatment and care.

Breastfeeding support - Derby

Our Infant Feeding Team provides mothers and families in Derby with advice and assistance to make informed feeding choices. The team also provides support to enable women who choose to breastfeed to do so for as long as they wish. This helps to improve health outcomes.

The team works closely with our health visiting team, and provides training and support to local children's centre staff and GPs.
Our Infant Feeding team contact details
0300 1234586 option 1, followed by option 7

Available Monday to Friday excluding Bank holidays.

Value of Breastfeeding

Women's bodies are designed to produce milk and babies are designed to receive it. Breast milk is perfectly made to give your baby everything they need. In the early days colostrum provides your baby with antibacterial fighting properties which help keep infections at bay. It is highly concentrated in a small volume as a baby's tummy can only take about:

5-7 mls in the first couple of days

Up to 25mls on Day three

40-60mls on day 10

As your baby grows, your breast milk changes to ensure your baby gets everything that is needed. Breastfed babies are less likely to suffer:

Insulin dependant diabetes

Eczema and asthma

Some childhood cancers

Obesity

Heart disease in later life

Chest infections and wheezing

Ear and urine infections

Sudden Infant Death Syndrome (also referred to as SIDS or cot death)

Breastfeeding also:

Can help visual development

Provides better mental (brain) development

May reduce the development of Crohn's disease

Promotes better mouth formation and straighter teeth

Reduces blood pressure.

For mums it helps to:

Reduce the risk of breast cancer

Reduce the risk of ovarian cancer

Promote stronger bones in life

Provide a faster return to pre-pregnancy figure.

If you breastfeed your babies for a joint total of two years or more, it can reduce your risk of developing breast cancer by 8%.

Breastfeeding is an instant soother if your baby is upset or needs comforting. It can also reduce the pain from immunisations.

We now know you can never overfeed a breastfed infant.

Breastfeeding clubs and clinics

Breastfeeding Clubs offer support for like-minded breastfeeding women and those who are providing breast milk. The clubs also welcome mums to be who would like to gain more information about breastfeeding.

All the breastfeeding clubs are led by a member of the Infant Feeding Team.

Breastfeeding clinics

Would you like to see an Infant Feeding Practitioner on a one-to-one basis? Please contact the Infant Feeding Team or your Health Visiting team to book into one of the following clinics (subject to availability):

Sinfin Children's Centre: Monday afternoons

Mackworth Children's Centre: Wednesday afternoons

Peartree Clinic: Wednesday mornings.

During pregnancy mums often start to develop a relationship or bond with their baby. Once your baby is born, this can continue in a number of ways.

You may have started this with skin-to-skin contact following your baby's birth which will have enabled you to say hello to your baby. This normally stimulates milk producing and mothering hormones.

Skin-to-skin contact helps your baby feel calm and safe as they will be able to hear the familiar sound of your voice and heartbeat. This special time promotes the positive mother-baby relationship, regardless of how a mother feeds her baby. It promotes the release of oxytocin, a hormone which has a calming, soothing effect on both you and your baby. Skin-to-skin contact is valuable at any time to help settle and calm a baby and it is also something your partner can enjoy with your baby. It can help you to get to know your baby and fulfil their need for love, comfort and food. You can't spoil a baby by picking them up.

When a baby is hungry they will start to show signs called feeding cues. These are:

Eye movement when waking

Rooting

Hands to mouth or sucking on fingers

Wriggling

Being restless

If the feeding cues are not responded to in a calming manner, babies will cry. It is not recommended to leave babies to cry for a long periods as this will increase their stress levels. When babies are picked up, cuddled and comforted they release oxytocin which helps them to feel calm and safe. Oxytocin levels are high during breastfeeding, helping your baby's brain to grow by making nerve pathway connections, which are an important part of brain development.

At times a baby will want a breastfeed for comfort; this is okay to do as a breastfed baby cannot be overfed.

Unicef - Useful guidance and information on positioning and attachment.
Responsive Feeding - Cluster feeds
Young babies feed for at least eight times in 24 hours and vary the amount of time they spend at the breast. Some feeds can be short, some can be long; mums are encouraged to look how their baby feeds over a 24-hour period. A lot of babies tend to feed frequently in the evenings; this is often referred to as cluster feeding and this is normal. Many mums may not know this and may think their milk supply has reduced but this is not usually the case. Mums are encouraged to be responsive to their baby's cues for feeding and comfort.

Responsive Feeding - Growth Spurts

Sometimes, for a day or two, babies can seem to want more frequent feeds than other times. Such times have been referred to as growth spurts. More frequent feeds at any time stimulate an increase in milk supply for future feeds to meet the needs of the baby. Mums are encouraged to respond to their baby's feeding cues.

How to know your baby is getting enough milk

On the first day your baby can only take about 5 - 7 mls of milk per feed. This first milk is referred to as colostrum. The amount a baby takes increases gradually.

Here are a few tips to help you know your baby is getting enough milk during each feed:

Your baby needs to be attached well at the breast. Feeding should be comfortable and pain free. Your baby needs to be fed when they want for as long as they want. During breastfeeds there will be a rhythmic swallow pattern; this starts off as rapid sucks, progressing to deeper sucks and swallows with some pauses. Towards the end of the feed you will notice some flutter-type sucks with occasional deeper swallows where your baby is getting the last of the fattier milk, so it is important you let your baby finish the feed.

Useful Webistes
Unicef baby friendly initiative
Signs that your baby is getting enough milk include:

Frequent, responsive feeding

Baby is pooing and weeing

Baby settles on the breast and after feeds

Baby is growing and gaining weight - their clothes are getting shorter or smaller

Baby is alert and responsive

Baby looks well

The contents of your baby's nappy is a cood indicator that your baby is getting enough milk. See the section 'What baby poo looks like' on the NHS page 'How to change your baby's nappy' for more details.

Hand Expressing and Storage Guidelines

This is a new skill to learn and to start with you may find you do not obtain much milk. The amount of milk expressed can vary. Healthy term infants can usually obtain more milk when feeding at the breast than the amount of milk that can be expressed. It is normal for your very nutritious breast milk to look thin, watery or even a bluey colour.
There are a few key points to follow which you may find helpful:

Firmly but gently massage your breast and roll your nipple. This helps stimulate the hormones to release the milk - known as let down or oxytocin reflex

Cup the breast in your hand

Feel for a change in texture which is approximately 2.5 cm from the base of the nipple

Put your thumb above and finger underneath making a 'C' shape on the change of texture.

Press and release with finger and thumb using rhythmic movement

It may take a little while for milk to appear- if it doesn't, move your fingers back slightly. Milk will usually trickle and then spurt out and then reduces to a trickle again

Move your fingers and thumb around the breast to express milk from the other milk ducts

Repeat on the other breast

Unicef - Advice and guidance for hand expressing

Storing your breast milk

It is important to wash your hands before you start and to use a sterilised container to collect your milk. Your milk should also be stored in a sterilised container with a lid. Label the container stating that it contains breast milk, your name, date and time.

It is recommended that you use a fridge thermometer so that your breast milk is kept at its best.

Storage in the fridge: Store at 0° to 4° and use within five days

Storage in the freezer compartment of a fridge: Up to two weeks

Storage in the freezer: Store at -18°C or lower and use within six months or three months if baby born prematurely

Once the baby has drunk from a bottle of expressed milk it should be used up within an hour or thrown away. To avoid wasting your expressed breastmilk it is best to offer the baby only a little at a time. You can do this by keeping most of it in one container, in the fridge, and using it to top up the baby's bottle a little at a time.

Defrosting your breast milk

It is recommended to defrost breastmilk in the fridge and use within 12 hours of removing from the freezer. If your breastmilk is still frozen after this time, or you need to use it quickly, defrost under cool, then warm, running water and use immediately after drying the container. Shake gently to mix the creamy, separated particles together. If your milk is often frozen after 12 hours in the fridge, try to freeze in smaller quantities.

Formula milk- what happens if given?

If you are thinking of giving formula milk there may be other options for you depending on your reasons. These may include expressing breast milk and giving this instead of formula, getting support with feeding if you are experiencing a difficulty or getting support to breastfeed discreetly when out and about.

Breastfeeding works on a supply and demand basis. If this is interrupted with formula milk the breast may not produce enough milk for future feeds.

When a breastfed baby is given formula it changes the protective coating that the breast milk creates in the baby's gut. This can increase the risk of baby getting infections such as gastroenteritis.

Babies given formula milk may appear to be less satisfied with subsequent breastfeeds as formula milk is harder for the baby to digest and can stay in the baby's tummy for longer.

Sucking from the teat of a bottle is different to breastfeeding and this may make it harder for your baby to attach correctly to the breast.

Giving formula milk may increase the risk of your baby developing allergies such as asthma and eczema.

Your breasts can become full and uncomfortable (engorged) if the baby does not go to the breast frequently enough. This can make it painful and difficult to attach the baby to the breast.

How partners can support breastfeeding mums

Breastfeeding can take practice to learn how to get it right.
Sometimes partners can feel left out so it is important to talk to each other about how you feel.
A mum is more likely to choose to and to continue to breastfeed if her partner is positive and supportive about it. There are lots of ways for partners to help with breastfeeding. Try the following:

Reassure your partner and praise and encourage her; if she believes she can breastfeed, she most likely will

Be involved with the baby in other ways so that the caring is shared such as winding the baby, changing nappies and bathing the baby

Help to reduce the household chores your partner has to do so that she can feed the baby for as long and as often as the baby needs

Encourage your partner to eat and drink regularly, so that she feels more able to cope

Encourage your partner to get specialist help if she is having difficulties with breastfeeding. Seeing a member of the Infant Feeding Team, for instance, can really make a difference

Helping the mum get into a comfortable position to feed

Have cuddles with the baby after feeds

Laying the baby on your chest, and having skin-to-skin contact

Bathing your baby

Taking your baby out for walks

Playing with your baby

Talking to your baby. Babies are really interested in watching things especially faces and often will start imitating mouth movements; this is the formation of very basic speech development.

Other suggestions for supporting the breastfeeding mum:

Talking and listening to each other

Encouraging the mum to attend a breastfeeding club

Having a positive attitude to breastfeeding

Making a sandwich in advance for the mum's lunch

Doing household tasks such as shopping, cooking or washing

Supporting the mum to enable her to have some 'me time' , perhaps a long soak in the bath

After a few weeks, if feeding is going well and you want to feed your baby, you could give expressed breast milk. Giving a baby a bottle before feeding is going well may result in your baby preferring the bottle.

Guidelines for dummy use and care of teeth

It can be difficult to know whether to use a dummy for your new baby or not. The following information may help you to decide what is best for your baby and you:

Introducing a dummy in the first few weeks when you are breastfeeding may discourage your baby from feeding from the breast

Your breast milk is produced in response to your baby feeding so if your baby does not feed frequently you may not produce enough milk to continue to meet his needs in the future

The sucking action at the breast is different from sucking a dummy. Using a dummy when your baby is still learning to breastfeed may mean your baby does not attach properly to the breast

Using a dummy may mean that you miss your baby's feeding cues. If your baby is unsettled, offer the breast before giving the dummy in case your baby is hungry. Remember it is OK to breastfeed your baby for comfort as well as food

Remember to sterilise dummies before every use to prevent the risk of infections.

Some reports suggest that some parents use a dummy to settle their baby to help to reduce the risk of sudden infant death syndrome. The Foundation for the Study of Infant Deaths states that dummies should not be used for breastfed babies for the first four weeks in order to allow for breastfeeding to become established.

Baby Teeth Matter

It is important to protect a baby's teeth from about six months of age or when teeth first appear. Brush your baby's teeth twice a day every day, using a small smear of fluoridated toothpaste. Do not forget to use the toothbrush pack that your Health Visiting Team gave you at the six-eight week review. Never let babies suck directly from baby food pouches as doing so can cause dental problems.

Introducing solid foods

Introducing Solids

In a healthy breastfed baby it is recommended to wait until your baby is around six months before giving them any other food or drink. The guidelines then recommend continuing to breastfeed alongside solid food until your baby is one year old and beyond.

Giving solids before this time will reduce the amount of breast milk your baby takes due to the solids taking the place of the milk in your baby's tummy. Breast milk is made on a supply and demand process. The foods available for younger babies are limited in order to reduce the risk of allergy. Foods such as baby rice, pureed fruit and vegetables contain fewer nutrients and calories than breast and formula milk and are less likely to meet the demands of a growing baby. Younger babies can only swallow food and not chew so it needs to be pureed and be runny in consistency.

Remember every day of breast milk counts.

Infants given solids before six months will push food out of their mouth with their tongue. This is a reflex which is the body's way of saying it is not ready for solid food. From about six months this tongue thrusting reflex will disappear. Trying to give solids earlier can increase the risk of allergies such as eczema and asthma and also infections such as gastroenteritis.

These signs indicate when your baby is ready for solids:

They can sit in a position and hold his head steady

They can chew food - even with no teeth present

They can pick up food and co-ordinate to put it in their mouth.

Infants at this age quickly progress onto family meals so this provides a great opportunity to be included in family meal times and to start to learn the social aspects of eating.
When babies are introduced to starting solids they can start with baby-led weaning which enables babies to eat at their own pace. Start with foods that are easy to pick up - thick sticks or long strips. Introduce new shapes and textures gradually so that your baby can learn how to handle them.

Don't expect your baby to eat much at first. During the first few months of baby-led weaning many babies eat only small amounts. Most healthy family foods can be offered to your baby. These include vegetables, meat, cheese, fruit, well-cooked eggs, bread (toast), rice, pasta and most fish. Offering a variety of foods will give your baby the chance to discover different tastes and textures. Always supervise your baby when offering food.

Never let babies suck directly from baby food pouches as this can cause dental problems.

Feeding whilst out and about

At first it may seem a little embarrassing or scary to breastfeed away from home. It may be easier to practise breastfeeding at home with the clothes you are likely to wear when you do go out for the first time. Wearing new or different clothing may not be easy at first to undo. Your next step could be visiting one of the breastfeeding clubs in Derby, where there are like minded mums who can share hints, tips and experiences. This may help you to develop your confidence.

You may find it beneficial to try on your clothes in order to find out which will be more comfortable to wear when breastfeeding away from home. If you have a new bra make sure you know how to open it and you can do so easily. Most mums use their existing clothes but there are clothes designed for breastfeeding mums such as tunic-style tops and shawls. But ordinary T-shirts can be just as effective. Some mums drape a muslin cloth or beach wrap over them or wear a waterfall style cardigan to feel more discreet. Some mums like to wear a vest top under their T-shirt which can be rolled down to keep their tummy covered. There are now capes and screens aimed at helping mums feel discreet. They are expensive and sometimes make you more noticeable. Have a try feeding in front of the mirror to see what others see rather then what you see when you look down. Others will not see as much as you!

Set yourself realistic goals; probably avoid the first couple of weeks before you go out and about to feed so you have gained more confidence with positioning and attachment.

A tip to help you feel more relaxed breastfeeding your baby when away from home is to have a trial run. Plan your trip, for example to a café at a time when it is less likely to be busy - so avoid lunch time. Get all your belongings ready, including the changing bag, pram in the car and then offer your baby a feed before you leave home. Go straight to the café and get your drink. Choose a part of the café where you would feel most comfortable. It is likely that your baby will be calm and relaxed after having had a recent breastfeed which makes the situation much easier. Then offer your baby a breastfeed. A lot of breastfeeding mums have found having a trial run really helpful even if their baby only had a brief feed. Why not give it a try!

If you are travelling by car you could buy a sun visor for the side window and sit in the back to feed.

There are a number of places local mums feel comfortable when breastfeeding - see below, 'Breastfeeding Friendly Places'.

Nationally, there has been an increase in the number of children with rickets which is associated with a lack of vitamin D.
Our main source of vitamin D is from the action of sunlight on our skin but in UK the sunlight is not strong enough to make vitamin D in the winter months.

Due to this, during pregnancy all women are advised to take a daily supplement of vitamin D to prevent babies being born with depleted stores. It is recommended that pregnant women take vitamin D supplement of 10 micrograms or 400units daily.
Women who breastfeed are advised to continue to take the vitamin D supplement. The amount of vitamin D in the mother's breastmilk will depend on her vitamin D intake and vitamin D stores; so as a precaution, it is now suggested that breastfed babies be given additional vitamin D, 8.5 to 10 microgram per day from birth until one year, as well as their mother.

If you are if you are eligible for the Healthy Start Scheme you can get vitamins free for your child from one month of age up to their fourth birthday and for yourself until your baby is one year old. If you are not entitled to the scheme you can buy vitamins at local retail outlets - please check the amount to be given as brands can state different doses.

You can exchange your Healthy Start vouchers for vitamins locally from:

Peartree Clinic

Sinfin Health Centre

Revive Healthy Living Centre

Coleman Health Centre

Breastfeeding Friendly Places

Here is a list of places in and around Derby where mums have felt welcome to breastfeed. If you would like to recommend somewhere please contact the Infant Feeding Team.
Parent Rooms

Derby Intu Parent Rooms

Marks & Spencer Baby Changing Room

Mothercare - The Wyvern

Restaurants and pubs

McDonald's (Ashbourne Road)

Olive Restaurant - Derby Intu

Cherry Tree (Toyota Roundabout)

Nandos - Derby

Pizza Express - St Mary's Gate, Derby

Deda at Cathedral Quarter, Derby

Jonty Farmer - Kedleston Road, Derby

Ikea - Nottingham

Mundy Arms - Ashbourne Road, Derby

Las Iguanas

Debenham's Café - Derby Intu

Zizzis - Derby

Starbucks - Derby Intu

Slug & Lettuce - Derby

Bluebell Farm - Spondon

Bonnie Prince Public House - Derby

Hackwood Farm - Mickleover

Fat Cats - Friar Gate, Derby

Finton's Bakehouse Tea Rooms

The Book Café, Derby

The Good Green - Sadler Gate, Derby

Brambles Café - Derby Intu

Jacks of Melbourne

Carluccio's - Intu / Nottingham

The Broadway - Duffield Road, Derby

Costa Coffee - Wyvern/Kingsway

Others

QUAD - Derby

Markeaton Primary School

Children's Centres

Tesco, Long Eaton

Breastfeeding Support contact details

Helpline: Tel: 0300 33 00 771

(8am - 10pm)

Tel: 0845 120 2918

24 hour help line

*Automatic connection to local advisor

Monthly meetings in Derby City Centre - learn more on the La Leche League website .

