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If you live in Bolton or Wigan, free home visits are available to provide pregnancy and infant feeding support in the comfort of your own home.

Our Peer Supporter Practitioners can offer support with-

*Latching your baby at the breast

*Breastfeeding positions

*Breastfeeding issues

*Signs of effective breastfeeding

*Expressing and storing breastmilk

*Paced and responsive feeding

*Emotional and practical support

To book a visit, call or text us on 07742234496, or email enquiries@breastfeedingtogether.co.uk

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Pregnancy Information Sessions. Free with various dates and locations available.

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Pregnancy Information Sessions. Free with various dates and locations available.

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We run 2 Pregnancy Information Sessions-

Plan and Prepare for Parenthood- Designed to give you all the information you need to make informed feeding choices, to know what to expect and when, packing your hospital bag and more information to help you when your baby arrives. We'd recommend attending this session from 12 weeks gestation.

Preparing to Breastfeed- This session was created for those thinking about breastfeeding, or to help you make your choice about feeding your baby. We talk about the benefits of breastfeeding, how to get breastfeeding off to a good start, how to latch your baby to the breast and how that should look and feel, and how to recognise if your baby is getting enough milk. We'd recommend you attend this session during your third trimester.

Please only book 1 ticket per family, and feel free to bring along anyone who will be supporting you on your journey. The sessions are relaxed and informative with plenty of time for all your questions.

Sessions are held at Family Hubs throughout Bolton Borough, evening and weekend dates are included. We also run sessions online.

Click Here To Book!

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Mastitis Protocol- Guidance has been updated for the treatment of Mastitis

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Mastitis Protocol- Guidance has been updated for the treatment of Mastitis

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Further research has led to the update of recommended treatment for mothers with symptoms of Mastitis.

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However we deliver our baby, skin to skin is recommended as soon as it's medically safe to do so, this is referred to as the 'Golden Hour'-1 hour of uninterrupted skin-to-skin contact to enable mum and baby to get to know each other.

Skin-to-skin has lots of benefits for both mum and baby-
*Regulates babies temperature, breathing and heart rate
*Releases oxytocin in baby to help them feel calm and relaxed
*Releases oxytocin in mum to relieve stress and act as a natural pain reliever
*Gives mum and baby an opportunity to get to know each other
*Stimulates milk-making hormone to aid milk production
*Build babies immunity to help prevent infection
*Encourages early bonding and attachment

If for any reason mum can't/chooses not to have skin-to-skin contact it's encouraged for partners to have skin-to-skin in place. Lots of those benefits for baby are still there and it encourages early bonding and attachment for them too.

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When can I express breastmilk for my baby?

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When can I express breastmilk for my baby?

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You’ve got to pump it up….

We get asked LOADS about pumping expressing milk, as families are often keen to add it into their breastfeeding journeys for lots of different reasons. Sometimes these reasons are clinical – and in these cases we’d always say check with your midwife and follow their advice, but otherwise, here’s our little pumping lowdown!

The biggest question we get asked is when should I start pumping milk?

Well, to start with ‘should’…..you actually don’t have to! Sometimes mums/parents can feel pressurised into expressing so that other people can give bottles. If exclusive breastfeeding from the breast is working for you, and you’ve no ‘need’ to give bottles, you don’t have to!

However lots of mums find that they either need or want to express and introduce a bottle. If this sounds like you, then you absolutely can!

However there are a few guidelines we recommend following. Waiting until breastfeeding is more established first is one. Doing this means your supply has time to settle down and work out how many babies you’ve had and adjust your supply accordingly! Holding off for 4-6 weeks usually means your supply has settled enough that the extra expressing is less likely to cause an oversupply - and the problems that can potentially come with that such as engorgement, blocked ducts and mastitis. It also allows baby to perfect their art at the breast before we introduce a different sucking technique. Feeding on a bottle is very different for babies and if introduced too soon it can result in a bottle preference or nipple confusion.

There are loads of different pumps out there, from ones that collect more that actively express to hospital grade electric ones – it’s all about what works for you!

If you want to chat through different pumps – we are here for you, providing impartial information and guidance.

And if you’re not sure or ready to buy a pump yet – we’ve even got a pump loan service!

So if and when you’re ready to pump it up – just get in touch!

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What's in breastmilk and what should the cycle of a breastfeed look like?