Supporter Line - Tel: 0300 100 0210

9:30am - 9:30pm

*Automatic connection to local advisor

Tel: 0300 330 5453

9.30am - 10.30pm

Non urgent enquiries - email

Supporter Line in Bengali and Sylheti

Tel: 0300 456 2421

9.30am - 9.30pm

*This system recognises the area code of your phone to do this. You will therefore not be connected to a local supporter if your telephone number is withheld or if you use a mobile phone.

National Breastfeeding Help Line

Tel: 0300 100 0212

9.30am - 9.30pm

Run by the ABM and the Breastfeeding Network

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Our core purpose is to work with people and lead communities in improving their mental and physical health and wellbeing for a better life; through delivering excellent and responsive prevention, diagnosis, early intervention, treatment and care. Breastfeeding support - Derby Our Infant Feeding Team provides mothers and families in Derby with advice and assistance to make informed feeding choices.

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Combi-feeding (breastfeeding and bottle feeding)

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When it comes to feeding their baby, some parents decide to exclusively breastfeed and some to exclusively formula feed. Many families decide to combine breastfeeding and formula feeding; this often called combination feeding or mixed feeding (NHS, 2019).

What is mixed feeding?

Mixed feeding usually means mixing breast and bottle feeding. The content of the bottle can be either breastmilk or formula milk.

Watch our video to find out more about mixed/combination feeding.

Why do some families combination feed?

You might start mixed feeding for a variety of reasons.

If you and your baby have some difficulties getting breastfeeding established or if there are concerns about your baby's weight, you might be advised to give some formula feeds alongside breastfeeding.

You might need to leave your baby for periods of time (for example, if you are returning to work).

Your partner might want to be involved with feeding.

You might be bottle feeding and want to start or resume breastfeeding.

It can be helpful to talk to a breastfeeding counsellor, a midwife or health visitor about your options and the potential impact on breastfeeding of mixed feeding (see below). You could also call our infant feeding line on 0300 330 0700.

How do I combine bottle feeding and breastfeeding?

Some families choose to express milk and feed it to their babies through a bottle. They might do this if someone else would like to feed the baby or if the mum has to be away from their baby for a while.

Others choose to substitute some breastfeeds for formula. If you want to do this, you and your baby will adjust more easily if you reduce the number of feeds gradually (NHS, 2019).

You can offer formula feeds before, during, after or instead of a breastfeed. Talk to your midwife, health visitor or a breastfeeding counsellor about this, as different options will suit different circumstances. And will also depend on what you wish to achieve ultimately.

There are some cases when formula might be given before a breastfeed (for example, with babies who are not breastfeeding well). In other cases, the formula feed might be given instead of a breastfeed. This might happen if you're not with your baby and can't breastfeed or if someone else is sharing the feeding.

Gradually cutting down breastfeeding reduces the chance of your breasts becoming uncomfortably engorged. It will also reduce your risk of developing mastitis (NHS, 2019). It helps to reduce the number of breastfeeds slowly, starting with the one which is convenient for you (NHS, 2020). If you substitute a breastfeed with a formula feed, it may take around five to seven days for the amount of milk your breasts are producing to adjust to missing that one feed (NHS, 2017).

If you 'top up' with formula during one or more feeds, rather than replacing an entire feed, this is likely to extend the gap between breastfeeds. It will also signal to your breasts to make less milk (NHS, 2020).

On the other hand, if you've been advised to 'top up' as a temporary measure and want to return to exclusive breastfeeding, it is important to express milk between feeds to prevent a decrease in the amount of milk you make (NICE, 2017). Try and feed your baby any available breastmilk before each formula feed.

What effect will combining breastfeeding and formula feeding have?

Your baby will enjoy the benefits of breastmilk, even if you're not exclusively breastfeeding. For instance, they will still gain some of the antibodies that will protect them against infection (NHS, 2019).

If you want to feed your baby with both breastmilk and formula milk, it is recommended to wait until feeding is firmly established before introducing a bottle (NHS, 2019). This can take up to a month (La Leche League, 2019).

It's best to wait until breastfeeding is established because breastmilk supply is generally driven by frequent, effective removal of milk from the breasts. Giving your baby formula reduces your milk supply, which is particularly important when you are both getting used to breastfeeding. If your baby breastfeeds less often, your breasts produce less milk (Daly and Hartmann, 1995).

You might have heard that babies can get 'nipple confusion' but there is no evidence that this exists (Kotowski et al, 2020).

How many breastfeeds does an older combination-fed baby need?

Older babies, beyond the newborn stage, can maintain your breastmilk supply alongside formula feeding as long as you breastfeed several times a day. Much older babies - from eight or nine months - can breastfeed just a handful of times a day, and there is still a supply.

Very well-established breastfeeding, with a baby who is one year or older, can continue with as few as one or two feeds in 24 hours.

If your baby is over six months they can use a beaker or cup rather than a bottle (NHS, 2020).

Tips to introduce a bottle to a breastfed baby

You might find your baby does not want to take a bottle at first. The different sensations may confuse them and they don't know the bottle contains food. But there are lots of different things you can try to help your baby:

Offer a bottle when your baby is relaxed and happy, rather than very hungry.

Maybe ask someone else to offer a bottle so they can't smell their mother's milk.

Try softening the teat with warm, boiled water.

Hold your baby in a different position from their usual breastfeeding one. It might help your baby get used to the new way of feeding.

Try a different bottle or teat, this might make a difference.

(La Leche League, 2019)

Unicef (2016) recommend feeding responsively, which means following your baby's cues, whether breastfeeding or bottle feeding. They also recommend using paced bottle feeding. The way a baby is fed with the bottle can affect their comfort, their control of the amount of milk they drink, and the transition between breast and bottle (Kotowski et al, 2020).

Tips for paced bottle feeding

Hold your baby upright, close to your body. (If your baby is lying back, they are less able to control how much milk they swallow, so they can overfeed.)

Touch the teat against the baby's top lip to encourage them to pull it into their mouth.

Hold the bottle horizontal, so that when the baby is actively sucking, they get milk and when the baby is pausing, they don't get milk.

Give the baby several breaks by removing the bottle from their mouth.

Watch what the baby is doing, rather than how much milk they have drunk. End the feed when the baby is no longer drinking.

(UNICEF, 2016; La Leche League, 2019)

This all helps to build a close, loving relationship, a responsive feeding relationship, and avoids overfeeding your baby.

Where can I go for breastfeeding support?

If you have questions, concerns or need support, you can speak to one of our breastfeeding counsellors by calling our infant feeding line 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.

Further information

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

Best Beginnings has video clips from the 'Bump to Breastfeeding' DVD.

UNICEF have produced a summary guide for parents on how to responsively bottle feed babies.

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Mixed feeding: combining breastfeeding and bottle feeding | Baby & toddler, Feeding articles & support | NCT

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Here we look at mixed feeding your baby, which is combining breastfeeding and bottle feeding

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Giving a breastfed baby their first bottle

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Meet Hazel. She's six weeks old and her mum Pam has been exclusively breastfeeding up until now. It's not been without some struggles but Pam has found drop-in groups, found people to help her and been supported by her husband Rob.You'll notice Hazel is dribbling milk a bit. It's her first time having a go with the bottle so we'll cut her some slack. As time goes on, mum will get more experienced at getting the balance of flow right for Hazel. Perhaps you don't know why, but today baby just isn't in the mood and the grumpiness continues. She might be overtired or need a nappy change or something else could be going on. That's normal and that's OK.Even with responsive bottle-feeding, it's possible a baby may overfeed. They can't easily switch off their sucking reflex and it is easier than breastfeeding, partly because the milk isn't gradually getting thicker and slower as the fat content rises. It's tempting to keep going but pause and see what cues your baby is showing. Maybe they need a chance to receive their feeling of fullness.

Today Hazel is going to have her first bottle of expressed breastmilk because Pam and Rob feel the time is right. Pam's latching issues have resolved and breastfeeding is definitely established.

Pam is really keen to make sure Hazel's breastfeeding skills are protected as much as possible.

A baby may take more than they need to so we may have to be careful.

After about six weeks, a baby on average takes 30ml for each hour in 24hrs. But some take a little less and some a little more. The time of day may also make a difference. So while a baby feeding every two hours will on average take around 60ml, we're not going to force that in. We're going to give baby a chance to take the lead.

10. Think about WHEN you give a bottle.
I don't mean in terms of how old the baby is - that's about when breastfeeding is established and you've thought about whether you need to give a bottle at all.

I mean what time of day and what impact that might have on your breastfeeding. We know that removing milk from your breasts between about midnight and 5am is particularly valuable because that's when your prolactin hormone levels are higher and removing milk sends precious signals to maintain supply. So a bottle being given by someone else at 2am may not be doing a breastfeeding mum the ultimate favour.

In the evening, when baby seems very restless and fussy might seem like a logical time. It's really normal for babies to be fussy for several hours often in the late afternoon and evening. We might even feel 'empty' and worry we don't have enough milk and a bottle might seem like a sensible choice but... it could be the worst time of all. Your baby may well be cluster feeding and sending crucial messages to develop your supply to meet their future needs. They are tanking up on really high fat content milk (that comes from an emptier breast, breasts can NEVER be entirely empty). They are coming to the breast for lots of other reasons that aren't just about milk. Giving a bottle at the end of a session of cluster feeding is probably less damaging than giving one to try and stop cluster feeding happening.

Talk to your breastfeeding counsellor or whoever is supporting you with breastfeeding if you feel you need to give a bottle. They can talk to you about your baby's history and behaviour and help you decide when is the right time for you. 8. Who gives baby the bottle can matter.
Sometimes babies take the bottle more easily if it isn't the breastfeeding mum who gives it. However, it's also true that whoever gives a bottle should be someone baby can trust. It's not the role for extended family and visitors who don't know baby well and may have their own ideas about how to do things. Bottle-feeding is also an act of communication - responding to baby and respecting baby.

9.
She knows that introducing a bottle teaches Hazel to feed in a different way and that leaving her breasts unused for a block of time could impact on her supply or leave her at risk of blocked ducts.

Pam has pumped for the first time and has brought a bottle along to a drop-in session to talk about responsive bottle-feeding.

The video here is a clip of our conversation. It's rough around the edges. You can hear my colleague at the beginning pressing record and the video runs out at the end because my iPad memory is full of my children jumping off sofas using 'time lapse'! But hopefully it gives you an idea.

Ten things that are important:
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1. Put yourself in baby's shoes (or Babygro feet).
This is WEIRD. It isn't at all like breastfeeding. Breastfeeding smells of mummy and tastes of mummy and it's warm and comfy. Baby can control the flow and when she gets sleepy the milk gets thicker and slower. Bottles look different. They taste different. Mummy is holding me differently (sometimes with a tense look on her face). Someone else might be giving me milk. The temperature is different and lots of stuff that is really special about breastfeeding just isn't there.

Is the baby showing stress cues? What are they doing with their hands? What is their facial expression like? What do you think your baby is asking?

2. If it doesn't work out the first time, that's OK.
It can take time. It might take a different mood or a different place or a different time of day or a different person. A first bottle refusal is not the end of the world. It is very very likely that things will work out in the end. It's just time for carers to be scientists and experiment with different variables and try different things out.

It's easy to panic but the vast majority of breastfeeding babies move between breast and bottle without too much trouble. There isn't evidence to suggest that you HAVE to give the bottle before a certain age. There isn't evidence to suggest a baby who refuses a bottle today might refuse tomorrow. And let's imagine your nightmare scenario - they continue to refuse. There are a bunch of other ways to get milk into a baby without a breast or a bottle being involved: cup feeding, sippy cup feeding, finger feeding with a tube, syringe feeding.

3. Every bottle manufacturer claims their bottle is 'the best'.
Let's use some logic. No bottle is going to be quite the same as the breast. Babies remove milk from the breast by moving their tongue in a wave-like motion that causes a fluctuation between positive and negative pressure. The milk comes out of the breast to fill a vacuum created by the drop of the rear tongue and the tongue compresses the breast while the mother has occasional milk ejection reflexes. Meanwhile the milk in the breast gets gradually thicker. No bottle comes close to that.

Milk from the breast isn't removed by a hard suck.

An initial suck gets the nipple into the correct position in baby's mouth and holds it there but after that it's really about the rise and fall of the tongue and there isn't a continued hard sucking action removing milk.

We can't use a bottle that works like breastfeeding but let's try and use one that LOOKS like breastfeeding in the way the baby's lips and tongue are positioned and let's encourage the baby to do something to remove milk rather than let it pour out through gravity.

It seems logical that wide bottles (that don't have the longest thinnest nipples) and that allow baby to get an entire mouthful will help us to maintain the association that feeding means a wide gape and the tongue touching against something.

4. Let's allow baby to have as much control as possible.
We'll start with touching the bottle teat to the nose or under the nose and see if we can stimulate a gape. When they ask for the bottle, we gently place the bottle on the tongue (which ideally should be down over the gum ridge and extended). It might be helpful at the beginning to touch the teat to the roof of baby's mouth to help stimulate the sucking reflex. Then if we keep the bottle as horizontal as much as possible, the baby can control flow. If the teat really starts to empty (and you can see that by looking through the inside of the bottle), you may need to start tipping it a little so they don't just swallow air.

Let's respect them if they really start to protest. Are they saying the milk is too fast? Do their hands look tense? Do they want the bottle to come out completely so they can take a breather?

5. If we focus too much on avoiding air getting in, we may not be using the optimum flow.
If our focus is on tipping up the bottle and filling the entire teat with milk, the flow could be too fast. The baby may struggle to catch their breath and may take more milk than they want to (which could cause discomfort and impact on future breastfeeds). If the hole in the centre of the teat is covered with milk, that's fine and if sometimes it isn't, that's OK. You'll hear that swallowing sounds different and you'll respond. And baby will appreciate a burp afterwards.

6. Babies like to be close.
When they are held close, they feel anchored and supported. We can use our bodies to help them stay semi-upright too. They might even be calmed by using skin-to-skin. If you are using bottles regularly, it's recommended to swap the side of your body you hold baby on and the hand you use to bottle-feed. This means baby's vision is stimulated equally and one side isn't always blinkered against the body. Perhaps less of an issue for Pam and Rob when Hazel is probably going to get no more than one bottle of expressed milk a day.

7. It might not always be perfect.

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Giving a breastfed baby their first bottle

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Meet Hazel. She's six weeks old and her mum Pam has been exclusively breastfeeding up until now. It's not been without some struggles but Pam has found drop-in groups, found people to help her and been supported by her husband Rob.You'll notice Hazel is dribbling milk a bit.

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Tip for Expressing Breastmilk

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1. Mothers may express milk for many reasons, and at many different times. A mother with gestational diabetes might express colostrum before her baby is born; mothers also express if they are separated from their baby, if their baby won't latch on, or to relieve engorgement. Once breastfeeding is established, many families share feeding using bottles of expressed milk.

2. Different pumps may be useful in different circumstances. Hospital-grade electric pumps can be hired locally. If you are only expressing now and then, a manual pump might be suitable. Colostrum can be expressed by hand without a pump.

3. Expressed breastmilk can be stored at room temperature for about 8 hours, in the fridge for 5 days, and in the freezer for 6 months. Defrost in the fridge and warm if necessary by putting the container of milk into hot water.

4. If you are giving both breastmilk and formula milk, you might want to offer them separately, giving the breastmilk first to maximise the amount taken, rather than diluting it with formula.

5. Expressed breastmilk can be given to the baby with a syringe, a spoon, a feeding cup, or a bottle. These will need to be sterilised.

6. If you are only expressing and your baby is not feeding at the breast, it is helpful to express very frequently: around 10 times in 24 hours, including once during the night, to mimic the feeding pattern of a baby.

7. Expressing in addition to breastfeeding usually increases the milk supply. Expressing instead of breastfeeding may decrease the milk supply.

8. Closeness with your baby stimulates release of the hormone oxytocin, which helps the flow of milk. Closeness with your breastpump is less likely to have this effect. Some women find that their milk does not flow easily for the pump. Therefore, the amount of milk you can pump is NOT a good indication of the amount of milk you can produce.

9. Warmth, gentle massage, and the sight/sound/smell of your baby can stimulate oxytocin and help milk to flow. Sometimes expressing in a warm bath can be effective.

10. The best time of day to express is whenever you have the time. Breasts produce more milk when they are frequently used, so it is possible to express before, after, or even during a feed. If you can't find time to express, and you don't have to, then leave it for a little while until things settle down.

For support with any aspect of infant feeding, you can call the NCT Feeding Line from 8am to midnight, every day, on 0300 3300 700.

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1. Mothers may express milk for many reasons, and at many different times. A mother with gestational diabetes might express colostrum before her baby is born; mothers also express if they are separated from their baby, if their baby won't latch on, or to relieve engorgement.

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Cup Feeding guidance

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In a society where we are used to bottles, it seems strange to suggest cup feeding that you feed a small baby with a cup. When I first started studying breastfeeding as a student, I was amazed to hear that the World Health Organization recommends avoiding all bottles and using only cup feeding for breast-fed babies. I wouldn't even have thought it's possible to feed a newborn baby from a cup!

Now, being older and more experienced, I can confidently say that it is absolutely possible. In fact, it's not even difficult once you get the technique right. When I worked in a neonatal unit, we taught the mothers to cup feed their premature babies. The babies started cup feeding when they were still very tiny - as small as 1,5 kg! - and they did very well. And you don't need to be especially clever to cup feed either; most of our moms were minimally schooled, unemployed women from the townships and farms, and they managed to cup feed perfectly. The best part is, nearly all of those babies transitioned to feeding exclusively at the breast with no problems at all. When I compare this to the breastfeeding difficulties of the babies I see in the private sector, who had bottles of breast milk in the hospital, cup feeding really seems like a no-brainer.

Why cup feeding?

Cup feeding has many benefits over bottle feeding, especially for a breast-fed baby:

When using a bottle, there is a significant risk that baby will learn to prefer the bottle over the breast. Not so with cup feeding.

Cup feeding allows baby to set the pace of the feed, which is similar to breastfeeding on demand. Baby decides how quickly and how much he wants to drink; unlike a bottle, you cannot force him to drink more.

Cup feeding ensures interaction between mom and baby. This helps mom to be more aware of baby's cues and behaviour, which strengthens the mother-baby bond. I'm not saying you can't interact during bottle feeding, but it is possible to bottle feed without paying any attention to the baby - not so with a cup.

Cups are easy to keep clean.

Because baby sits upright during cup feeding, milk will not pool in the mouth and throat. This (in theory) reduces the risk of tooth decay and ear infections.

Which babies are candidates for cup feeding?

Cup feeding is ideal for any baby that needs to get expressed breast milk or formula before breastfeeding is well established. Some of the common scenarios include:

A baby that does not suckle well from the breast for whatever reason. Things I see often include a baby that is sleepy from a difficult birth, tongue ties and inverted nipples. Cup feeding provides a way to continue feeding the baby while you work on the breastfeeding problem.

Premature, sick and small babies that are not yet strong enough to take all their feeds at the breast. As I said above, I've used cup feeding with these babies for many years, with excellent results.

If mom wants to give expressed milk for whatever reason in the first 6 weeks or so, before breastfeeding is well established (for example, if mom needs to go somewhere or if she is expressing because of a very sore cracked nipple).

If mom is in poor hygienic circumstances, where she cannot wash and sterilize bottles (in this case, even formula should be fed with a cup)

Once baby is a bit older and breastfeeding is well established, it is possible to give a bottle in a way that doesn't interfere with breastfeeding. If that's you, check out this post on paced bottle feeding. Otherwise, keep reading for instructions on how to cup feed.

How to cup feed a baby

Preparing the cup

You can use almost any kind of cup to feed a baby - even a teacup! The only requirement is that it must be clean, free from cracks and not have a lip. I find a small plastic cup is the easiest to use, but you can use whatever you have available. Even the cap that you place over the teat of a baby bottle works well.

Place your milk in the cup. It is easiest to feed the baby if the cup is one third to two thirds full; if the cup is too full it spills a lot, and if it is too empty you have to tilt the cup at an awkward angle. Rather refill your small cup from a larger container regularly to keep it comfortable.

If the milk is cold from the fridge, you can warm it by standing the cup in a container of hot water (never in the microwave!). Room temperature milk should be fine, though.

Position the baby

Many people recommend swaddling the baby while you cup feed, so that his hands don't knock the feeding cup. In practice, however, swaddling has one big problem: baby tends to fall asleep! A sleeping baby cannot drink. I also like to be able to see baby's hands during feeding, so that I can spot if he's getting stressed. So here's what I do:

Sit baby upright, or nearly upright, on your lap. This is very important to prevent choking! Hold baby nice and close to your body to help support his back and neck.

Use your arm to support baby's back. Baby should be sitting against your non-dominant arm - i.e., if you're right-handed, let baby sit on your left leg and support him with your left arm.

Tuck baby's arm that is closest to you between baby and your body, and tuck the other arm in between baby and your arm.

Alternatively, use the hand of the arm that is holding baby to hold both of baby's arms in front of his body.

You other arm needs to be free to hold the cup, obviously. You will use your dominant (strongest) arm to hold the cup.

If you are still learning to cup feed, I recommend you take baby's shirt off (make sure you're in a warm room!) so that you can catch any spills with the cup. Otherwise, if baby's already feeding well, just put a bib on baby or place a paper towel on baby's chest to catch any small drips.

How to feed

With baby positioned as above, pick up the cup and hold it to baby's lips. Wait for baby to open his mouth and put the cup in his mouth. The cup should reach all the way to the corners of the mouth so that the whole lower lip is against the cup. This prevents milk from spilling out at the corners of the mouth.

To let baby drink, just tip the cup until the milk is touching baby's lip or tongue. Do not pour the milk into baby's mouth. I repeat: do not pour the milk into baby's mouth! If you pour, baby has no control over how fast the milk flows, and there is a real risk that the milk can go into baby's lungs if he cannot swallow fast enough. When the milk touches baby's lips or tongue, he will sip or suck the milk in.

Watch baby closely: when he stops sipping, or if he shows any stress signals, tilt the cup back to upright and let him take a few breaths first. Stress signals to look out for include: gulping, wide eyes, frowning, arching his back or splaying his fingers (as if he's gesturing "stop!"). These things all show that the milk is flowing to fast for baby to handle. Stop and give baby a breather. When you continue feeding, make sure baby is in an upright position and don't tilt the cup so far, so that baby has more control over the milk flow.

If any milk spills out of the mouth, use the cup to catch those drips. Every drop of milk is precious!

When baby closes his mouth to show that he's had enough, it's time to end the feed. If baby needs to take a certain amount at each feed, just wait 30 minutes to an hour and try again. Never force a baby to drink; it can create a hatred of feeding that lasts a lifetime.

Transitioning from cup to breast

How you transition from cup to breast will depend on the reason why you were using the cup in the first place. If you were just giving an occasional cup feed in-between successful breastfeeds, you can ignore this section.

Many times, however, we use a cup because the baby isn't taking the breast. In this case, you need to keep trying to offer the breast - you don't want to be expressing forever! Offer the breast before every cup feed, and in-between cup feeds at any time when baby seems interested. Once baby starts taking the breast, you can offer the cup after breastfeeds just in case baby wants a bit more milk. Pretty soon, baby will not need the cup anymore, and you will hopefully go on to have a long and happy breastfeeding relationship.

Alternatives to cup feeding

Just to round out the picture, here are a few other ways that you can feed expressed breast milk to your baby:

Using a syringe. This is even easier for baby to handle than the cup, and it's usually how we start to feed our premature babies. A syringe works well when you're feeding relatively small volumes of milk. In most cases, a 5-10 ml syringe is a comfortable size. When feeding with a syringe, be very careful not to squirt the milk faster than baby can swallow it!

Using a teaspoon. This is only really useful in the first few days, when you may only be producing drops of colostrum. Express them directly onto the spoon and feed to baby.

Using a bottle. I only recommend using a bottle once breastfeeding is well established, otherwise you may end up with a baby who refuses the breast. Always do paced bottle feeding - read more about that in this post.

Have you ever used cup feeding or any of the alternative methods I discussed here? If so, leave a comment and tell me about your experiences!

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Cup feeding: when baby can't breastfeed - Love and Breast Milk

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In a society where we are used to bottles, it seems strange to suggest cup feeding that you feed a small baby with a cup. When I first started studying breastfeeding as a student, I was amazed to hear that the World Health Organization recommends avoiding all bottles and using only cup feeding for breast-fed babies.

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National Breastfeeding Helpline run by BfN and ABN. 9.30am-9.30pm every day.

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National Breastfeeding Helpline - Helpline

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This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website.

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BEARS Amber Valley Breastfeeding Support (Belper, Alfreton, Ripley)

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BEARS Amber Valley Breastfeeding Support (Belper, Alfreton, Ripley)

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Current support is through phoneline and messaging.

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B.E.A.R.S Breastfeeding Support across Amber Valley

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B.E.A.R.S Breastfeeding Support across Amber Valley, Ripley, Nottinghamshire, United Kingdom. 984 likes · 125 talking about this · 1 was here. Breastfeeding Experience, Assistance and Reassuring...

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Breastmates Peer Support (Matlock, Buxton and High Peak)

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Breastmates Peer Support (Matlock, Buxton and High Peak)

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Provides a private messaging support service and Zoom support groups with peer supporters several days and evenings a week. See their page for details.

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Breastmates Breastfeeding Support. 647 likes · 19 talking about this. Breastmates offer mum to mum support with breastfeeding. We are based in the High Peak, Buxton, Matlock, Wirksworth and Bakewell.

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Responsive Feeding Day & Night - why it is important for the milk supply

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by Dr. Amy Brown

Responsive parenting e.g. responding promptly and appropriately to a baby's needs is widely recognised as an important protective element for infant health, wellbeing and development ¹. When babies feel secure in the care of a primary caregiver, they go on to have better outcomes socially, educationally and emotionally ².

There are many elements to responsive parenting but one of the central aspects within this relationship is the importance of responsive feeding. Responding to a baby's feeding cues (both of hunger and satiation), whether they are breast or bottle fed is an important step to helping a baby develop not only a secure attachment relationship, but in establishing longer term positive eating behaviours. Responsive feeding takes advantage of a young baby's natural ability to regulate their intake of calories - something that can disappear when a baby gets older ³. Feeding when they are hungry and being able to stop when they are full helps them to retain this ability ⁴.

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However, the notion of responsive feeding can lead to significant concerns for new parents, particularly in relation to how often breastfed babies feed. One concern is whether feeding frequently is a sign that the baby isn't getting enough milk, exacerbated by not being able to see how much milk the baby is consuming. Others may worry about whether babies need to learn to feed less frequently in a set pattern. However, responding to a baby's natural cues is a critical step in establishing milk supply and encouraging healthy weight gain and development in babies.
How often do babies breastfeed?
As with everything, how often a baby naturally wants to feed will vary amongst individuals. However studies that explore how often babies breastfeed find that most do so between 8 - 12 times per 24 hours, although some feed much more than that (up to around 18 times in some studies). Most tend to feed towards the latter part of that range, with around 11 - 12 feeds per 24 hours ⁵.

Notably, babies calorie needs do not change vastly after the first few weeks, but they become able to take bigger feeds. This means that from around 8 - 12 weeks some babies start feeding in longer intervals. However, this pattern doesn't necessarily remain. Studies that have tracked this longitudinally find that many babies do start to feed less often but then start feeding again more frequently (akin to a newborn) around 4 months of age, before dropping down again. This fits with the commonly observed 'four month growth spurt', which is often seen as a mistaken need for solid foods ⁶. However, as with everything, some babies will continue to take smaller feeds more often until they move to solid foods (and, still even then). Just as with adults, some of us prefer set meals a day whereas others prefer to graze.

As well as being little and often, most babies don't naturally breastfeed to a set pattern e.g. every three hours. If allowed to feed whenever they want to, many breastfed babies are good at feeding according to hunger, which doesn't fit into a set pattern (how many adults truly eat or drink at precise set intervals?). Things like growth spurts and cluster feeding (where babies feed numerous times over a period of up to a few hours) are common and are thought to stimulate the body to produce more ⁷.

Variations will also occur according to the content of the mothers milk. Research has shown that fat content can vary between mothers. Mothers who produce milk with a higher fat content are more likely to have babies that have shorter feeds e.g. they take in a similar energy density to those with lower fat content in their milk who take a little longer to consume it ⁸.

Breastmilk also changes in content, particularly in terms of calories and fat. During a feed, milk becomes denser in fat as the feed progresses. Fat content and energy density are also higher during the day than the night. In hot weather breastmilk can also be less energy dense, encouraging infants to consume more of a higher water content milk ⁹. Again, this can affect the amount or frequency of how often babies feed. Generally, the less energy dense the milk, the more they take in.

Feeding frequency is also context dependent. In Western culture our norm is to separate from our babies to some extent. Baby wearing for most of the day and co-sleeping are normal from an evolutionary perspective but not common in our society today. Put simply, this means that babies do not always have easy and unfettered access to the breast. However, in cultures where co-sleeping and carrying infants in a sling are common, and babies therefore have free access to the breast, they feed far more frequently than this. An observational stud of the rural hunter- gatherer tribe known as the !Kung, found that babies breastfed on average four times an hour, with an average feed being two minutes or less ¹⁰. Other studies show less frequent feeds, but sill significantly more than in Western cultures. For example one study in rural Thailand found babies averaged 15 feeds over 24 hours ¹¹. In the UK, when babies do co-sleep, they feed more per night ¹².
Why do babies need to breastfeed so often?
Firstly, breastmilk is low in fat and protein but high in carbohydrates and lactose, which makes it easy - and quick - to digest. It is more easily digested than formula milk, which means that breastfed babies often feed more frequently than formula fed babies (approximately every two hours compared to three hour for formula fed babies) ¹³. Breastfed babies reach a fasting state quicker than formula fed infants, with 75% of breastfed infants reached a fasting state within 3 hours from the last feed compared to 17% of formula fed babies ¹⁴.

Breastfed babies also tend to consume less milk than formula fed babies at each feed, preferring to feed little and often compared to many formula fed babies. A baby's tummy has a maximum capacity of 90ml. Breastfed babies tend to take smaller feeds, not completely filling their stomach. In the first six months babies need around 750ml of milk a day meaning that even at maximum capacity that equates to feeding around every three hours ¹⁴. Research has shown that formula fed babies take in more milk from the first day of life (about twice as much on day one and three times as much by day two) ¹⁵.
Why is responsive feeding so important?
Meeting the frequent and unpredictable feeding needs of a breastfed baby can feel challenging and is a common reason why mothers stop breastfeeding - either through anxiety that something is wrong, or a belief that formula will offer a more convenient feeding schedule ¹⁶. However, responsive feeding is not only normal but important for a number of reasons.

Feeding responsively is particularly important when a baby is breastfed because it is intrinsically linked to establishing and maintaining a good supply of breastmilk. Breastmilk starts to be produced in small amounts during pregnancy. Once the placenta is removed after birth this production shoots up, supported by rises in the hormones prolactin and oxytocin ¹⁷.

However, once this initial surge has occurred, one of the most important things for breast milk supply is frequent feeding. Simply, the more milk is removed from the breast (either by a baby or by expressing), the more milk is produced. The human body is very clever at matching how much milk is removed (e.g. how much the body believes the baby needs) to how much it produce ¹⁸. One study that asked mothers to either feed their newborn baby responsively or to feed to a set 3 - 4 schedule found that babies who were fed responsively consumed a third more milk ¹⁹.

Because responsive feeding is linked to a better milk supply, it has a knock on effect onto outcomes for babies. Responsive feeding is associated with mature milk coming in quicker after the birth ²⁰, regaining birth weight faster ¹⁹, and a lower risk of jaundice ²¹. Conversely, supplementing with formula milk, particularly in the early days and weeks, can lead to a drop in supply, or difficulties with latch ²². Using a pacifier can also reduce milk intake as it can lead to a delay in how often babies are fed. Babies who use a pacifier feed on average for half an hour less each day which equates to one fewer feed< ²³.

Based on this, it is not surprising that babies who are fed responsively are more likely to continue being breastfeed ²⁴. Meanwhile, trying to breastfeed to a parent led routine is associated with stopping breastfeeding ²⁵. This can apply to wider parenting style; mothers who adopt a routine for feeding, sleep and day to day care of their infant are more likely to stop breastfeeding in the early days ²⁶. Notably, those who stop breastfeeding after using a routine are more likely to report breastfeeding difficulties e.g. low milk supply, pain on latch and a fussy baby - likely a knock on impact of lower milk supply from less frequent feeding ¹⁶.
What about night time feeding?
Babies' needs do not cease to exist simply because it is dark outside. One of the main needs infants have at night is to feed. A baby's stomach is still the same size and breast milk still easily digested at night as it is in the day. Research suggests that it is not until around two months that a baby's natural day and night circadian rhythm kicks in. Until that point, the concept of sleeping for an extended period of time is not something that babies are physiologically designed to do - and even then it can take a while to get into the habit ²⁷.

However, society continues to sell us the myth that babies should start sleeping through the night after the first few weeks, and that getting them to this stage is an achievement. Aside from evidence to the contrary, given that around a third of adults report at least mild insomnia, should we really believe that babies who cannot meet their own needs if they wake should be able to sleep all night? How many adults when they wake have a drink of water?

Waking at night is also thought to be protective. Babies want to be close to their mother at night and sleeping close to them helps babies maintain their temperature ²⁸, heart rate ²⁹ and have steadier breathing ³⁰. Sleeping too deeply may be a risk factor for SIDS. Babies who have died of SIDS are more likely to have longer periods of uninterrupted sleep and moved about less in their sleep ³¹.

Research exploring night waking in the first year brings estimates of between 30 - 80% of babies still waking at least once with a number of studies saying most babies continue to wake once or twice a night throughout the first year ³². Although sleep problems in older children can be an issue, waking at night as a baby has no link with later sleep problems or development ³³.

Feeding at night is also common - and important - in supporting breastfeeding. Firstly, the body takes into account feeds at night when establishing milk supply. Babies take in around a third of their milk supply at night (although in toddlers in cultures where co-sleeping is the norm, this can rise to 50% as many are busy and distracted during the day) ¹¹. Feeding at night is an important step in developing a good milk supply. Although it may be dark outside, the body still considers frequency of feeds at night when establishing milk supply.

Feeding at night is also an essential part of providing a high level of contraceptive cover through the Lactational Amenorrhea Method. This method offers 98% security of contraception as long as babies are fed responsively (and are under 6 months and receiving no formula milk or solid foods). Feeding at night is an important part of this ³⁴.

Additionally, feeding at night is important from a hormonal perspective. Prolactin is linked to milk supply; generally the higher prolactin levels you have, the more milk is made. Prolactin levels are already higher at night but also rise further when your baby feeds, so feeding at night is a great opportunity to really drive those levels higher and help your milk supply ³⁵.

Sometimes parents worry about their baby continuing to breastfeed at night based on the myths that a) babies should sleep through the night and b) breastfeeding stops babies sleeping through the night. However, rather than being something breastfed babies do more, breastfeeding at night should be recognised as something that is very normal. In countries where night-time infant care and co-sleeping is the norm, babies breastfeed around four times a night ³⁶.

Some studies do show that very young babies who are formula fed start sleeping for longer at an earlier age more, suggesting that breastfeeding was likely used as a tool to encourage the baby back to sleep quickly ³⁷ and have longer periods of deep sleep ³⁸. However once babies get a little older, this difference disappears. One study found that for babies aged 6 - 12 months, babies who were breastfed did more at night than babies who were formula fed. However they did not ³². Indeed, two studies exploring the sleep patterns of mothers who breast or formula fed found that breastfeeding mothers got more hours of sleep overall, alongside feeling in better health< ³⁹ whilst another found that mothers who were breastfeeding actually had more rest per night that those who formula fed because it took less time to resettle the baby ⁴⁰.

When parents are thinking about a routine for feeds, one of the most common places they start is by trying to reduce night feeds, and more generally encourage 'sleeping through the night'. However, sleep training can have a negative impact on breastfeeding success. One intervention to reduce night waking in babies aged 6 - 12 months found that although babies started sleeping for longer, breastfeeding rates dropped far more rapidly than expected during the course of the study ⁴¹.