By watching our baby breastfeed we can see how effectively they are able to remove milk. If you have any concerns about whether your baby is getting enough milk, please seek some qualified and experienced breastfeeding support.

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This is the first few months of your babies life.

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For more information about this period, you can join our Online Session. We will give you lots of tips for managing The Fourth Trimester period!

Session Booking - Breastfeeding Together

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Online Pregnancy and Parenting Information Sessions. Free with various dates and times available.

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Online Pregnancy and Parenting Information Sessions. Free with various dates and times available.

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Our Online Pregnancy and Parenting Sessions are packed full of information to prepare you for the arrival of your new baby and to support you in the early days and months with your newborn. These sessions are friendly, informal and there's plenty of opportunities for you to ask as many questions as you need.

We run 5 online sessions as follows-

*Preparing to Breastfeed

*Plan and Prepare for Parenthood

*Safer Sleep for Babies

*Breastfeeding Your Newborn

*Introducing Solid Foods

For more information, visit our Booking Site-

Book here!

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Colostrum Harvesting & Hand Expressing- Find out more about the benefits of Colostrum Harvesting.

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Colostrum Harvesting & Hand Expressing- Find out more about the benefits of Colostrum Harvesting.

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Watch our informative video for more tips and information all about Colostrum Harvesting.

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The World Health Organisation recommends exclusive breastfeeding for the first 6 months of a babies life, then alongside solid food until at least the age of 2 years and beyond.

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World Health Organisation- Feeding Choices

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World Health Organisation- Feeding Choices

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For more information you can visit their website here-

https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding

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"Skin-to-skin contact is a key part of the UNICEF UK Baby Friendly Initiative standards. It helps babies adjust to life outside the womb and supports mothers to initiate breastfeeding and develop close, loving relationships with their baby."

Unicef

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Hand Expressing is a great tool at various stages during your breastfeeding journey.

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Hand Expressing- Removing milk from the breasts using your hand

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Hand Expressing- Removing milk from the breasts using your hand

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Hand expressing can be used for various reasons-

*Collecting colostrum in the early days

*Helping to relieve engorgement

*Assisting a baby to latch

*Relieve discomfort when separated from baby

*Help remove blocked ducts

*Simple and easy way to remove milk in the absence of a breastpump

Watch our video for more information.

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One of the most reliable indicators of effective breastfeeding

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In those early days, babies only need small volumes of colostrum. It can be difficult to know if baby is getting enough milk when breastfeeding, but by monitoring babies nappy output, this gives us an indication of what baby is drinking.

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Is your babies poo a different colour than usual?

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Sometimes we don't see what we expect when we open a nappy! Unusual coloured stools can be typical, but on occasions you may need to seek some medical advice.

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More information about Paced Bottle Feeding

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If you've decided to express your breastmilk, please find some guidance above.

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It's a good idea to wait until your baby is born before buying a breastpump. There are so many different types of pumps available, and it really depends on why you're expressing as to which kind of pump would be suitable.

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How to hold baby and bring baby to the breast to achieve an effective latch.

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A newborn's tummy is about the size of a grape, holding around 5-7mls of milk, about a teaspoon! We typically see newborns feeding frequently, but this is really common at this stage. Colostrum, the first milk, is perfectly designed for their tiny tummies, packed full of everything your baby needs. As their tummies grow, we do see longer periods between feeds and more settled periods. Their tummies do grow quickly and start to hold higher volumes of milk. Your milk changes all the time to meet the needs of your baby!

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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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This video is fantastic and shows us the importance of how we hold our baby and how this can impact their ability to latch effectively.

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding success and what a mother can do to deeply attach her baby to her breast.

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Attaching Your Baby at the Breast - Video - Global Health Media Project

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding

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When observing baby at the breast, this is the typical suck-swallow pattern the feed will follow. 

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When a baby feeds from the breast we look at their sucks and swallows to establish how effectively they're removing milk from the breast. Each baby, each feed and each day will be different. By watching our babies suck and swallow pattern we can see which part of the cycle they're up too.

How long does this cycle last? Ultimately this depends on why our babies are feeding. We know that breastfeeding is about so much more than nutrition, they go to the breast for comfort, security, reconnection with mum, pain relief and much more. Some babies will even go through this cycle more than once, but our babies are very good at letting us know. In most circumstances we can follow their lead and breastfeed responsively.