Feeding responsively is therefore a critical element of establishing and maintaining milk supply, supporting weight gain and promoting positive longer term eating behaviour in children. More importantly, it is the norm and biological expectation of young babies, and a central element of a responsive parenting relationship however a baby is fed. Feeding responsively can be demanding for mothers though and as a society, rather than trying to normalise routines and scheduled feeding, we should be looking towards how we can value and support our new families better. Mothering the mother so she can breastfeed her baby, and more widely, supporting the new family and a unit makes the new responsibility of caring for a young baby that little bit easier.
References and links http://psycnet.apa.org/journals/dev/42/4/627 https://www.ncbi.nlm.nih.gov/pubmed/19112517
3. Fomon, S.J., Filmer, L.J., Thomas, L.N., Anderson, T.A., & Nelson, S.E. (1975). Influence of formula concentration on caloric intake and growth of normal infants. Acta Paediatrica Scandinavia , 64/2, 172 - 81.
https://www.ncbi.nlm.nih.gov/pubmed/1168981 http://onlinelibrary.wiley.com/doi/10.1111/j.2047-6310.2012.00071.x/abstract https://www.ncbi.nlm.nih.gov/pubmed/16510619 http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.1999.tb01083.x/abstract http://europepmc.org/abstract/med/1476844
8. Tyson, J., Burchfield, J., Sentence, F., et al. (1992). Adaptation of feeding to a low fat yield in breast milk. Pediatrics , 89/2, 215-220.
http://pediatrics.aappublications.org/content/89/2/215.short https://www.ncbi.nlm.nih.gov/pubmed/22797414
https://www.ncbi.nlm.nih.gov/pubmed/7352291
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442252 http://adc.bmj.com/content/89/12/1106 http://www.nature.com/ejcn/journal/v58/n9/full/1601964a.html http://pediatrics.aappublications.org/content/80/3/434.short http://www.tandfonline.com/doi/abs/10.1080/07315724.2001.10719033 http://onlinelibrary.wiley.com/doi/10.1111/j.1365-277X.2010.01145.x/abstract http://europepmc.org/abstract/med/7818388 http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.1986.tb10313.x/abstract http://www.sciencedirect.com/science/article/pii/S0140673652904509 http://jamanetwork.com/journals/jamapediatrics/article-abstract/510586 http://www.academia.edu/1603964/The_initiation_of_lactation_the_effect_of_early_versus_delayed_contact_for_suckling_on_milk_intake_in_the_first_week_post-partum._A_study_in_Chiang_Mai_Northern_Thailand https://www.ncbi.nlm.nih.gov/pubmed/24529621
https://www.ncbi.nlm.nih.gov/pubmed/10506275
http://pediatrics.aappublications.org/content/107/3/e38.short http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054229 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0083893 https://www.ncbi.nlm.nih.gov/pubmed/12897290 http://adc.bmj.com/content/75/3/249.info https://pdfs.semanticscholar.org/68c7/5209655dd68925115082acd8730ca1aaea06.pdf https://journals.physiology.org/doi/full/10.1152/jappl.1998.84.4.1374 http://europepmc.org/abstract/med/2740699 http://online.liebertpub.com/doi/abs/10.1089/bfm.2014.0153 https://www.nationalelfservice.net/cms/wp-content/uploads/2013/01/Price-2012-Sleep-Med.pdf
34. Labbok, M.H. et al. Multicenter study of the lactational amenorrhea method (LAM): I. Efficacy, duration, and implications for clinical application. Contraception 1997; 55(6):327-36

https://www.ncbi.nlm.nih.gov/pubmed/9262927

35. Riordan, J. & Wambach, K. (2010) Breastfeeding and Human Lactation 4th ed. Jones and Bartlett, p. 89
https://books.google.co.uk/books?hl=en&lr=&id=lDb3BQAAQBAJ&oi=fnd&pg=PR1&dq=Riordan,+J.+%26+Wambach,+K.+(2010)++Breastfeeding+and+Human+Lactation+4th+ed.+Jones+and+Bartlett,+p.+89&ots=NrFUzunn3I&sig=OMVyHApWEzVmFRKVEXYY4dynQeQ#v=onepage&q&f=false http://journals.sagepub.com/doi/abs/10.1177/089033440101700307 http://onlinelibrary.wiley.com/doi/10.1046/j.1523-536X.2003.00243.x/full https://www.researchgate.net/profile/Jon_Moon3/publication/21676170_Sleep_Organization_and_Energy_Expenditure_of_Breast-Fed_and_Formula-Fed_Infants/links/5543d6230cf24107d396377b/Sleep-Organization-and-Energy-Expenditure-of-Breast-Fed-and-Formula-Fed-Infants.pdf http://www.ingentaconnect.com/content/springer/clac/2011/00000002/00000002/art00007
http://onlinelibrary.wiley.com/doi/10.1111/jpc.12089/full

41. Hall, W.A., Saunders, R.A., Clauson, M., Carty, E.M. and Janssen, P.A., 2006. Effects of an intervention aimed at reducing night waking and signaling in 6-to 12-month-old infants. Behavioral Sleep Medicine, 4(4), pp.242-261.
http://www.tandfonline.com/doi/abs/10.1207/s15402010bsm0404_4 About Amy Brown:

Dr. Amy Brown is an Associate professor in Child Public Health in the Department of Public Health, Policy and Social Sciences at Swansea University, UK. Her research explores the psychology of maternal and infant health and wellbeing, particularly during the first 1001 days of pregnancy and the first two years of life. She has a particular expertise in infant nutrition, but her research also explores the wider yet inter related issues of normal baby behaviour, sleep, parenting and postnatal depression.

As part of her role, Dr Brown leads the MSc in Child Public Health - an interdisciplinary programme which explores the evidence base behind child public health policy in the UK and internationally. This programme is particularly popular amongst health professionals and graduate students alike and has attracted students from South Korea, Nigeria, Canada, Guatemala and Ghana to name a few.

Check out her book Breastfeeding Uncovered at:

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Importance of Responsive Feeding * KellyMom.com

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The importance of responsive feeding in establishing a good breastmilk supply by Dr. Amy Brown Responsive parenting e.g. responding promptly and appropriately to a baby's needs is widely recognised as an important protective element for infant health, wellbeing and development1. When babies feel secure in the care of a primary caregiver, they go on to [...]

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Hand Expressing (how to do it)

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Antenatal hand expressing colostrum - short guide

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SKIN TO SKIN - why the first undisturbed hour is so important, and its importance for all parents.

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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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Sound on

Breastfeeding/Nursing Aversion and Agitation is a phenomenon whereby breastfeeding triggers negative emotions like anger or irritation, skin-crawling sensations and particular intrusive thought like feeling trapped or an urge to de-latch (Yate, Z., 2020)

*Yate, Z :"When Breastfeeding Sucks: What you need to know about Nursing Aversion & Agitation", Pinter & Martin, London)

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Breastfeeding Aversion Home | Aversion Sucks

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Breastfeeding and Nursing Aversion and Agitation research and support for being touched out and having negative emotions and particular intrusive thoughts when breastfeeding because #aversionsucks

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So you've probably heard about this thing called a Haakaa. You might even have one! Maybe you used it and loved it and spread the word to all of your new mama friends! And yep, indeed, it was pretty revolutionary when it was first released: A one-piece, soft flexible device that you just stick onto your breast, and huzzah, you suddenly have a bunch of expressed breastmilk with absolutely zero effort. What's not to love?

But. This post isn't going to be about how handy the Haakaa is - there are a plethora of articles out there that do that. Yes, I think it's a brilliant tool to have in my toolbox as a lactation consultant, but I have also seen it cause some pretty big problems. And these particular issues keep popping up again... and again... and again.

Many mums get themselves a Haakaa in order to collect the drops of milk that would otherwise go into a breast pad. Often, their supply started off pretty high, and the Haakaa is being used to relieve some pressure from very full breasts when baby is feeding on the other side.

What do I see? By the time I see them, their baby is overwhelmed by their milk, often gags, pulls off repeatedly in distress, and finds it difficult to control their suck-swallow-breathe coordination. Mums may have continued clogged ducts and can be at a much higher risk of breast inflammation and mastitis, and often come to me very sad that they have never managed to experience that beautiful, cosy, nurturing feed they'd dreamed of; their vision of breastfeeding did not include a constantly gagging, choking and distressed baby throughout every feed.

Why does this happen? There seems to exist this idea that all the Haakaa does is collect leaking milk, and that because it doesn't have a motor or doesn't require a pumping motion, it does not stimulate supply. But remember the most simple rule of breastmilk production: The more milk you take out, the more milk you make. I can assure you that your breast pads are not collecting 80ml (or much more!) of milk during a feed on the other side! In this situation, your body is receiving the. feedback that this milk was needed for your baby, so you will continue to make this amount, and your supply will eventually regulate at this higher level.

How can we fix it? If mums come to see me early enough, before supply is fully regulated, then all we need to do is get mums off their Haakaa. We teach hand expression as an option to deal with pressure and discomfort instead, which should only be required for a very short period of time. For those where it's more complicated and their supply really needs to be brought down a little, then a knowledgeable IBCLC can provide good support to allow them to experience the feeds they'd dreamed of. (But don't start using the Haakaa again once things regulate!! This often happens, and very very quickly your supply reverts back to being overwhelming.)

Problem 2: Low Weight Gain

This is now something I've seen around half a dozen times, so it's definitely happening. These mamas, from what I've seen, have all had something that scared them and reduced their confidence in their body's ability to make enough milk for their baby. Perhaps their baby lost quite a lot of weight in hospital, or this mama has a history of low supply with a past child, or their milk took a while to come in, or they needed to supplement with formula for the first week; for whatever reason, these mamas are worried. To better explain this situation, I'm going to introduce you to Emma, a fictional amalgamation of a bunch of parents I have seen in this situation. Emma had unexplained low supply with her first baby and stopped breastfeeding at 8 weeks. She still carries a lot of pain with her about this experience, and so desperately wants a different story with her new baby.

What do I see? Early on, like many others, Emma leaked a little on her unused breast when she was feeding from the other. She feared losing even a couple of drops of that treasured milk, so she heard about the Haakaa, which would collect all of this this leaked milk. Emma knows the supply-and-demand concept of milk production, so she became really excited when she would see 20ml being drawn out in the Haakaa, then 30ml, then 40ml. She knew this would mean her body would continue producing more milk for as long as she continued to collect it, and it was empowering for her to watch her much-longed-for milk fill it! For each feed, she would bring her baby to one breast and put the Haakaa on the other. She'd then swap breasts and latch her baby to the side where the Haakaa just was. Bubba latches, sucks a couple of times, falls asleep and begins that sleepy, weak, non-rhythmic kind of suck that we know is not conducive with active feeding ('non-nutritive sucking', for those playing at home). They could potentially stay on this breast for really quite a long time, taking only very very little milk. These babies have then theoretically been on both breasts, are then considered content and asleep, so the feed is then finished. Baby sleeps, mum puts her milk from the Haakaa in the fridge.

So what's wrong with that? All newborns are sleepy... and it's a universal truth that parents who are working hard to get their newborn's weight up are also working very hard to keep their baby awake at the breast! They seem so hungry, but then the moment they latch on, they do three sucks and then bam - asleep! But another universal truth, however, is that one of the best (if not the best!) ways to keep a baby awake and active at the breast is to get that milk flowing! A baby who is latched to a breast with a slow flow is going to fall asleep much faster than a baby who is having to suck swallow breathe, suck swallow breathe, suck swallow breathe, repeat. But in Emma's situation, the Haakaa has removed this initial, fast-flowing stored milk, so now the baby has to work harder and stay active longer to get the next, slower-flowing letdown. And some babies who are struggling may not be able to do that.

Then what happens? Then comes the moment when Emma learns that baby is not gaining enough weight, and she is told to give 30ml of additional milk in a bottle after each feed at the breast. All of her fears of repeated low supply are now being realised, and it can be very hard, though also very confusing, as she clearly has all of this milk that she has expressed! Ideally, this is when Emma gets in contact with me, and after a lot of discussion, it becomes clear that the only thing that needs to change is that she needs to stop using the Haakaa! Leave that milk in the breast, use a breast shell to collect the leaking drops if you want to, and get that fast-flowing milk from the first let-down into the baby's stomach directly, instead of into the Haakaa, then into a bottle, and only then into the baby. Sounds simple, but when you are in the thick of it, sometimes you can't see this, and you fall into a spiral - I totally totally get that.

Sometimes, though, I don't get called until later... It is the same situation as above, with low weight gain, but things get more complicated.

What do I see? When I come, I see a baby who is thriving, but a mama who is in a lot of distress. Every time they try to breastfeed, their baby either pushes the breast away, arches their body away, and just refuses to latch. If they are still latching, then they only latch for a moment before then pulling off abruptly, crying in distress and then refusing to relatch. Mums in this situation often tell me that they feel such a strong sense of rejection and such deep sadness, and feel totally helpless. Milk is in there, they know it, but they can't get their baby to take it. Bubba is crying, mama is crying, the mum feels she has no option but to then get the bottle of milk and feed her bubba this way. Milk is left in her breast, and her supply really does start to now go down. It's a really tough, emotional situation.

Here, mums were told to supplement their baby with their expressed milk in a bottle after every feed. They are prioritising their baby's growth, which we all want! But doing it in this way can be problematic... there are other very effective ways to supplement when needed. In this situation, quite quickly, the issue of a bottle preference can start to emerge - and when I talk about bottle preference, I'm really talking about a milk-flow preference. When milk comes from a bottle, the milk comes immediately and continuously; When milk comes from your breast, your baby has to work hard for a little while before any milk comes, and then the flow rate varies throughout a feed - fast, then slow, then fast, then slow, throughout. Babies are clever. Of course they would prefer milk to come immediately and easily! Sometimes, in their distress, mamas try to force their babies to latch. And full disclosure, I've been here with a non-latching baby, and I too have taken his little head and pushed him towards my breast, his body pushing back against me. I now know that this kind of thing can make babies even more averse to coming towards the breast - they need to be the boss.

What can we do? Clearly, this situation needs a lot more work than just 'stop using the Haakaa'. It needs patience and care, lots of skin-to-skin and trust in your baby's instincts. Step one is to get back to basics and focus on skin to skin: make your breasts available in a totally stress-free way, always ensuring that we are keeping baby fed. "I'm here when you're ready, bubba. Here's my breasts, right here, whenever you're ready. No stress!" Step two is to look into alternative ways to feed the baby that milk that they need while they are on their strike - know that there are so many options besides bottles, and if you do want to use a bottle, know that there are actually breastfeeding friendly ways to be offering that bottle. But, 'How to Deal with a Nursing Strike' is a whole other post, so let's just say that this is definitely a situation that needs patience, but it is a situation that can be solved! That's what we lactation consultants are here for. If you're in a situation like this, get a hold of a Lactation Consultant IBCLC as soon as you can, and have faith.

* * *So what's the take-home message?

So there you have it, three situations that I've been seeing enough times throughout this last year that it warrants a discussion. I love the Haakaa! I think it is a brilliant tool for breastfeeding, but it is not a one-size-fits-all device that works for everyone in the same way. We need to stop viewing it as something that gives a zero-effort freezer stash with no repercussions. Yes, I still recommend them to many mums in certain situations, but I don't just tell them to whack it on and enjoy - there's more to it than that.

*For tips on when I think you CAN use the Haakaa well, see my next post!*
(Thanks to Angela and Ruth in my online group for sharing their pics and allowing me to use them here!)

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How NOT to use a Haakaa - Milk and Motherhood

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So you've probably heard about this thing called a Haakaa. You might even have one! Maybe you used it and loved it and spread the word to all of your new mama friends! And yep, indeed, it was pretty revolutionary when it was first released: A one-piece, soft flexible device that you just stick onto [...]

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Antenatal Expression of Colostrum - La Leche League GB

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Mothers start to produce colostrum (early milk) while pregnant. Being able to express colostrum is a useful skill to have. Saving your expressed colostrum may also be beneficial if your baby is likely to need special care after birth. Why express while pregnant? Being familiar with your breasts and…

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Brilliant video showing baby-led weaning in action

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Brilliant video showing baby-led weaning in action

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Paced Bottle Feeding For The Breastfed Baby

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Blog posts from Prof Amy Brown, professor of maternal and child public health (Breastfeeding researcher)

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

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

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

Minimizing early engorgement

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

Try these suggestions

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

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

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

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

Treat engorgement to...

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

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

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

When to treat

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

Engorgement after the first weeks

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

Common causes of engorgement are:

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

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

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

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

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

Treating engorgement
Reduce swelling and keep milk flowing:

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

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

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

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

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

Be sure your baby is sucking effectively:

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

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

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

Reverse pressure softening

works by moving fluid away from the nipple area.

Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola.

You can also press with the sides of fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby's lips will be.

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

Keep comfortable:

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

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

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

Watch out for symptoms of mastitis:

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

Temperature over 38.4ºC or flu-like symptoms.

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

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

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

Further Reading

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

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

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

Copyright LLLGB 2016

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Engorged Breasts - avoiding and treating - La Leche League GB

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

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This page gives you some tips on how to hand express and store your breastmilk. It also answers some frequently asked questions on this topic.

You might be thinking of returning to work, or study, or planning a night out. It can also help relieve pressure from a blocked duct or mastitis. Expressing small amounts of colostrum before your baby is born can help give your baby extra milk in the first few days.

Please also refer to our downloadable leaflet on Expressing and Storing Breastmilk.

If you will be exclusively expressing (feeding only expressed breastmilk), whether for just a few days or longer, you might like to read our blog post on this.

Note: If your baby has been ill or was born prematurely please discuss this information with your health professional to check that the storage times apply. This is especially important if you are bringing your colostrum or milk into hospital for your baby.

Your breastmilk

Can be expressed by hand, by hand pump or by electric pump. Once you know how, hand expressing is easy and needs little equipment.

Contains anti-infective ingredients that limit the growth of unwanted bacteria.

Should still be handled and stored carefully to stop unwanted bacteria from getting into your milk and growing.

Stays at the highest quality when stored in a fridge, particularly when running at 4°C or below. Note: some fridges run higher at 5-10°C - if you don't know the temperature of your fridge assume it is running at this higher temperature.

Can be frozen, which affects some (but by no means all) of the nutrients and anti-infective ingredients of breastmilk.

Expressing breastmilk

When you first start to express it is common to get only a few drops of milk. As with breastfeeding, the more you practice, the easier it gets. Expressing at a different time of day may work better for you.

When might I need to express?

Before your baby is born - you may be advised that your baby might need extra milk when they are born. You can express and store your first milk (colostrum) from 36 to 37 weeks gestation. You can read more about this here.

In the first few days - if your baby is sleepy, or to help them attach and feed.

For both these stages your midwife will give you small oral syringes to collect your milk. These are usually 1ml to begin with.

Use the ideas in this leaflet to discover what works for you. Colostrum usually starts in tiny droplets and is often sticky - having help to collect these drops in the syringe can be useful.

Aim to express twice a day from 36-37 weeks for no more than 10 minutes, freezing the same day.

Once your baby is born, express as needed aiming to stimulate your breasts at least 8 times a day including once overnight through direct breastfeeding or expressing as this will increase your milk supply to meet your baby's needs and can help you feel more comfortable.

Hand Expressing

Once your milk is flowing, you will need a wide mouthed container like a sterile plastic pot or container that is well-cleaned and scalded with boiling water - a jug is ideal - so get this ready before you start.

Remember to wash your hands first.

Find somewhere comfortable to relax, then to help your milk to flow (let down) you might:

Relax with a warm drink, music or TV.

Have your baby close, or look at a photograph, clothing or toy to remind you of your baby.

Warm your breasts in a bath, shower or using warm flannels and practice expressing.

Try some ways to gently massage your whole breast, working from the outside toward your nipple.

Take care not to drag your skin:

Stroke with your fingertips

Roll using your knuckles.

Try using circular movements.

Make a 'C' shape by placing your thumb above and your fingers below your breast 2-3 centimetres back from your nipple

Gently press your thumb and fingers together, release your fingers and repeat in a rhythmic movement.

Sometimes pressing inwards back towards your chest wall as you squeeze helps. You may need to experiment with how far back from your nipple to squeeze - everyone is slightly different.

When the milk flow slows, re-position your fingers and thumb (as if moving them around a clock face), then express another area of your breast.

Try to express all areas of your breast and alternate between breasts.

See this video on hand expressing from UNICEF for more ideas.

Good hygiene is very important:

Always wash your hands before expressing and handling breastmilk and ask others giving expressed milk to do the same.

Always use a sterile container with a lid, not the collection jug, to store your breastmilk. You can buy disposable containers. Take care with plastic bags that can puncture easily.

Try to use a different storage container each time you collect milk. If necessary, newly collected milk may be cooled and added to previously stored milk on the same day only.

Label the storage containers or syringes with your name, breastmilk, time and date and put inside a clean sealed bag or box before storing. Name and date the bag too.

Store your breastmilk in the fridge or freezer as soon as possible.

Store away from meat products, eggs or any uncooked foods. Store at the back of the fridge and not in the door.

Storing expressed breastmilk

How long can I keep my breastmilk at room temperature if a fridge is not available?

If your breastmilk is freshly expressed it will keep for 6 hours without refrigeration, either at home or away from home. See 'travelling with breastmilk' section below for more details.
If your baby has been ill or was born prematurely please discuss this with your health professional to check that the same storage times apply.
How long can I store breastmilk in the fridge?

You can store your breastmilk for up to 3 days where you don't know the temperature, or it runs between 5-10°C.

Breastmilk can be stored for 5 days in a fridge running at 4°C or lower.*
*One study has shown fresh breastmilk can be used for up to 8 days when the fridge temperature is kept stable at 4°C or below.

If the fridge temperature goes above 4°C during this time, use your milk within 6 hours or throw away.

If you can't use a fridge at 4°C, try using a cool bag or box with deep frozen ice packs (changed every 24 hours). Protect your milk from direct contact with the ice packs or it may freeze - try wrapping the ice packs in kitchen towel. The bag can also be used to carry milk.

The lower the storage temperature, the longer expressed breastmilk can be stored. The storage temperatures given here include a degree of caution so that your milk remains safe for your baby.

If you wish to store your breastmilk for longer than 5 days, freeze as soon as you can after expressing.
If taking colostrum or milk into hospital follow their storage and transport times. REMEMBER: The more often the fridge door is opened, the more likely the temperature will rise. Try to check the temperature of every fridge (or cool bag) used for storing your milk each time you use it. If the fridge has no built in thermometer, use a fridge thermometer which can be bought cheaply from kitchenware stores.
How long can I store breastmilk in the freezer?

Breastmilk can be stored in a freezer at -18°C for up to six months.

You can store breastmilk in the ice compartment of a fridge for two weeks.

Safe Storage of breastmilk in the home

This table aims to provide a guide to how long you can store breastmilk for a full term baby with no additional health concerns.

Why are there variations in recommendations for storing expressed breastmilk?

More information about this can be found at the bottom of this page.

Please note that previous versions of our leaflet are still available in our shop and the information is still correct, noting the above.

Feeding baby expressed breastmilk

What happens if my baby doesn't take all of one bottle? Can I put it back in the fridge or on the side use it again?

Once the baby has drunk from a bottle of expressed milk it should be used up within an hour or thrown away. To avoid wasting your expressed breastmilk it is best to offer the baby only a little (e.g. 30ml) at a time until you know your baby's pattern. You can do this by keeping most of it in one container, in the fridge, and using it to top up the baby's bottle a little at a time.

Defrosting frozen breastmilk

How do I defrost my milk?

Ideally, defrost frozen breastmilk in the fridge. This milk should be used once fully defrosted which usually takes about 12 hours. If your breastmilk is still frozen after this time or you need to use it quickly, try defrosting under cool, then warm, running water. Dry the outside of the container with kitchen paper before use and use immediately. If you frequently find your milk is frozen after 12 hours in the fridge, try to freeze in smaller quantities.

How long can I keep defrosted breastmilk?

Defrosted breastmilk should be used straight away once it has fully defrosted. Throw away any unused milk.

Why can't I defrost breastmilk in a microwave?

Breastmilk should not be defrosted in the microwave because it heats unevenly, destroying antibodies and nutrients. There is also a risk of scalds and the milk would need to be left at room temperature before use.

Travelling with expressed breastmilk

How do I bring my milk home, which I have expressed at work or elsewhere?

Try to use a cool bag for transportation and put the milk in the fridge once you are home.

Fresh breastmilk can be transported within 24 hours provided storage temperatures are maintained using an insulated box or bag and deep frozen ice-packs, and total storage and transportation times do not exceed the recommended storage times.

Previously refrigerated breastmilk can be kept cool (10°C or below) for up to 24 hours when in a well-insulated bag with deep-frozen ice-packs. Take care not to freeze your milk by wrapping the ice-packs in kitchen paper first. Ensure this milk is used within the recommended refrigeration storage times as mentioned above.

Re-heating expressed breastmilk

How do I re-heat expressed breastmilk?

Expressed breastmilk can be used straight from the fridge. It does not need to be warmed. If you would like it warmed place the container (such as a bottle or sealed cup) in warm water to take the chill off. Take care not to over warm.

If the milk smells sour DO NOT USE.

When stored, the cream and milk may separate out. This is normal. Shake gently to mix before use.

Some babies are reluctant to take milk from a bottle, particularly at first. Try offering milk from a cup or spoon. They may be less reluctant when someone else gives it. If expressed milk is refused try not to worry - your baby will make up any missed feeds by breastfeeding more often or for longer on your return. See also info on this page about introducing a bottle.

Finding a breast pump

The two UK breast pump hire companies are:
Ardo breast pumps Medela breast pumps
Your midwife, health visitor or a local breastfeeding supporter may also be able to give you details of pump hire services near you.

Useful links
Human Milk Foundation
UKAMB (UK Milk Banks - find out about donating or receiving milk)
Milk Bank Scotland
Antenatal Expressing - more detailed information about this

References

(links checked May 2023)

Cook, P. Food Standards Agency. MCN10. 2006 Handling and storage of expressed breastmilk pp1-12 https://www.nice.org.uk/guidance/ph11/documents/mcn-consultation-expert-report-handling-and-storage-of-expressed-breast-milk2

Eglash, A, Simon, L, and The Academy of Breastfeeding Medicine, ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants, BREASTFEEDING MEDICINE Volume 12, Number 7, 2017 (c) Mary Ann Liebert, Inc. pp390-395 https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/8-human-milk-storage-protocol-english.pdf See correction to freezer temp here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065517/

Forster, Della A et al. (2017) Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. The Lancet, Volume 389, Issue 10085, 2204 - 2213 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31373-9/ppt

Hands A. (2003) Safe storage of expressed breastmilk in the home. MIDIRS Midwifery Digest, vol 13, no 3.

Royle, J. Weaver, G. (2016) Guidelines for the Preparation and Handling of Expressed and Donor Breast Milk and Special Feeds for Infants and Children in Neonatal and Paediatric Health Care Settings. 2nd Ed. Section 6, p18-32
BDA Guidelines for the Preparation and Handling of Expressed and Donor Breast Milk and Specialist Feeds for Infants and Children in Neonatal and Paediatric Health Care Settings
IMPORTANT: If you have any further questions on expressing or breastfeeding, do contact your midwife, health visitor or breastfeeding supporter for help and support. You can also call the National Breastfeeding Helpline on 0300 100 0212, open 9.30am-9.30pm every day of the year.

Page reviewed and updated November 2019

Variations in Recommendations for Storing Expressed Breast Milk

Written by Anabel Hands

In 2003, aware of the confusion for mothers resulting from the significant variations in recommendations for storing expressed breast milk, the BfN decided to collate all available information from primary research papers, and national and local guidance documents. These findings were published in the MIDIRS Midwifery Digest 1. The study found that storage temperature clearly determines storage time. Recommended storage times given in our Expressing and Storing Breast Milk leaflet were based on the primary research papers discussed in the study. You can find the link to this leaflet below for more information 2.

Our publication was sent to other breastfeeding organisations, including the Department of Health (DH), to facilitate agreement on storage recommendations using the results of primary research. The DH asked the National Institute of Clinical Excellence (NICE) to review breast milk storage guidelines, and official storage recommendations were changed from 24 hours in the fridge to up to 5 days at 4°C or lower, two weeks in the ice compartment of a fridge and up to six months in a freezer (March 2008) 3.NICE also recognised that refrigeration preserves the unique properties of breast milk more effectively than freezing. The National Health Service (NHS) adopted these guidelines, which appear in their leaflet Off to the best start (updated November 2009) which you can find a link to below 4.

Although a little different to BfN guidelines, the NICE and NHS recommendations took into account that fridge temperatures can vary and that a 5-day storage time covered most situations, including the need for milk expressed at the end of one working week to be used at the beginning of the following week. Some busy hospital neonatal units restrict the time milk is refrigerated as an added precaution; this is because their fridges are opened very frequently, which may affect the storage temperatures 5.

Other breastfeeding organisations, such as La Leche League, updated their published recommendations to distinguish between acceptable storage (8 days in the fridge) from ideal storage (72 hours in the fridge), and also recognised that refrigerated expressed breast milk was preferable to frozen breast milk (March 2012) see link below for more information. These recommendations are in line with the BfN leaflet 6.

It is important for mothers and breastfeeding supporters to note that leaflets and recommendations inconsistent with the published research are still in circulation, particularly on the Internet, and that countries outside of the UK may recommend different guidelines.

Please note that previous versions of our leaflet are still available in our shop and the information is still correct, noting the above.

References

1. HANDS A. Safe storage of expressed breast milk in the home. MIDIRS Midwifery Digest, vol 13, no 3, Sep 2003, pp 378 & 385.

2. BfN (Breastfeeding Network) leaflet. Expressing and storing breast milk. September 2004.

3. National Institute for Health and Clinical Excellence (NICE) Public health guidance 11: Maternal and child nutrition. March 2008.

4. Department of Health. Off to the best start. Crown Copyright 2007 278957 5p 200k Nov 09 (BEL) 299223.

5. MCN consultation: Expert report & Handling and storage of expressed breast milk. 05 April 2007.

6. La Leche League International. "The Breastfeeding Answer Book" Updated March 2012.

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Expressing and storing breastmilk - The Breastfeeding Network

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This page gives you some tips on how to hand express and store your breastmilk. It also answers some frequently asked questions on this topic. You might be thinking of returning to work, or study, or planning a night out. It can also help relieve pressure from a blocked duct or mastitis.

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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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Debunking the myths about low supply

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Forgive me for asking but...

Do you REALLY have low milk supply?

This is a very important place to start. Please bear with me. I don't mean to doubt your situation and be annoying patronising lactation consultant woman but it's crucial to note that the MAJORITY of new mothers who fear they have low milk supply DO NOT.

The majority of women who start to use formula because they worry they aren't making enough or baby isn't getting enough DO NOT HAVE A PROBLEM.

I cannot emphasise this enough.

Every day mothers panic and end breastfeeding or start using formula and there is not an underlying problem with their milk supply. But of course - once they start using formula without correct support, they often will start to send signals to their breasts to really reduce supply.

· You do not have low milk supply just because your baby won't go the X number of hours between feeds that the book on your coffee table tells you they should. Or your mother-in-law. Or the X number of hours your friend's baby is going between feeds.

A normal happy healthy baby who has a gorgeous mummy with a normal healthy milk supply might get hungry an hour after the last feed, or 90 minutes, or 45 minutes or two hours. They might be cluster feeding and hardly want to come off the breast at all. They might be having a growth spurt and feed every hour for a day.

· You do not have low milk supply because your breasts have stopped leaking. Some mothers leak less than others. MOST mothers notice that leaking reduces at the weeks go by and the teeny tiny sphincter muscles responsible tighten.

· You do not have low milk supply because your breasts feel softer than they used to. The excessive fullness we experience in the early days of breastfeeding is about vascular engorgement (blood and lymph) and it's about the body inefficiently storing unnecessary amounts of milk between feeds. As time goes by, the breasts get cleverer at storage (don't forget milk is also made while a baby is actually feeding). There is also less blood and lymph needed in the breasts as breast tissue growth slows down. At the beginning, it's often very obvious which breast is going to be fed from next. That feeling goes. And many mothers mistakenly connect it with a reduction in milk supply. We are not all supposed to continue feeling heavy and full throughout our breastfeeding experience. Don't ever think 'I'll wait to let my breasts fill up!' Noooooo. This shows a misunderstanding of how lactation works to a spectacular degree. When breasts are fuller, milk production slows down. When breasts are emptier, milk production increases. Emptier softer breasts may well be making a heap more milk in a 24 hour period than the engorged full versions.

· You do not have low milk supply because your baby feeds for a short time. Plenty of babies get everything they need in under ten minutes. Probably not five - but sometimes a feed might even be five minutes long. Lots of babies use their tongue and jaw muscles super efficiently and gulp and glug and slow down as the milk gets fattier and thicker and then come off happy. It might take them nine minutes or nineteen. A baby might start off life needing 30 minutes to drain a breast (when we say 'drain', breasts are never completely empty, it just means the baby has taken out all the milk they usefully want to). As a baby gets older, this can dramatically reduce. It doesn't mean less milk is going in. If a small sleepy jaundiced baby falls asleep very quickly at the breast without some solid minutes of good swallowing, that's a different story. Overall however, a longer feed does not always mean a better one.

· You do not have low milk supply because you have small breasts. Large breasts are a combination of fatty tissue and glandular tissue. You cannot tell much about someone's milk production by the size of the breasts. If you are really worried your breasts don't 'look right', we'll come back to this later.

· You do not have low milk supply just because your baby wakes up a lot. Plenty of young babies feed with similar intervals day and night. Plenty continue waking every 2-3 hours for a while.

· You do not have low milk supply because your baby won't 'go down' after a feed. So you feed your baby and they drop off to sleep on the breast. You move them to the Moses basket and they wake up as if you just placed them on a sheet of molten lead. And they seem to be rooting again. This happens because being next to you skin-to-skin was nice and cosy and relaxing and warm and it smelt good. The Moses basket is cold and NOT YOU. You probably triggered the Moro startle reflex when you moved them. You probably moved them about 15-30 minutes after a feed when the hormone cholecystokinin had dropped in their blood stream causing them to be more wakeful. Your teeny primate mammal baby finds the breast a lovely place to be. They like to suck to relax themselves. Babies like second helpings. This does not mean you are not making enough milk.

· You do not have low milk supply because your baby will take milk out of a bottle after a feed. Put a teat against a young baby's palate and you trigger that baby's sucking reflex. Babies will usually continue to take milk beyond the point that they need it. This is one of the reasons we see links between bottlefeeding and obesity.

You do not have low milk supply you cannot feel your 'letdown' reflex (milk ejection reflex). Some women feel an electrical tingle at the point the milk lets down. Some don't. Crucially some feel it for the first few weeks and then it fades. This fading sometimes worries people. It does not mean anything has changed with your milk supply and it is perfectly normal for the sensation to go.

· You do not have low milk supply because you don't pump very much milk. Pumping and breastfeeding are surprisingly unrelated. Your baby removes milk in a completely different way. Plenty of women with healthy milk supplies fail to pump much at all. Their bodies can't be tricked into eliciting the milk ejection reflex (or 'letdown'). Plus pumps don't always work. Suction goes as valves get old.

These are the things that REALLY tell you a mother might have low milk supply:

· Weight gain problems. A newborn is born and then loses weight. They regain birth weight at around two weeks. They then put on about 150-200g a week after that. That slows down after around four months. If your newborn loses more than 10% of their body weight, we might pay attention but we'll also want to look at things like your birth. Did you have a drip in labour that filled you and your baby with fluid? Did your gorgeous newborn look a wee bit like the Stay Puft marshmallow man in their first photos? That fluid elevated the birth weight and as it comes out again in the first few days, we might see more of a weight drop. That doesn't necessarily mean feeding or supply is a problem. However we wouldn't want your baby to lose weight after about day five or lose weight a second time. It might take some babies three weeks to get back up to birth weight.

Have a look at the chart in your red book. Notice how we have birth weight line and then a space where the curvy lines don't go and they start again at week two. Just because your baby was born on the 75th percentile, that doesn't mean we would expect them to definitely re-start on the 75th after that two week gap. That's why the lines don't continue. That's why we have that space. We start again at two weeks. Your baby might be on the 50th then. They then ideally will roughly stick in the same vicinity. But babies wobble around a bit. They might dip below. They might get close to the 25th. And then they might bob back up again. We don't expect all babies to hug a line exactly. This chart is a guide. It's about averages. It's not about mathematical certainties.