If your baby isn't gaining weight as expected or you're experiencing issues with breastfeeding, please seek out some skilled breastfeeding support.

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We don't need to wait until our baby is born to start the bonding process. There's lots of things we can do throughout pregnancy to bond with our unborn baby.

Babies ears are fully developed from around 16 weeks gestation where they can hear sounds from inside the womb such as mums food digesting, her tummy rumbling and her heartbeat.

From around 24 weeks gestation baby can hear sounds from the outside world, at amount 50% volume, the sound would be much quieter and muffled.

Now is the perfect opportunity to spend time talking to your baby, singing to your baby, reading books and playing your favourite songs.

It's also a great time to get partners and siblings involved in the bonding process. Baby will get to know mums voice throughout pregnancy, so others spending some time to talking, singing and reading to baby helps them get to know other important people, the start of that secure attachment and bond.

Babies not only respond to the sounds they hear but also to your movements and motion. If they kick, give them a poke back, spend time rubbing your bump and get your partner to massage bump. Some research suggests babies are more likely to respond to their mothers touch as they get to know this early.

Get to know your babies pattern of movements. If there's ever a change in movements and you're at all concerned, please speak to your midwife.

Every parent experiences a mixture of emotions during pregnancy and the arrival of their new baby. Not all parents will experience that rush of love often described. But it can take time to build those feelings and there's lots of things that can be done once baby arrives to build that secure attachment.

Having lots of skin to skin with baby helps release oxytocin for both baby and for the person having the skin to skin.

It's not only recommended for mum to have lots of skin to skin, but also partners and siblings. With the release of oxytocin comes the building of a secure attachment between caregivers and babies. Research shows us the benefits of skin to skin contact for children up until at least the age of 5!

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Welcome to our informative Padlet, where you can find all the information you need to prepare you for your new arrival, and for useful information along your journey with your new baby.

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Welcome to our informative Padlet, where you can find all the information you need to prepare you for your new arrival, and for useful information along your journey with your new baby.

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Use the headers to find the section you'd like more information on. Click on any videos, link or infographics to watch and save anything you find useful.
You can contact us for more information or support via phone, text, email or social media.

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It is a myth that breastfeeding is easy. Breastfeeding takes time and practice for both mothers and babies. Many mothers experience challenges with breastfeeding, but the right support can help overcome these issues.

If you are facing issues with breastfeeding, reach out to your midwife, breastfeeding specialist or health care provider for support.

Here are some of the most common breastfeeding issues, and our tips that can help you find relief.

1. How do I make sure my baby has a good breastfeeding latch?

Establishing a proper latch is the key to making sure that breastfeeding is a comfortable experience for both you and your baby. To make sure your baby is well attached:

Bring their nose directly opposite your nipple.

Let their head tilt back a bit so their top lip can brush against your nipple. This should make their mouth open.

When their mouth is wide open, bring them quickly to the breast with their head back and chin leading. This way, your baby can take a large mouthful of breast and not just the nipple.

Your breast will be drawn deep into your baby's mouth and your nipple will be positioned back into the soft part of your baby's mouth. This will ensure you won't get sore and your baby can get all the milk they need.

Signs of good attachment include:

A comfortable experience with no pain

More areola is visible above your baby's mouth than below

Your baby's mouth is wide open

Their lower lip is turned out

Their chin is touching - or nearly touching - your breast

2. What can I do about low milk supply?

It can be frustrating if you feel that you are not producing enough milk for your baby. If you are worried about your milk supply, reach out to your health care provider. In most cases, there is something going on that they will be able to help you identify.

Some common causes of low milk supply include:

A delay in initiating breastfeeding

No or very little skin-to-skin contact

A delay in milk coming in due to delivery complications, illness or diabetes

Poor attachment

Feeding at fixed times

Short feeds

No nighttime feeding

Infrequent feeds

Worry and stress

Lack of confidence

Lack of bonding

Dislike of breastfeeding

Tiredness

To help prevent low milk supply and maintain a healthy amount of breastmilk for your baby:

Engage in early skin-to-skin contact at delivery and initiate breastfeeding as soon as possible.

Ask for skilled breastfeeding support after delivery to ensure good attachment and effective suckling.

Practice rooming-in (staying and sleeping in the same room as your baby) 24 hours a day.

Breastfeed exclusively unless supplementing your milk supply is medically necessary as indicated by your health care provider.

3. What treatments are available for engorged breasts?

Having engorged breasts can be extremely painful. While full breasts can feel uncomfortable, engorgement is a different problem.

They will feel hot, heavy and hard

They will feel painful, look abnormally swollen with fluid (oedematous) and tight. They may also look shiny and red

Milk will be flowing

Milk will not be flowing

You won't have a fever

You may experience a fever for 24 hours

Common causes and ways to prevent engorged breasts include:

Causes of engorgement

Ways to prevent engorgement

Plenty of milk

Remove milk frequently (by hand expressing or with a pump) and initiate breastfeeding early

Delayed start to breastfeeding

Start breastfeeding soon after delivery

Poor attachment to the breast

Ensure proper attachment

Infrequent removal of milk or restricting the length of feeds

Allow unrestricted breastfeeding

Reach out to your health care provider if you are experiencing engorged breasts.

4. How can I prevent cracked nipples when breastfeeding?

Sore or cracked nipples are usually a sign that your baby is not properly attached at the breast when feeding. Make sure that your baby has a good latch. If one or both of your nipples begin to crack or bleed, reach out to your health care provider as soon as possible for support. At home, try dabbing a bit of expressed breastmilk onto them after you feed. Breastmilk has healing properties that help relieve soreness.

5. What causes mastitis and blocked milk ducts? How do I prevent them?

Breastmilk flows through a system of ducts in your breasts to reach your baby. Sometimes, an area of these ducts can become blocked which stops the milk from flowing easily. Blocked ducts can be painful. Mastitis, an inflammation of the breast, can occur when a blocked duct does not clear or when the build-up of milk in your breast causes swelling or inflammation. Speak to your breastfeeding consultant, midwife or health care provider if you are experiencing pain from blocked ducts.

Some causes of blocked ducts and mastitis include:

Short or infrequent breastfeeds

Not removing the milk from part or all of the breast properly

Damaged breast tissue

Bacteria entering the breast through a crack in the nipple

To help relieve pain and treat your symptoms, try:

Improving milk removal

Correcting poor attachment

Wearing loose-fitting clothing

Breastfeeding more frequently

Gently massaging toward the nipple

Applying a warm compress to the area in pain

Varying feeding positions

Breastfeeding isn't a 'one woman' job, and it is very common to run into bumps along the way. Reach out to your health care provider with any concerns and surround yourself with family, friends and loved ones for support along the way. You've got this!

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Learn about the challenges and how to face them

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https://www.youtube.com/watch?v=gltirYRBrRw

Breast Compressions can be really useful to help baby breastfeed more effectively. Please seek out some skilled breastfeeding support if you're concerned your baby isn't getting enough milk.

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How do I know my baby is getting enough breastmilk?

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Breastfeeding? It can be hard to know if your baby is consuming enough milk. Here are the signs your baby is – and isn’t – getting enough to grow and thrive

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Breastfeeding is normal and natural and is not supposed to hurt. If breastfeeding hurts at any time check through our suggestions and links below and seek help from your IBCLC lactation consultant or breastfeeding helper. Without quick help, pain during feeding can quickly cause sore or cracked nipples. And if breastfeeding hurts, because your baby isn't attached to the breast (latched) correctly, this can reduce your milk supply leading to a baby who seems to be constantly feeding, fussing or pulling off the breast or one who isn't gaining much weight.

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Why does breastfeeding hurt?

The most likely reason for breastfeeding to hurt is when a baby attaches to the nipple without a deep mouthful of the surrounding breast tissue. If the nipple is not far enough into the baby's mouth, it will tend to be pinched between the tongue and the roof of baby's mouth and this will be very painful. Your nipple may come out of baby's mouth slanted like the top of a new lipstick instead of rounded like a cherry on a cake. Or nipples may even look white for a few moments as if the blood has been squeezed out of them.

Shallow latch (painful)

Latching mostly on the nipple rather than the breast is often called a shallow latch. In a shallow latch your baby's tongue won't be in the best position against the breast. Your baby may find it difficult to get enough milk and breastfeeding is more likely to hurt. Babies breastfeed many times a day so it won't take long for breastfeeding in a painful latch to lead to sore nipples including cracked or grazed nipples or blisters on nipples.

Deep latch (comfortable)

When the breast fills the baby's mouth in a deeper latch; a baby's tongue cups more of the milk making or glandular tissue in the breast. In a deep latch the nipple is protected from the painful pinch because it is deep in a baby's mouth at the junction of the hard and soft palate.