· Nappies. In the early days (first four weeks), we look at poo and pee. After your milk has come in (around day two to five), we'd expect to see six wet nappies in 24 hours and three poos the size of a £2 coin or bigger. After week four, some babies' poo rate can slow right down. This doesn't mean anything is wrong. Some babies can skip several days between poos and this isn't anything to do with milk transfer or supply. However if someone tells you it's OK for a ten day old baby not to poo for a few days, don't believe them. We'd need to investigate that situation. Only later on do we relax.

Weight gain and nappies. That's it. Those are the only things that tell us about milk supply. You may hear people say that 'babies should be settled after a feed' but some babies get wind or need to poo or have reflux or wake up and want second helpings. Let's be careful about even saying that. Let's look at weight gain and nappies.

So let's now assume you do have low milk supply. How many of you are still with me? I'm sorry if you are. I'm sorry if your baby only put on 60g last week and 90g or less or nothing the week before that and they are slipping down the percentiles. I'm sorry because I know how scary that can feel. Nothing feels like it matters more. There are things we can do.

1. Find people.

Find people who know about breastfeeding. Someone who tells you just to use formula in this situation is not who you need. If that's all they can offer you, they don't know about breastfeeding and you need someone else. You need someone who understands how lactation works. These people may actually still tell you to use some formula in some situations (or donor breastmilk) but they will do so alongside telling you how to protect and develop your milk supply. You also need people close to you to look after you. If you are going to do all the other stuff on this list, you need to have people who love you who will cook your dinner and run you a bath sometimes. And text you just before the weigh-in clinic next week to say they are thinking of you.
2. Breastfeeding M.O.T.
Someone like a breastfeeding counsellor or IBCLC (lactation consultant) should check your latch. You might not be sore and your nipples might not be misshapen after a feed but something still might be going wrong. Your latch needs checking. Is baby's chin deep into the breast? Is baby's body close to yours? Is baby's ear/ shoulder/ hip in a line?

They shouldn't just check your latch but look at your breastfeeding management. Are you feeding enough? Maybe your baby doesn't show cues very strongly and someone told you to wait for them and you're sometimes going four hours between feeds? Maybe you need to feed more frequently?

They may also need to take a closer look at your baby. Is there a reason why baby may not be transferring milk effectively? Is this someone who can look at baby's tongue, jaw and palate? Are they familiar with the term 'tongue tie' and especially 'posterior tongue tie'? Would they know what to do if there was one? That might mean suggesting an exaggerated latch or different positions or it might mean referring you to a tongue tie specialist.

When are you changing sides? Too quickly? (and baby is missing the fatty milk). OR did someone tell you to stick on one side forever to get that 'hind milk' and the baby is on 45 minutes without doing a heck of a lot? Maybe you need to change sides at 20-30 minutes instead and get baby a greater volume of milk overall and fatty milk overall. Both of these habits can cause weight gain problems. Get someone to help you recognise what swallowing looks like so you'll know when to change sides and when good feeding has finished.

3. Google ' breast compressions'. You'll get to a video and handout from Dr Jack Newman. You can finish a feed with breast compressions and get an extra dose of fatty milk into baby.

4. You have 3 sides and 4 sides. This is ' switch nursing'. Try and go back to the first side. There will be milk there. The more breastfeeding you do, the more milk you will make. The second time you return to that breast, the milk will be fattier and richer and you'll send great signals to your body to make more.

5. Find time.

If you are going to build up your supply, get help. You can't devote time to switch nursing and skin-to-skin when you have to go to Tesco to buy milk and pick up another child from school. If this is 'Operation Milk supply', who can help you? You'll read people talking about a 'babymoon'. Go to bed, they say. Just you and the baby. Feed lots. If that sounds appealing, go for it. Personally my babymoon would involve the sofa and box sets and crisps. However there's no point in babymoooning until next Christmas if your latch and breastfeeding management are the issues. Get that checked first.

6. Using a pump.

Baby feeding effectively is first choice but pumps can be useful. You can pump on an emptier breast to send even more signals to your milk supply. But we're not going to take a baby off the breast do be able to pump.

You don't need to wash and sterilize a pump every time you use it. Pop it in a plastic bag and put it back into the fridge between pumping sessions. 10 minutes is ample. If you are pumping for 30 minutes and 'nothing is coming' out, you are not getting a letdown and you are not doing yourself any favours. Use hand expression before and after (google 'Marmet hand expression') and prepare the breasts with warm compresses and massage if you can. You can take an hour and do some 'cluster pumping' or 'power pumping'. Pretend to be a baby having a cluster feed. Pump for ten minutes. Break for five. Pump again and repeat.

Just check your pump is the best one available. If it's second hand or you have had it a while, it might need servicing or replacement parts. You also might want to consider hiring a hospital grade double electric pump from someone like www.ardobreastpumps.co.uk to give yourself the opportunity to pump both sides together as effectively as possible.

Pumping shouldn't hurt. Make sure your flanges are the right size - that means they are the right diameter for the size of your nipple. Don't think that cranking up the suction will automatically do better things. And don't think, "I don't want to pump because I will empty my breasts and baby will have less milk." Certainly they might be less appreciative if you pump just before a feed is due and you leave them with an emptier breast full of thicker fattier milk but pumping overall will increase milk supply and stimulate milk production. You are not 'taking their milk away'.

You might also be someone who always gets better results with just using hand expression so stick with that.

Of course, you might not want to pump at all and just focus on feeding baby more effectively and frequently.

7. Galactagogues.

Taking herbs and medication that increase milk supply. Not right for everyone but some women really feel they helped. You need to read about side effects and dosage on sites like kellymom.com. Fenugreek, blessed thistle and goat's rue are popular. Some doctors prescribe domperidone in certain situations. These are never a substitute for good breast emptying and a breastfeeding MOT.

8. The science part.

In a book, this bit would be under a little flap as we're only talking to a small group of people.

Did you have breast surgery?

Are your breasts very widely-spaced or asymmetrical, or very tubular with a bulging areola? Did they not really change much in pregnancy (or puberty)?

Do you have PCOS? Some women with PCOS (not all) have a reduced milk supply.

These are times when it's worth finding an IBCLC and getting technical.

Some doctors will do hormonal testing for you. There are medications that can help develop breast tissue especially in pregnancy.

What about your thyroid levels? This is something relevant for more people than you might realise. If you are trying everything and low milk supply continues to be a problem, ask your doctor to check your thyroid levels. There are sometimes medical reasons mothers have a low milk supply and doctors and lactation consultants may be able to help you. These are not the most common reasons why people have low milk supply by a long shot. Hence the need for the flap.

Most people who genuinely have low milk supply got themselves into a pickle with using artificial nipples or not breastfeeding enough or breastfeeding ineffectively. And it can almost always be reversed.

Also remember that just because you had low milk supply in your first breastfeeding experience, it doesn't mean a subsequent lactation will also be a struggle. The development of all that breast tissue first time round often helps.

Hold in your mind the fact that women can relactate after not breastfeeding at all for several weeks. We CAN send signals to increase supply again in the vast majority of cases. There are tons of us in real life and online who want to support you.

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Forgive me for asking but... Do you REALLY have low milk supply? This is a very important place to start. Please bear with me. I don't mean to doubt your situation and be annoying patronising lactation consultant woman but it's crucial to note that the MAJORITY of new mothers who fear they have low milk supply DO NOT.

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This video guides mothers through 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? Try viewing here or Please contact us

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Hand expression video - Baby Friendly Initiative

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See the Breastfeeding Network website for FAQs and a leaflet all about expressing and storing breastmilk. Problems viewing this video? Try viewing here or Please contact us

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Simple, animated video about how lactation works.

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Simple, animated video about how lactation works.

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

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The Mush Stops Here

Baby Led Weaning, quite simply, means letting your child feed themselves from the very start of weaning. The term was originally coined by Gill Rapley, a former health visitor and midwife.

According to the most recent research most babies reach for food at around six months, which is also the time that mothers are being encouraged to wean* by their Health Visitors, in accordance with the WHO guidelines.

The distinct advantage of weaning at around six months is that by then, our children are developmentally capable of feeding themselves proper food, in other words - no more mush!

You just hand them the food in a suitably-sized piece and if they like it they eat it and if they don't they won't. (But they do, really they do... check out the baby with the pork chop).

That's the essence of Baby Led Weaning. No purees, no ice cube trays, no food processor, no potato masher, no baby rice, no weird fruit and veg combos... just you and your child, eating food that you enjoy with you and your family.

Please browse the site, or come and join us on the very welcoming Baby Led Weaning Forum

* re 'wean'. This is meant in the Brit sense, not the American. In the UK, 'weaning' means 'adding complementary foods', whereas in the States it means 'giving up breastfeeding'. Two nations divided by a common language, and all that. In fact, there is even a helpful hands-across-the-ocean translation thread on the subject on the forum, which solves the mystery of what the UK equivalent of the Graham's Cracker might be. (While we're on the subject of terminology... if it was up to me, I'd have called this whole thing Baby Self-Feeding, but that ship has sailed, my friends, and Baby-Led Weaning it is.)

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Baby Led Weaning, quite simply, means letting your child feed themselves from the very start of weaning. The term was originally coined by Gill Rapley, a former health visitor and midwife. According to the most recent research most babies reach for food at around six months, which is also the time that mothers are being encouraged to wean* by their Health Visitors, in accordance with the WHO guidelines.

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What Are the Symptoms of Food Allergy in Babies and Children?
Symptoms of an immediate food allergy:
Mild to moderate symptoms typically affect the skin, the respiratory system and the gut.

A flushed face, hives, a red and itchy rash around the mouth, tongue or eyes. This can spread across the entire body.

Mild swelling, particularly of the lips, eyes and face.

A runny or blocked nose, sneezing and watering eyes.

Nausea and vomiting, tummy cramps and diarrhoea.

A scratchy or itchy mouth and throat.

Severe symptoms (anaphylaxis). These require urgent medical attention.

Wheezing or chest tightness, similar to a severe asthma attack.

Swelling of the tongue and throat, restricting the airways. This can cause noisy breathing (especially on breathing in), a cough or a change in voice

A sudden drop in blood pressure (called hypotension) leading to shock.

Dizziness, confusion, collapse, loss of consciousness and sometimes coma.

Symptoms of delayed food allergy:

Eczema (information on Eczema can be found here)

Reflux - an effortless vomiting

Poor growth

Swelling in the small bowel

Constipation and/or diarrhoea

Raising knees to chest with tummy pain

Frequent distress and crying

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Symptoms of an immediate food allergy: Mild to moderate symptoms typically affect the skin, the respiratory system and the gut. A flushed face, hives, a red and itchy rash around the mouth, tongue or eyes. This can spread across the entire body. Mild swelling, particularly of the lips, eyes and face.

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It seems that all the the information I see regarding toddler nutrition assumes that your toddler is no longer breastfeeding and is eating mainly solids. As a result, many moms of breastfeeding toddlers (particularly those who are eating few solids) have lots of questions about how to adapt this information to their particular child.

Introduction

Your child can continue breastfeeding just as often during the second year, but offer solid foods a few times a day. After 12 months, you can begin offering the solids BEFORE baby nurses, if you wish, instead of after. Your milk is still an important part of baby's diet and will offer him many benefits (nutritionally, immunilogically and emotionally). There is not any particular "recommended number of times per day" that a toddler should be nursing. Some are only nursing once or twice a day, while others continue to enjoy lots of time at their mother's breast. As baby slowly moves into eating more solids, your milk will fill any nutritional gaps nicely. Once you do start to breastfeed less often, remember that you must make a greater effort to ensure that your child eats several meals of nutritious food each day.

Cow's milk?

Many nursing moms are told that they must introduce cow's milk at a year. Your nursing toddler is already getting the best milk he can get - mother's milk! Breastmilk has a higher fat content than whole cow's milk (needed for baby's brain growth), and all the nutrients of human milk are significantly more bioavailable than those of cow's milk because it is species specific (not to mention all the components of mother's milk that are not present in cow's milk).

There is no need to add cow's milk to your toddler's diet (or the equivalent nutrients from other milks or foods) as long as your baby is nursing at least 3-4 times per day. Cow's milk is really just a convenient source of calcium, protein, fats, vitamin D, etc. - it's not required. There are many people in many parts of the world who do not drink milk and still manage to get all the calcium, protein, fats, vitamin D, etc. that they need.

Good non-dairy sources of protein include meats, fish, peas & beans (chick peas, lentils, baked beans, etc.), tofu and other soy products, boiled eggs, peanut and other nut butters (if your child is not allergic).

Good non-dairy sources of fats include soy and safflower oils, flax seed and flax seed oil, walnuts, fish and fish oils, avocado. Adding fats to cooking and baking can work well, for example, stir fry in safflower oil or make mini-muffins with soy or rice milk, oil or butter, and eggs.

Calcium may be derived from many nondairy sources.

Vitamin D can be supplied by sunlight exposure and food sources.

If your child is not nursing regularly and is not allergic to cow's milk products, but simply doesn't like cow's milk, you can incorporate milk into your child's diet in other ways. Many children like cheese, whole-fat yogurt or ice cream. You can also put milk into various food products: pancakes, waffles, muffins, French toast, scrambled eggs, mashed potatoes, and baked goods.

Some moms wish to offer cow's milk to their toddler, but baby doesn't like it. Over the age of 12 months, milk becomes a more minor part of a child's diet. It is sometimes helpful to mix increasing amounts of cow's milk with your expressed milk to help baby get used to the taste. Many dietitians see nothing wrong with adding some flavor (such as strawberry or chocolate) to cow's milk.

Pediatricians now recommend that any cow's milk be whole milk from a cup after the first year and until the child is at least 2 years of age. This ensures that your child receives enough fat, which is essential to proper brain development. After the age of two, if growth is good, you can switch to low-fat or nonfat milk. Note: If your child is nursing, then remember that mom's milk is "whole" milk - the more breastmilk your child gets, the less need to worry about your child getting additional fat from whole milk or other sources.

It's best to limit the amount of cow's milk that your child receives to 2-3 cups (16-24 ounces) per day, since too much cow's milk in a child's diet can put him at risk for iron-deficiency anemia (because cow's milk can interfere with the absorption of iron) and may decrease the child's desire for other foods.

How much should my toddler be eating?

Between ages one and five, a child's growth is in a decelerated stage; that is, they have slowed down in growth. Since growth slows down, their need for calories subsequently decreases, which in turn leads to a smaller quantity of food ingested per day. Added to the decelerated growth is a burgeoning independence which limits the variety of foods your child is willing to eat ("finicky eater"). Rest assured that toddlers do not need as much food as you might expect because of this slowing down of the growth rate. Three small meals and two snacks a day (and some will eat a good bit less) will probably be enough to fuel even the most active toddler. Please realize, too, that finicky eaters are the rule rather than the exception.

Some toddlers are eating very few solids, or even no solids, at 12 months. This is not unusual and really depends on your child - there is quite a big variation. We like to see breastmilk making up the majority (around 75%) of baby's diet at 12 months. Some babies will be taking more solids by 12 months, but others will still be exclusively or almost-exclusively breastfed at this point. It is normal for baby to keep breastmilk as the primary part of his diet up until 18 months or even longer. An example of a nice gradual increase in solids would be 25% solids at 12 months, 50% solids at 18 months, and 80% solids at 24 months.

Some children take a little longer to begin taking solids well. Some of them have food sensitivities and this may be their body's way of protecting them until their digestive system can handle more. Others are late teethers or have a lot of difficulty with teething pain. At this point there is NOTHING that your milk lacks that your child needs, with the possible exception of enough iron. As long as his iron levels are within acceptable levels and when he does eat you are offering him foods naturally rich in iron, then you have plenty of time before you need to worry about the amount of solids he's getting.

All you need to do is to continue to offer foods. Don't worry if he's not interested or takes very small amounts. Your only true responsibility is what you offer, when you offer it and how you offer it, not whether or not he eats it. That has to be up to him. Trying to force, coax, or cajole your child into eating is never recommended. Continue to nurse on demand, day and night, and trust your child to increase the solids when he's ready. As baby slowly moves into eating more solids, your milk will fill any nutritional gaps nicely.

Average toddler growth

see Average Toddler Growth

Feeding suggestions for toddlers

Finger foods are always great for toddlers, and your toddler will also begin to learn how to feed himself with a spoon and fork. Many babies prefer to eat foods which they can pick up and feed themselves, rather than foods that must be spooned to them. A lot of babies would rather have food right off the table than the blander-tasting baby foods.

After the age of twelve months, continue to be on the lookout for any allergic reactions to new foods and keep in mind that the choking hazard is still very real. Supervise your toddler's meals in case of choking, and continue to avoid foods such as popcorn, hard candies, hot dogs, jelly beans, chunks of carrots, grapes, raisins, and nuts. Cut or finely chop such foods, or simply wait until your baby gets older.

Toddlers should be offered a variety of foods. They can eat the same things as the rest of the family. Foods rich in protein, calcium, and iron, along with fruits and vegetables, breads, etc. should be made available on a routine basis. Serve the most healthful foods possible, but don't expect your toddler to eat a big meal at each sitting. Most children, when offered nutritious meals and snacks and allowed to eat what they wish, will meet their nutritional requirements over several days or even a week. Don't let your child fill up on empty-calorie snacks, but don't force him to eat when he doesn't want to.

Many toddlers eat better when they have food available throughout the day, rather than just at a few set times (see grazing). Simply offer your toddler nutrient-dense snacks throughout the day (cut-up vegetables, bite-sized pieces of fruit, hard-boiled-egg slices, yogurt, whole wheat breads and cereals, cheeses) and let him eat what he wants. Some parents have had good luck with Dr. William Sears' suggestion of a "nibble tray," where you fill a tray (like an ice cube tray, muffin tin, etc.) with several types of healthy foods and leave it out for your toddler to nibble on throughout the day.

Check out the current USDA daily food guide for preschoolers (ages 2-6).

Additional information

Feeding the Picky Eater by William Sears, MD

Is your child getting enough to eat? How to tell by William Sears, MD

Calorie Boosters for Kids by Kelly Vieira, MS, RD

Daily Food Guide for Preschoolers from the US Department of Agriculture

Dietary Reference Intakes (DRI) and Recommended Dietary Allowances (RDA) from the USDA Food & Nutrition Center

Latham MC. Human nutrition in the developing world, (FAO Food and Nutrition Series No. 29). Rome: Food and Agriculture Organization of the United Nations, 1997.