Babies Need a Big Mouthful

While there might be some milk in your nipple, the milk is mostly in the ducts in your breast. The baby who just chews on a nipple won't get much, and it'll hurt! When your baby has a big mouthful of breast beyond your nipple, that's when it's comfortable. And that's where the milk is. So when it feels good, it is good. As Toronto paediatrician Jack Newman often says: "It's called breastfeeding, not nipple-feeding."

How to get a deep latch

Positioning your baby. The way your baby is held can make a big difference to how well he can latch on and breastfeed. In the right position your baby may automatically improve his latch and know what to do. See the articles Breastfeeding Positions for Newborns, Breastfeeding Videos and Why Skin to Skin? for ways to hold your baby so he can get a big mouthful of breast easily and get a deeper latch.

Attaching your baby. In addition to the way you hold your baby, there are a number of techniques available to help your baby get a deep attachment. See Latching Tips for further information.

Get help. Although pictures and videos can be helpful, the best way to check yours and your baby's position is to see an IBCLC lactation consultant who will take a full history, and work with you one-to-one to make breastfeeding comfortable.

My health visitor says the latch looks fine, but I still have pain

Simply looking at a baby's latch doesn't tell the full story about what is happening to the nipple inside a baby's mouth. If breastfeeding hurts there is still something wrong. Try to find an IBCLC lactation consultant or another breastfeeding specialist for a second opinion. It can be difficult to find the cause of the pain sometimes but painful feeding is not normal. Possible reasons for ongoing pain include:

Latch not deep enough

One helper's idea of a good latch may be quite different from another's particularly if they haven't had much training in breastfeeding support. Before assuming something more complex is the cause of breastfeeding pain it can be helpful to check positioning and attachment with a specialist.

Nipple vasospasm

Vasospasm of the nipple is when the little blood vessels in the nipple contract or narrow. This phenomenon can be triggered when the nipple is squeezed tightly in a shallow latch so that the tiny blood vessels in the nipple are compressed, leading to decreased blood flow and oxygen in the nipple. When baby lets go of the nipple it may look white where the blood has been squeezed out of the nipple and the nipple may look misshapen where it has temporarily been squeezed out of shape. As the blood returns to the nipple, it can be very painful causing a deep throbbing, burning type pain. Nipple vasospasm can also be triggered by other causes eg stress, cold temperatures or exposure to cigarette smoke, so even if breastfeeding is comfortable this can be an explanation for unexpected nipple pain. For more information on causes and prevention see Nipple Vasospasm and Breastfeeding and Latching Tips.

Tension or compression from the birth

Any tension or compression from a baby's birth may affect the nerves and muscles involved in sucking and swallowing and affect breastfeeding comfort. This could cause high muscle tone, a tight jaw, poor tongue movement or a preference for one breast over another. Forceps, ventouse or cesarean deliveries tend to be the most common causes, but sometimes even in an intervention free birth there can be physical issues due to the way a baby was positioned in the uterus. Some mothers find body work such as cranial osteopathy from a skilled therapist can improve things, particularly if their baby has had a difficult birth.

Fast let-down and oversupply

If a mother has a very fast flow or seems to have too much milk, a baby can learn that by pinching the nipple they can slow down the flow of milk which can cause sore nipples. A breastfeeding specialist can suggest ways to help your baby cope with the flow and see What is a Fast Let-Down? and Oversupply of Breast Milk.

Allergies (when baby is in pain)

An unexpected cause of mysterious nipple pain-when latch and positioning might look fine-could be associated with a baby's pain or discomfort. Lactation consultant and author Robyn Noble explains that if a baby is uncomfortable or in pain they can be very tense, especially around the jaw, and tend to clamp down on the breast. Noble calls this a hypertonic bite response and sees it frequently when a baby has a food allergy to something from mother's diet that is present in breast milk. Hypertonic bite response may cause soreness and marked creasing to the nipple, possibly extending to the areola (the darker area of skin around the nipple). . When the cause is food allergy related there will usually be other symptoms see Milk Allergy in Babies, and symptoms can often be helped when the mother follows an elimination diet.

Tongue function

If the membrane under a baby's tongue (the frenulum) is very short or tight it can sometimes prevent the tongue from moving properly. In some cases, this can be a cause of painful breastfeeding, even with very careful positioning. For help with breastfeeding contact an IBCLC lactation consultant who may suggest tailored positions for you and your baby, or trying some simple tongue exercises to improve tongue function and strength to make breastfeeding more comfortable. Sometimes body work may be helpful to strengthen muscles involved in feeding. Your lactation consultant may recommend you see a tongue-tie practitioner to evaluate your baby's tongue function for a procedure to release the tongue-tie (a frenotomy). See Is My Baby Tongue Tied? for further information.

Nipple confusion

Sometimes a baby who has had bottles will try to apply the way they get milk from the bottle (like sucking through a straw) to the breast-and this can cause pain. Over use of pacifiers might also cause a different suck for some babies. It can help to try to avoid bottles and dummies completely while a baby learns the right technique. If supplements are needed you could try cup-feeding or a supplemental nursing system instead. However using these Tips to Bottle Feed a Breastfed Baby and the ideas in Best Bottle for a Breastfed Baby can help to make bottle feeding more like a breastfeed. Pacifier, Dummy or Soother-Yes or No? has more information about using a pacifier.

Other causes of nipple pain

Although attachment and positioning are generally the main causes of painful feeding, other possibilities include:

Nipple infection; bacterial or fungal

Sometimes the same painful symptoms described for vasospasm or mammary constriction syndrome (see below) are due to an infection or skin condition, particularly where there has been broken skin and nipple damage. Mothers may describe a shooting, stabbing or burning pain in the nipple or breast. An infection might be bacterial, or fungal (thrush/candida/yeast) or even both at the same time. An infection may be painful and continue to be painful even with a corrected latch. For more information see Thrush on Nipples and Staph, MRSA and Breastfeeding and check with your health professional.

Nipple piercings or previous nipple surgery

Previous surgery to nipples including nipple piercings may be a source of ongoing pain see Breast Surgery and Breastfeeding and Breastfeeding With Pierced Nipples.

Eczema, dermatitis, psoriasis

Nipples can be sore due to other medical causes unrelated to breastfeeding. The article Causes of Sore Nipples discusses eczema, dermatitis and psoriasis on the nipple as well as infections. Your doctor will confirm whether any of these could be a possibility for you and suggest treatments.

Blocked nipple pore

The openings in the nipple through which milk leaves the breast are known as nipple pores. If a nipple pore is blocked, a small white or yellow spot may be seen on the nipple surface. Known as nipple blebs or milk blisters, blocked pores can be very painful. There are several theories for nipple blebs including suboptimal attachment and positioning, an associated blocked milk duct or an inflammatory response to nipple damage See Blisters on Nipples for more information to resolve this situation if you have a painful white spot on your nipple.

Poorly fitted breast pump

If a mother pumps regularly alongside breastfeeding, a poorly fitted breast pump could be the cause of sore nipples. Pumping shouldn't be painful but the wrong sized flange or a suction that is too high can quickly damage nipples. Some authors point out that pump parts should be thoroughly cleaned between feeds and not harbouring any bacteria that could contribute to infection. See How to Increase Milk Supply When Pumping for more information on choosing the right pump and Babies in Common have a handy summary called the Flange FITS™ Guide.

Care of nipples

Once nipples are no longer being rubbed inside a baby's mouth thanks to optimal positioning and attachment, sore nipples usually quickly heal on their own. Sometimes however, very sore nipples may need a little medical help to hasten healing (check with your doctor). Bear in mind some remedies can potentially be a cause of sore nipples, or inflame nipples further-if a mother is sensitive to an ingredient in a topical ointment she is using or if the ointment is causing over hydration and breakdown of nipple skin. Even purified lanolin, a popular home remedy for sore nipples made from sheep's wool, can cause an allergic reaction or moisture associated skin damage in some mothers. For more information see Treatments for Sore Nipples.

Nipple pain and an older baby

Sometimes nipples may begin to feel sore unexpectedly after months of pain free feeding. There can be a number of causes for this.

Changes to positioning. It is natural to pay less attention to latching and positioning once breastfeeding is going well. Bear in mind that babies can outgrow certain positions or breastfeeding pillows and new positions may be needed.

Teething. Sometimes when a baby is teething they may accidentally clamp down or graze the nipple. For tips to avoid this see Baby Biting While Breastfeeding. It is thought that the increase in a baby's saliva during teething can contribute to sore nipples at this time.