Dairy

Calcium and nursing toddlers by William Sears, MD

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Nutrition for Breastfeeding Toddlers * KellyMom.com

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It seems that all the the information I see regarding toddler nutrition assumes that your toddler is no longer breastfeeding and is eating mainly solids. As a result, many moms of breastfeeding toddlers (particularly those who are eating few solids) have lots of questions about how to adapt this information to their particular child.

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A food allergy is when the body's immune system reacts unusually to specific foods. Allergic reactions are often mild, but they can sometimes be very serious.

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Foods to avoid giving your baby - NHS.UK

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Which foods babies and toddlers should avoid, including salt, sugar, nuts, low-fat foods and saturated fat.

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Guide to weaning from First Steps Nutrition

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Guide to weaning from First Steps Nutrition

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Read more for support for parents on tongue-tie

Many babies have a piece of membrane under their tongue (the frenulum) which does not usually cause problems. Tongue-tie (ankyloglossia) occurs when the frenulum is abnormally short, stopping the tip of the tongue from protruding beyond the lower gum. This may cause problems with feeding as a result of the inability to move the tongue in a normal way and therefore attach and suck effectively. The frenulum may reach the tip of the tongue and be easily seen, and may be either thin and stretchy or thicker/tighter. A posterior frenulum, which is at the back of the tongue, can be less easy to see and in some cases may only be felt. If you and/or your baby are experiencing feeding difficulties, an assessment of your baby's tongue function and a feeding assessment by a specially trained professional will determine whether a division of the membrane ( frenulotomy) could help.

Many tongue-ties are asymptomatic and do not require treatment, and some may resolve spontaneously over time. In some instances, support to improve attachment is all that is needed. However, if the condition is causing problems with feeding, surgical division of the lingual frenulum can be recommended and carried out as early as possible. This may enable the mother to continue breastfeeding rather than having to switch to artificial feeding.
NICE has approved the division of tongue-tie.

FIND OUT MORE

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Information for parents and health professionals on identifying and managing tongue tie, and other useful resources on the condition.

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Check out stylish,
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By Kelly Bonyata, IBCLC, Becky Flora, IBCLC and Paula Yount

Breastfeeding is not an all-or-nothing process. Night weaning is a workable alternative for many moms, and baby continues to receive the many nutritional and immunilogical benefits of breastmilk.

Remember that sleeping through the night is a developmental milestone (like walking or toilet training) that different babies will reach at different times. At some point, your child will sleep through the night - even if you do nothing to encourage it.

If night weaning is not going well, then consider backing off and trying again a little later. The closer your child is to reaching this milestone on his own, the easier it will be for both child and parents.

Getting your baby to sleep is not a battle to be won, as it is so often portrayed in books and the media. The real goal should be for your family to get the sleep they need, while respecting the needs of the youngest family member(s).

Gentle methods for encouraging less night nursing

Following are suggestions for easing your baby into less night nursing...

Eliminate discomfort

Teething.If you suspect teething at all, it may help to give baby a pain reliever before bedtime (check with baby's doctor for suggestions). Some babies nurse more often to try to relieve gum pain. Teething pain is often worse at night.

Room temperature.Find your baby's temperature comfort level: some babies will wake if they get too hot or too cold.

Solid foods.Has baby recently started solids? Many babies (particularly those under six months) start or increase night waking after the introduction of solids, due to problems digesting the food. Try avoiding solids in the evening, or consider decreasing or eliminating the solids until baby's digestive system matures more. Several studies have shown that adding solids to a baby's diet does not help baby to sleep more at night.

Allergy.Babies with food allergies, environmental allergies or eczema may wake more at night due to discomfort.

Reflux.Discomfort from reflux may also keep baby up at night.

Illness.Illnesses like ear infections and colds can interrupt baby's sleep, and result in increased night nursing. A bad diaper rash or other rash might also affect baby's sleep. Anytime baby suddenly increases night waking, keep an eye out for illness.

Maximize baby's nursing during the day and during any night wakings

Nurse more during the day.Encourage baby to nurse more often during the day (perhaps every 2 hours instead of every 3), so that she takes in more milk during the daytime hours.

Minimize distractions.During the day, nurse in a room that is as free of distractions as possible. Turn off the light, close the door, pull the blinds, etc. Get your older children busy doing something before you start nursing. Try nursing while lying down. Sometimes babies can become so distracted during daytime feedings that they don't take in enough milk and then have to make up for it with more frequent night feedings. One study showed that older babies can consume as much as 25% of their total daily intake of mother's milk during the night, probably partly because of daytime distractibility.

Tank up before bedtime.Nurse often in the hours leading up to bedtime (at least every 1-2 hours). Some moms nurse on one breast only during this time period so that baby gets more of the higher fat milk available at the end of a feeding (this helps baby go longer between feedings). When baby wakes at night, try nursing on the other breast for all or most of the night, again so that baby gets more of the higher-fat milk.

Listen to your child.Only your child knows if she's really hungry - don't automatically assume that your child is not hungry or thirsty. Many adults wake at night for a drink of water or even to get a snack.

Maximize sleep for the entire family

Dream feed.Nurse baby right before you go to bed (even if baby has already gone to bed), so that you get a longer period of sleep before she wakes again. Many babies barely wake at this time, even though they may get a good nursing in.

Try to begin settling baby before he's overtired.Some babies have a hard time going to sleep when they're overtired, so keep an eye out for signs of sleepiness.

Try different sleep arrangements.Find out what sleeping arrangement work best for the entire family while continuing to meet baby's needs.

Full-time co-sleeping.Many babies sleep better when they are close to mom. Consider sleeping close to your baby - many families have found that baby and the rest of the family gets more sleep this way (click here for information on safety). Sleeping near your baby and nursing baby to sleep will not teach bad sleep habits. All the co-sleeping babies/toddlers who I know have begun to sleep through the night at some point without any type of training or encouragement or change in sleep location.

Part-time co-sleeping.Part-time co-sleeping works for many families, where baby sleeps in her crib until the first night waking and then joins mom and dad for the rest of the night.

Separate beds.If you're not comfortable with baby in your bed or if you are currently sleeping with baby and no one is getting any sleep, then try other options. Consider placing baby on a pallet on the floor beside the bed, or place baby's crib with the rail down beside your bed. That way, baby will be close enough that nursing won't interrupt sleep quite so much (such as when you get up each time and go to baby's room). Another option that works for some families is putting a bed for just mom and baby in baby's room for awhile, or Dad might instead choose to sleep in another location himself.

Gentle methods of night weaning for toddlers

Limit Access.After you nurse, place the baby back in her area, or slide her away from you so that close proximity doesn't encourage more frequent nursing. Wear clothing that makes it harder for baby to access your breast at night.

Get Dad in on the nighttime routine!If your baby appears to be waking only for comfort during the night, she may accept Dad as the comforter (and won't expect Dad to nurse her). Dad can comfort baby in other ways, such as offering a drink, just lying next to her, holding her, etc. Dad may even be able to sleep with baby in another room with less interruption than if baby were sleeping near mom.

Increase daytime contact.Allow baby unlimited nursing and cuddling during the day. Sometimes toddlers will seek out the breast more at night when they aren't getting enough close cuddling during the day. Sometimes we as busy mothers, especially if we have other children, forget to pick these little ones up often during the day and just sit and cuddle with them. If you can increase this close contact during the day, she may need it less at night. If you work, night nursing may be her way of trying to reconnect with you.

Talk to your child.With an older child, you may be able to explain something like this, "When the sun goes down, or when we go night-night, num nums (or whatever she calls them) go night-night, too. She probably won't accept or understand this completely at first, but if you say it before bed each night and repeat it each time she awakens, in time she'll "get it".

Just say "no"... or "later."With an older child (over 18 months), feel secure enough to say "no" (at least some of the time) while staying sensitive to your child's needs. At night, you might say, "not now, but we will later." She may - or may not - awaken again to nurse later.

Substitute other comfort measures.You also may try other things to settle her, such as a back rub, just holding and cuddling, getting her a drink of water, humming softly, etc.

Is night weaning necessary to get baby to sleep through the night?

People may tell you something to the effect of "If you nurse your child at night (or sleep near your child, or a zillion other things), you won't be able to discontinue it in the future." This sells books, but it isn't true at all!

Remember that night waking in babies and young children is temporary!

Children grow out of night waking, even when we do nothing to discourage it. This period of time will be a very tiny part of your child's years with you.

A child's internal timetable for sleeping through the night can vary greatly. Some parents are comfortable with letting the child lead when it comes to night weaning, but for others night nursing truly interferes with their quality of life. If night nursing is not working for you, then encourage changes while taking into account the needs of your child.

Your goal is to maximize sleep for everyone, and if what you're doing works, then you've met your goal. If it's not working (or stops working) then you can always do things differently. All parents find that they change the way they do things as their child grows older and reaches different developmental stages - sleep is just another thing that changes as your child grows.

Additional information

@

@ other websites

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Breastfeeding is not an all-or-nothing process. Night weaning is a workable alternative for many moms, and baby continues to receive the many nutritional and immunilogical benefits of breastmilk. Remember that sleeping through the night is a developmental milestone (like walking or toilet training) that different babies will reach at different times.

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The purpose of breast compression is to continue the flow of milk to the baby when the baby is only sucking without drinking. It is possible to know when a baby is getting milk from the breast - the pause in the chin means baby got a mouthful of milk. The longer the pause, the more milk the baby got. If baby is no longer drinking on his own or drinking is slowing down, compressions can be used to "turn sucks or nibbling into drinks", and keep baby receiving milk. Breast compressions simulate a milk ejection reflex (let-down reflex) and stimulate a milk ejection reflex. See also our blog on breast compression.

The technique may be useful for:

Poor or slow weight gain in the baby

Fussy babies. Babies who are fussy usually want more milk.

Frequent feedings and/or long feedings

Sore nipples in the breastfeeding parent

Recurrent blocked ducts and/or mastitis

Encouraging the baby who falls asleep quickly to continue drinking not just sucking

A "lazy" baby, or baby who seems to want to just "pacify". Incidentally babies are not lazy, they respond to milk flow, so that if flow slows, babies may start to fall asleep. Or if they are older, they may pull away from the breast.

Please note: Babies are not lazy. They respond to milk flow. If flow is slow, or milk does not flow at all, young babies will tend to fall asleep. Older babies may pull away from the breast when flow is slow.

Breast compression is not necessary if everything is going well. When all is going well, allow the baby to "finish" feeding on the first side and then offer the other side. How do you know the baby is finished the first side? When the baby is just sucking (rapid sucks without pause) and no longer drinking at the breast ("open mouth wide - pause - then close mouth" type of suck). Breast compressions help baby to get more milk.

Breast compression works particularly well in the first few days to help the baby get more colostrum. Babies do not need much colostrum, but they need some. A good latch and breast compression help them get it.

IT MAY BE USEFUL TO KNOW THAT:

A baby who is well latched on gets milk more easily than one who is not latched on well. A baby who is poorly latched on can get milk only when the flow of milk is rapid. Thus, many breastfeeding parents and babies do well with breastfeeding in spite of a poor latch because most breastfeeding parents produce an abundance of milk. However, the breastfeeding parent may pay a price for baby's poor latching-for example: sore nipples, a baby who is "colicky", and/or a baby who is constantly on the breast (but drinking only a small part of the time).

In the first 3-6 weeks of life, many babies tend to fall asleep at the breast when the flow of milk is slow, not necessarily when they have had enough to eat and not because they are "lazy" or want to pacify. After this age, sometimes before, they may start to pull away at the breast when the flow of milk slows down. However, some pull at the breast even when they are much younger, sometimes even in the first days and some babies fall asleep even at 3 or 4 months when the milk flow is slow.

BREAST COMPRESSION-HOW TO DO IT
(Use with the other information provided in the "Latching and Feeding Management" information sheet)
1. Hold the baby with one arm.

2. Support your breast with the other hand, encircling it by placing your thumb on one side of the breast (thumb on the upper side of the breast is easiest), your other fingers on the other, close to the chest wall.

3. Watch for the baby's drinking, ( see videos) though there is no need to be obsessive about catching every suck. The baby gets substantial amounts of milk when he is drinking with an "open mouth wide-pause-then close mouth" type of suck.

4. When the baby is nibbling at the breast and no longer drinking with the "open mouth wide-pause-then close mouth" type of suck, compress the breast to increase the external pressure of the whole breast. Do not roll your fingers along the breast toward the baby, just squeeze and hold. Not so hard that it hurts and try not to change the shape of the areola (the darker part of the breast near the baby's mouth). With the compression, the baby should start drinking again with the "open mouth wide-pause-then close mouth" type of suck. Begin breast compression when the baby is not drinking much and before the baby gets too sleepy.

5. Keep the pressure up until the baby is just sucking without drinking even with the compression, and then release the pressure. Release the pressure if baby stops sucking or if the baby goes back to sucking without drinking. Often the baby will stop sucking altogether when the pressure is released, but will start again shortly as milk starts to flow again. If the baby does not stop sucking with the release of pressure, wait a short time before compressing again.

6. The reason for releasing the pressure is to allow your hand to rest, and to allow milk to start flowing to the baby again. The baby, if he stops sucking when you release the pressure, will start sucking again when he starts to taste milk.

7. When the baby starts sucking again, he may drink ("open mouth wide-pause-then close mouth" type of suck). If not, compress again as above.

8. Continue on the first side until the baby does not drink even with the compression. You should allow the baby to stay on the side for a short time longer, as you may occasionally get another letdown reflex (milk ejection reflex) and the baby will start drinking again, on his own. If the baby no longer drinks, however, allow him to come off or take him off the breast.

9. Offer the other side and repeat the process.
12. Remember, compress as the baby sucks but does not drink. Wait for baby to initiate the sucking; it is best not to compress while baby has stopped sucking altogether. Watch our videos to see how compressions are used. The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
10. You may wish, unless you have sore nipples, to switch sides back and forth in this way several times. But, remember, improving the latch is very important to preventing and treating sore nipples. Nipple soreness is caused by a poor latch.

11. Work on improving the baby's latch.

In our experience, the above works best, but if you find a way which works better at keeping the baby drinking with an "open mouth wide-pause-then close mouth" type of suck, use whatever works best for you and your baby. As long as it does not hurt your breast to compress, and as long as the baby is "drinking" ("open mouth wide-pause-then close mouth type" of suck), breast compression is working.
Make an appointment at the Newman Breastfeeding Clinic.
You will not always need to do this. As breastfeeding improves, you will be able to let things happen naturally.

This information sheet may be copied and distributed without further permission on the condition that you credit International Breastfeeding Centre it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don't know what this means, please email us to ask!

©IBC, updated July 2009, June 2017, October 2021

Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).

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International BreastFeeding Centre | Breast compressions to increase milk flow to the baby

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The purpose of breast compression is to continue the flow of milk to the baby when the baby is only sucking without drinking. It is possible to know when a baby is getting milk from the breast - the pause in the chin means baby got a mouthful of milk.

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

your breast milk is perfectly designed for your baby

breast milk protects your baby from infections and diseases

breastfeeding provides health benefits for you

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

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

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

Health benefits of breastfeeding for your baby

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

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

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

Some studies have also found that breastfeeding for at least 6 months may reduce your baby's chance of getting childhood leukaemia. But more research is needed into this.

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

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

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

Health benefits of breastfeeding for you

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

Breastfeeding lowers your risk of:

Got a breastfeeding question?

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

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

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

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The science of human milk and breastfeeding

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By Kelly Bonyata, BS, IBCLC

The First Week

How often should baby be nursing?

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

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

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Is baby getting enough milk?

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

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

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

Breast changes

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

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

Baby is having no wet or dirty diapers

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

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

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

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

Weeks two through six

How often should baby be nursing?

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

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

The following things are normal:

Frequent and/or long feedings.

Varying nursing pattern from day to day.

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

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

Is baby getting enough milk?

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

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

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

Milk supply?

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

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

The Importance of Colostrum by Paula Yount

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

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

What is Normal? by Paula Yount

Breastfeeding as Baby Grows by Becky Flora, IBCLC

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

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

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Mammary constriction syndrome (MCS) is a new explanation for deep breast pain during breastfeeding. It was first described by Edith Kernerman IBCLC and Dr Jack Newman, a Canadian paediatrician and breastfeeding expert, of the International Breastfeeding Centre.

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Tightening of blood vessels

If there is a sudden tightening (i.e. narrowing or constriction) of blood vessels in an area of the body, it reduces blood flow and oxygen to that area. This sudden tightening of vessels is known as vasospasm. A baby breastfeeding in a shallow latch can trigger a nipple vasospasm which can cause a burning or stabbing pain in the nipple(s). And when a constriction of blood vessels happens deeper in the breast, it can cause deep stabbing or shooting pains in the chest-this collection of symptoms is known as mammary constriction syndrome.

Causes of mammary constriction syndrome

Tension in a mother's shoulders or chest can cause her pectoral muscles beneath the glandular tissue in the breast to press on the blood vessels that supply the breast and nipples. Tension may have several causes including the way a mother is sitting to breastfeed for long periods or the tensing of her shoulders in anticipation of a very painful latch. Edith Kernerman explains;

Because of difficulties the mother may have had during pregnancy, labour, or after birth, she may have tightness in her shoulders and chest that causes her pectoral (chest) muscles to press on the blood vessels that lead to her breasts and nipples, causing a lack of blood flow and oxygen, leading to pain. This pain may be throbbing or constant, deep or superficial, itchy, tingling, aching or knife-like, burning or freezing, shooting, sharp or dull, or a combination of any of the above. Also, if a latch feels painful, the mother may tighten her shoulders, clench her teeth, etc., causing the cycle triggering pain to begin again.

Edith Kernerman recommends treating mammary constriction syndrome with a technique she calls pectoral muscle massage. This involves massage of the chest muscles to help ease the tension and trying gentle pectoral muscle stretching, just before a breastfeed. She also suggests a mother with this syndrome should try to keep her back supported rather than hunching forward over her baby and avoid heavy carrying (e.g. shopping bags or heavy car seats).

Pectoral muscle massage

There is a great post online about mammary constriction syndrome on Jack Newman's Community Facebook page. He describes how most cases of breast pain-and/or nipple pain-in breastfeeding mothers are the result of a poor latch at the breast. And how this can lead to the secondary problem of vasospasm symptoms of the nipple and mammary constriction syndrome (often mistakenly diagnosed as thrush on nipples as the symptoms are very similar). In the excerpt below Dr Newman briefly describes the treatment technique of pectoral muscle massage;

It involves rubbing the chest muscles ( not the breast) quite vigorously for about 45-60 seconds on the affected side. There are four places to massage: 1) above the breast against the chest wall; 2) between her breasts just to the side of the breast bone; 3) under the breast against her rib cage; 4) on the side of her body, beside her breast, against the rib cage. One of these four areas is likely to be the ideal spot for her to relieve her pain.

Other causes of deep breast pain

Finding the Causes of Sore Nipples and the right answers to Why Does Breastfeeding Hurt? are not always straightforward, mammary constriction syndrome may only be part of the puzzle. Deep breast pain can be associated with engorgement with breast milk or mastitis and is sometimes confused with thrush. See our articles on Engorged Breasts, Mastitis Symptoms and Treatment and Thrush on Nipples for more information.

Seek skilled help

Contacting an International Board Certified Lactation Consultant (IBCLC) will help you pinpoint the most likely causes of pain and you may enjoy reading the full chapter on Sore Nipples in Dr. Jack Newman's Guide to Breastfeeding.

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Mammary Constriction Syndrome - Breastfeeding Support

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Mammary constriction syndrome (MCS) is a new explanation for deep breast pain during breastfeeding. It was first described by Edith Kernerman IBCLC and Dr Jack Newman, a Canadian paediatrician and breastfeeding expert, of the International Breastfeeding Centre. Support us on Social Media Follow us on Facebook and Twitter If there is a sudden tightening (i.e.

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Unicef UK Baby Friendly Initiative | Positioning and attachment

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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 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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This article looks at how dads and partners can help support a new mum who is breastfeeding in the early days.

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Attaching Your Baby at the Breast – Breastfeeding Series

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Our breastfeeding counsellors have been receiving lots of questions about coronavirus and breastfeeding. So here we answer your most frequent questions.

Does breastmilk contain coronavirus?

From the limited evidence that is currently available, it's not thought that breastmilk contains or can transmit coronavirus (RCOG, 2020). The biggest risk of infection is through close contact between mother and baby. We know that transmission is by airborne droplets from coughing and sneezing (RCOG, 2020).

Can I still breastfeed if I might or do have coronavirus?

Absolutely. In fact, experts think that the benefits of breastfeeding to bonding and feeding outweigh the potential risks of passing on the virus (RCOG, 2020). Breastmilk boosts a baby's immune system (Unicef, 2020).

You might find it helpful to talk everything through with one of our breastfeeding counsellors, or your healthcare provider. You can call our Infant Feeding Support line for information and support: 0300 330 0700, between 8am and midnight.

How can I breastfeed more safely if I think I might have coronavirus?

Experts recommend the following precautions for breastfeeding (these also apply to parents using formula milk):

1. Thorough hand washing before you touch your baby or anything to do with feeding. This may include nipple shields, breast pumps and dummies. Use soap and water and wash your hands for 20 seconds.

2. Not sneezing or coughing on your baby - make sure you cover your mouth and nose with a tissue or sleeve when you sneeze or cough.

3. Wearing a face mask, if available, while feeding.

4. Very carefully follow sterilisation instructions for breastfeeding equipment after using it - for more information see our article about how to sterilise feeding equipment. This includes making sure all food preparation areas are clean, such as kitchen worktops.

5. Potentially ask someone else to feed your baby your expressed breastmilk - see our article about expressing breastmilk for more information.

(NHS, 2020; RCOG, 2020)

Where can I go for support now many social activities have stopped?

It's always helpful to talk to other women who are breastfeeding for support, tips and company. Although breastfeeding drop-ins may be closed to limit the spread of coronavirus, peer support can be found on most social media platforms online, like this one.

As well as support from our breastfeeding counsellors and your health care providers, our breastfeeding commissioned services are offering virtual breastfeeding support via zoom groups, text messaging and one-to-one calls.

If you live in any of these areas and would like some support from a breastfeeding peer supporter, please get in touch:

Many of our local NCT branches are also providing online breastfeeding peer support via closed Facebook groups. Get in touch to find out more - search on your postcode and message your closest branch to see if they have any online peer support.

Will I be offered the coronavirus vaccine if I'm breastfeeding?

The Joint Committee on Vaccination and Immunisation (JCVI) say that it's safe for breastfeeding women to have the Covid-19 vaccination.

So if you are breastfeeding your baby, you should be offered the COVID-19 vaccine and booster. Further information can be found on the Royal College of Obstetricians and Gynaecologists website.

A health professional such as a GP or midwife can talk you through the risks and benefits to help you make an informed decision about vaccination. Be aware that lots of anti-vaccine stories are spread online and they're not based on scientific evidence. Find out more about breastfeeding and the vaccine here.

Further information

We support all parents, however you feed your baby. You can call our feeding support line on 0300 330 0700 (option 1) to talk to a breastfeeding counsellor about your questions or concerns, whether you're breastfeeding, using formula milk or introducing solids. They have had extensive training, will listen without judging or criticising, and will offer relevant information and suggestions. The line is open everyday from 8am to midnight, including bank holidays.

Read the the NHS advice on what you should do when you're self isolating.

Take a look at the latest public health guidance for pregnant women and parents.

Interactive, engaging and social, our antenatal course is a great way for you to meet other local parents, and get essential unbiased information and knowledge about pregnancy, birth and early days with your baby.

Click on the following links for guidance on self-isolation and social distancing in Arabic, Bengali, Cantonese, French, Gujarati, Mandarin, Polish, Portuguese, Punjabi, Urdu and Welsh.

For more information about coronavirus in various languages see here.

For more information and support, click on the links to see our articles about:

Coping with self-isolation and being stuck at home with your baby
How to look after your baby when you're not feeling well
Coronavirus: top tech and apps to keep you connected to friends
Dealing with anxiety over coronavirus
Coronavirus outbreak: surprising things you can get delivered

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Is it safe to breastfeed with coronavirus? | Baby & toddler, Feeding articles & support | NCT

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The thought of getting coronavirus while breastfeeding your baby might feel worrying. Here are the facts.

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Some research about being responsive to your baby's needs..

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Why you might want to put the baby books down...

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How often should I bottle-feed my baby?

When it comes to bottle-feeding or breastfeeding, all health professionals recommend 'responsive' feeding. This means learning to recognise the early signs that your baby is hungry (often called feeding cues) and never forcing them to finish a feed if they've had enough.

This is particularly important for babies who are formula fed because they can be over-fed and either become sick or put on too much weight (UNICEF UK, 2016).

Responsive feeding may therefore help reduce the risk of obesity (DiSantis et al, 2011).

Watch our video for tips on how to bottle-feed your baby.

How do I know when my baby is hungry?

Your baby's early feeding cues can include movements like:

sticking their tongue out

putting their hands to their mouth

starting to get restless

opening their mouth and turning their head to the side

sucking on their fists or fingers.

(NHS, 2015; UNICEF UK, 2016)

Crying is usually a late sign of hunger. If you wait until your baby starts crying for milk, you might find it more difficult to settle them for a feed (UNICEF UK, 2016). If your baby is upset, try to soothe them before you offer a feed. Skin-to-skin contact is great for calming babies.

How do I bottle-feed my baby?

You can read more about expressing breastmilk for a feed. If you're using formula milk, you'll need to safely prepare your baby's feed first.

Find somewhere comfy to sit and hold your baby close to you. They should be fairly upright, with their head supported, so they can breathe and swallow comfortably (NHS, 2015; UNICEF UK, 2016).

Feeding your baby responsively is a lovely way to bond with them (UNICEF UK, 2016; First Steps Nutrition Trust, 2017). Try talking to them gently and look into their eyes to reassure them during feeds. This helps them to feel safe and loved (NHS, 2015; UNICEF UK, 2016; NHS, 2018).

Focusing on your baby while you're feeding them also helps to pick up their feeding cues. Research has shown that mums who were distracted by things like using a mobile device or talking to another adult were less sensitive to their baby's cues. Distraction made mums more likely to overfeed their baby, possibly increasing their risk of obesity (Golen and Ventura, 2015).

Hold them upright and rub or pat their back to bring up any wind (NHS, 2015; UNICEF UK, 2016). Read our tips for bottle-feeding your baby for more information.

Babies should never be left alone to feed with a propped-up bottle, as they could choke on the milk (NHS, 2015; First Steps Nutrition Trust, 2017).
A quick guide to responsive/paced bottle feeding:

Hold your baby in an upright position, with their head supported, close to the parent's body.

Touch the teat against your baby's top lip, encourage them to open their mouth and pull the teat into the mouth.

Keep the bottle in a horizontal position (not tipped above your baby where the weight of the milk could force them to drink too quickly). A horizontal positions means when your baby pauses in sucking, the milk stops flowing, so they aren't forced to drink.

Allow pauses in drinking. When your baby pauses, withdraw the bottle slightly or completely to give them a break. They may need to burp in the pauses.

Short breaks allow babies to register fullness, so they can regulate the amount of milk they drink.

If your baby is showing hunger cues, offer the bottle again.

Be careful not to force your baby to take the bottle or to finish the bottle.

Follow your baby's lead on how much they want to drink, rather than going by how much is in the bottle.

(UNICEF 2017, UNICEF 2016, NHS 2015)

Who should bottle feed my baby?

Babies build up trust and confidence during feeding, gradually learning what to expect. This is partly how they develop healthy emotional and social attachment (UNICEF UK, 2016). In the early weeks and months, it might help to keep most of your baby's bottle-feeds for you and your partner, or one other trusted person (NHS, 2015; UNICEF UK, 2016).

If someone else is bottle-feeding your baby, talk to them about how you feed your baby so there's some consistency (UNICEF UK, 2016).

How much milk should I give them?

You can usually trust your baby to feed according to their appetite, so be guided by them. In the early weeks, your baby might be unpredictable, and their needs may change day by day. Newborn babies generally take quite small amounts of formula to start with in frequent intervals (NHS, 2015; First Steps Nutrition 2021).

As a general rule, by the end of the first week most babies will require approximately 150ml to 200ml per kilogram of body weight per day, until they're six months old. For example, a baby weighing 6kg at the end of four months, would approximately need 900ml to 1200ml of infant formula per day (First Steps Nutrition Trust, 2021).

A formula fed baby will need to be fed according to the guidelines for their weight and age (First Steps Nutrition, 2021).

Babies are likely to need night feeds for first year of life, as 70% of 6-18 month olds wake up at least once per night (Hysing, 2014).

Babies start eating solid food from about six months - this leads to a gradual reduction in the amount of milk they need. But as milk is still their main food for the first year of life, most babies are still drinking around a pint of milk a day at 12 months (NHS, 2015; First Steps Nutrition 2021).

What if my baby refuses the bottle or is fussy with bottle-feeding?

If your baby is hard to feed after the first 20ml to 30ml then they may need a break at this point (see the information about responsive feeding above). You could try changing their position, putting them over your shoulder to see if they need burping and then offer them the bottle again. If they're not interested, they may just need to feed little and often - this is normal for some babies (NHS, 2015).

If this doesn't help or your baby is often fussy or fights the bottle, ask your health visitor to watch you feed them, as they might have some suggestions (NHS, 2015).

If you've breastfed your baby so far, they may be reluctant to take a bottle at first. The different sucking actions needed may confuse them and they may not take a bottle feed from you (Zimmerman and Thompson, 2015). There are plenty of different things you can try to help your baby.

You could ask someone else to offer them a bottle.

Hold your baby in a different position from your normal breastfeeding one.

Offer the bottle when your baby isn't particularly hungry. When a breastfed baby is hungry, they are thinking about the breast, so might get agitated if offered a bottle until they learn that this is also food.

You can try a variety of teats.

Some breastfed babies never drink from a bottle, but move straight onto a sippy cup (NHS, 2017).

How do I know if my baby is getting enough milk?

There are certain signs that will tell you if your baby is getting enough milk. For example, their weight gain and number of wet and soiled nappies. Generally, your baby should be producing around six wet nappies a few days after birth (NHS, 2017).

Read our article Is my baby feeding well and getting enough milk? to find out more.

What sort of bottles and teats should I use?

You can use whichever bottles and teats you and your baby prefer. Yet the use of larger bottles (more than 6oz) has been associated with increased formula intake among two month old babies, leading to a risk of overfeeding (Wood et al, 2015).

Some teats are more suited to paced bottle feeding. Choose teats that fill with milk when the bottle is held in a horizontal position, as some need the bottle to be inverted to fill the teat. These are less suited to responsive feeding.

You can buy teats with different sized holes that vary the flow depending on your baby's age and ability to suck and swallow (UNICEF UK, 2016; Which?, 2018).

It's important to replace bottles and teats when they look worn. This is because it's not possible to keep them clean otherwise and worn teats can also disintegrate or split (NHS, 2017).

You might like to take a look at our page on how to make up formula safely.
This page was last reviewed in March 2021.
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, 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 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.

Read more about bottle-feeding in the UNICEF UK 2016 guide to infant formula for parents.

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How to bottle-feed your baby | Baby & toddler, Feeding articles & support | NCT

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When it comes to bottle-feeding or breastfeeding, all health professionals recommend 'responsive' feeding. This means learning to recognise the early signs that your baby is hungry (often called feeding cues) and never forcing them to finish a feed if they've had enough.

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If you're planning to bottle feed with expressed breast milk or infant formula, these tips will help keep your baby safe and healthy.

Buying bottle feeding equipment

You'll need a number of bottles and teats, as well as sterilising equipment.

There's no evidence that one type of teat or bottle is better than any other.

Simple bottles that are easy to wash and sterilise are probably best.

Making up bottles

Make sure your bottles and teats are sterilised and wash your hands thoroughly.

If you're using infant formula, follow the instructions on the packaging carefully when you make up the feed.

See how to make up baby formula.

How to bottle feed your baby

Bottle feeding is a chance to feel close to your baby and get to know them.

Make sure you're sitting comfortably. Enjoy holding your baby and looking into their eyes as you feed them.

Hold your baby fairly upright for bottle feeds. Support their head so they can breathe and swallow comfortably.

Brush the teat against your baby's lips and, when your they open their mouth wide, let them draw in the teat.

Always give your baby plenty of time to feed.

Keep the teat full

When bottle feeding, keep the teat full of milk, otherwise your baby will take in air.

If the teat goes flat while you're feeding, gently poke your little finger into the corner of your baby's mouth to release the suction.

If the teat gets blocked, replace it with another sterile teat.

Winding your baby

Your baby may take short breaks during a feed and may need to burp sometimes.

When your baby has had enough milk, hold them upright and gently rub or pat their back to bring up any wind.

Throw away unused milk

Throw away any unused formula or breast milk after you have finished bottle feeding your baby.

Be guided by your baby

All babies are different. Some want to feed more often that others, and some want more milk.

Just follow your baby's lead.

Feed them when they seem hungry and don't worry if they don't finish the bottle.

Don't leave your baby alone

Never leave your baby alone to feed with a propped-up bottle as they may choke on the milk.

Help with bottle feeding

Talk to your midwife, health visitor or other mothers who have bottle fed if you need help.

You'll find the phone number for your health visitor in your baby's red book.

Your questions about bottle feeding

Why doesn't my baby settle after feeds?

If your baby swallows air while bottle feeding, they may feel uncomfortable and cry.

After a feed, hold your baby upright against your shoulder or propped forward on your lap. Gently rub their back so any trapped air can find its way out.

There's no need to overdo it - wind isn't as big a problem as many people think.

Why does my baby sometimes vomit after feeds?

It's normal for babies to bring up a little milk during or just after a feed. This is called possetting, regurgitation or reflux.

Keep a muslin square handy just in case.

Check that the hole in your baby's teat is not too big. Drinking milk too quickly can make your baby sick.

Don't force them to take more milk than they want during a feed.

Sitting your baby upright on your lap after a feed may help.

If it happens a lot, or your baby is violently sick, seems to be in pain or you're worried for any other reason, talk to your health visitor or GP.

Can formula make my baby constipated?

When using formula, always use the amount of powder recommended on the packaging.

Don't add extra formula powder. Using too much can make your baby constipated and may cause dehydration.

If your baby is under 8 weeks old and hasn't done a poo for 2 to 3 days, talk to your midwife, health visitor or GP, particularly if they are gaining weight slowly.

Your baby should be gaining weight and have plenty of wet and dirty nappies.

Infant formula and allergies

If you think your baby might be allergic to or intolerant of formula, talk to your GP. If necessary, they can prescribe a special formula feed.

Some formula is labelled as hypoallergenic, but this isn't suitable for babies with a diagnosed cows' milk allergy.

Soya formula should only be given to babies under medical supervision.

Always talk to your GP before using hypoallergenic or soya-based formula.

Read more about cows' milk allergy and lactose intolerance.

Get Start4Life pregnancy and baby emails

For information and advice you can trust, sign up for weekly Start4Life pregnancy and baby emails.

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If you're planning to bottle feed with expressed breast milk or infant formula, these tips will help keep your baby safe and healthy. You'll need a number of bottles and teats, as well as sterilising equipment. There's no evidence that one type of teat or bottle is better than any other.

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Good evidence based information on choosing and using formula milks

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Infant milks for parents & carers — First Steps Nutrition Trust

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First Steps Nutrition Trust is a charity which provides clear, evidence-based and independent information and support for good nutrition from pre-conception to five years of age.

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Ingredients lists showing the difference between breast milk and formula.

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Cow's Milk Allergy Advice | Help on CMPA | Allergy UK

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Information on Cow's Milk Allergy / Cow's Milk Protein Allergy, with free factsheets on related topics to do with CMA / CMPA. For more guidance, contact our free helpline.

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From First Steps Nutrition

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NCT leaflet

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Association of Breastfeeding Mothers (ABM)

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Association of Breastfeeding Mothers (ABM)

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Lots to explore here in the ABM information library

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Browse support in our Information Library by stage, need, family member. Our most popular leaflet is Relactation: restarting breastfeeding after a gap.

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NCT leaflet

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Amazing poem about feeding in public

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First Steps Nutrition guide

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NCT leaflet

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NCT leaflet

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An article about how antibodies in breast milk protect your baby from infections.

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Articles from NCT on feeding your baby

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Whether you're breastfeeding, formula-feeding or both, you'll find lots of useful articles about feeding here. Plus, tips on introducing solids when you're ready.

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More info from an NCT colleague on introducing solids.

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More info from an NCT colleague on introducing solids.