Return of periods. Some mothers notice sensitive or sore nipples around the time of ovulation or just before menstruation due to changes in hormones.

Pregnancy. It is very common for mothers to have sore nipples when pregnant due to hormonal changes.

Starting solids. Traces of food in a baby's mouth may occasionally contribute to nipple soreness. Or, if a baby has food allergies which emerge when solid food is started, this could sometimes cause sore nipples through hypertonic bite reflex (see above under allergies).

Causes of deep breast pain

Mammary constriction syndrome

Mammary constriction syndrome is a recently described syndrome related to nipple vasospasm (see above). It is described fully by Edith Kernerman, IBCLC in Dr Jack Newman's Guide to Breastfeeding (see excerpt below) and there's more information in Mammary Constriction Syndrome (on this website).

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.

Engorgement, mastitis or a blocked duct

There are several potential causes for your breasts becoming full and tender and uncomfortably engorged (over full of milk). If this happens at any stage it's important to feed your baby often or pump to drain the breasts to resolve the engorgement and avoid possible mastitis. Mastitis is a very painful inflammation of the breast. Check the suggestions in our articles Engorged Breasts, Blocked Milk Duct and Mastitis Symptoms and Treatment and ask your IBCLC lactation consultant for help with breastfeeding to understand what caused the engorgement and prevent it happening again.

Thrush

Deep breast pain is sometimes said to be associated with a fungal infection (thrush) however not all authors agree that deep breast pain can be caused by thrush. See Thrush on Nipples for more information.

Previous breast surgery

Previous breast surgery including breast implants or breast reduction could be a potential cause of persistent pain during breastfeeding for some mothers see Breast Surgery and Breastfeeding.

Protect your milk supply while you work on making breastfeeding pain free

Whenever there is pain and a poor latch there is a chance that your breast milk supply may drop and that your baby won't be getting enough milk. Expressing after feeds by hand expressing or pumping will keep your breasts well drained and so stimulate your breast milk supply. The expressed breast milk can be fed back to your baby after a breastfeed as needed (by spoon, cup, syringe, bottle or supplementary nursing system). Continuing to get regular weights (weekly, or more often if needed until breastfeeding is pain free) will help to gauge how much milk your baby is getting and see Is My Baby Getting Enough Milk? Other helpful articles to maximise your baby's breast milk intake include How to Make More Breast Milk, One Breast or Two Per Feed? and Breast Compression.

It can be difficult to find the cause of the pain sometimes but painful feeding is not normal. Click To Tweet

Summary

There are several reasons why breastfeeding might hurt. The most common reason for breastfeeding to hurt is if a baby isn't latched correctly leading to sore or damaged nipples, deep breast pain or both. Once cracked or grazed, nipples are more susceptible to infections, another possible cause of ongoing pain. Your breastfeeding specialist can help to find the most likely reason for pain alongside your health professional who will check for medical causes.

Footnotes & References

O'Hara M. Bleb histology reveals inflammatory infiltrate that regresses with topic steroids: a case series. Breastfeed Med 2012

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Why does breastfeeding hurt? There can be many reasons for breastfeeding to hurt from a shallow latch to a tongue tie (tight membrane under the tongue).

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Mastitis (breast inflammation), includes a wide range of symptoms, from a small, tender area (often called a blocked duct), through to severe infection.

If your breasts are inflamed or swollen, it's important to act quickly to relieve discomfort and stop it getting worse. You may also need to deal with any underlying causes.

LLL Leaders are here to help.

What do all these words mean? A quick guide

What are the signs of mastitis?

How can I prevent mastitis in the future?

Mastitis just means 'breast inflammation'. Recent research is changing how mastitis is viewed and treated. It's now understood as a wide spectrum, from a small, tender area - often called a blocked duct - to a severe infection.

Milk blisters/blebs look like tiny white or yellow dots on the tip of the nipple. They can cause no trouble, or they might be very painful (often described as 'stinging' pain). Sometimes they form in one or more 'milk pores', blocking milk from coming out of part of the breast. They are part of the mastitis spectrum of related conditions and the self-treatment measures suggested for mastitis may help. Milk blisters that don't block milk coming out, and don't hurt, can be safely left alone. They eventually disappear.

Engorgement is when the whole breast becomes swollen with extra fluid. It's common 2-5 days after birth, when milk production is increasing very fast. The mastitis self-treatment measures described below are helpful for engorged breasts, too. Treat engorgement promptly to avoid developing mastitis.

A breast abscess is a collection of pus (infection) within the breast. It is usually a complication of mastitis that was not adequately treated. An abscess needs urgent medical treatment: drainage and antibiotics.

One or more areas that are tender (sometimes called a blocked duct).

Your breast might feel warmer, harder, or lumpier than usual.

There may be a patch of skin on your breast that has changed colour (dark skin might look darker than usual, on light skin you might see a red patch).

You might have a fever and feel like you have the flu. Your body may respond to inflammation with an increase in temperature - it doesn't necessarily mean you have an infection. See below, "Do I need medical help?"

Could it be a breast abscess?

Most (though not all) people with an abscess feel very ill. If you have one or more lumps in your breast that don't get smaller as milk is removed, and don't respond to the treatments for mastitis suggested in this article, contact your GP or NHS 111. An abscess needs urgent medical treatment. It's usually possible - and may be preferable - to continue breastfeeding while an abscess is treated, if you want to. LLL Leaders can support you through it.

When breasts are too full of milk, or the breast is injured, your body may react with inflammation - a response to a threat. Blood flow to the area increases, and fluids and immune cells rush in to repair damage and fight off bacteria. As pressure within the breast increases, it feels tender or painful, and it may become difficult for the milk to flow easily.

Common causes of mastitis

Issues with positioning and attachment: Your baby is not removing milk efficiently.

Scheduling or limiting feeds: If breasts aren't relieved as often as they need to be, this can result in mastitis (and decreased milk production). The amount of milk breasts can hold - and how long they can comfortably hold it for - varies hugely between individuals, and changes over time.

Oversupply: Having a lot more milk than you need. Sometimes it's caused by 'overpumping'. Sometimes it just happens - this is more likely with second or subsequent babies. Your baby may get upset, gag, and splutter when your milk releases. They are probably growing very fast. Your breast/s may feel uncomfortably full a lot of the time. If you're struggling with oversupply, LLL Leaders can help.

Suddenly removing less milk than usual: For example, because your baby is ill, sleeping longer, or you are away from your baby.

Weaning: If you reduce the amount you breastfeed faster than your breasts can manage.

Breast injury, e.g. from a too-tight bra, bag or sling strap, breast pump, or seatbelt. Or even sleeping on your stomach.

Bacterial infection in the breast, possibly through an open nipple wound.

Less common causes of mastitis

Previous breast surgery, such as implants

Being under a lot more stress than usual, or extremely exhausted

Being anaemic or having other health conditions that make your immune system work less well

Gut health. Some experts think that imbalances in the 'microbiome' (the bacteria that live in your body) may make some people more likely to get mastitis. The breast has its own microbiome which is affected by many factors, including your diet, antibiotic use, and whether your baby feeds direct at the breast. It's a developing field of research.

Factors that may make mastitis more likely:

Causes of engorgement

your baby is unwell and feeding less than usual, or less than your breasts need

your baby starts sleeping for a longer stretch at night

you are away from your baby and don't express as often as your breasts need.

In the first few days after birth, you may have more engorgement if you were given extra fluids during labour and birth. But engorgement can happen at any stage of breastfeeding if there's more milk than your breast/s can comfortably hold. For example, if:

Take standard doses of an over-the-counter non-steroidal anti-inflammatory medication such as ibuprofen, if you can usually take it. Paracetamol may also be helpful if you're in pain, but ibuprofen is more useful for mastitis, because it also reduces inflammation. Both are safe to take while breastfeeding.

Experiment with cold or cool compresses on the affected area/s between feeds, to see what helps you feel most comfortable. Some cultures and communities advise new mothers to avoid cold in the early week after birth, and to use heat instead - if this is the case for you, see "things to avoid", below.

Remove milk as often as you need to, to keep the breast as comfortable as you can. Feed your baby whenever they want to be fed or continue expressing whenever you would usually express. Offer a feed or express some milk if your breast feels very full and uncomfortable.

Rest as much as you can. Inflammation is tiring for your whole body. Those who have had mastitis often say that they got it when they were under extra stress, or busier than usual - it may be a sign that you need to slow down. Rest is an important part of healing. Taking time off work, or having a partner or support person help you care for your baby can be useful for a few days.

Experiment with different feeding positions. This may help you be more comfortable and help to drain different areas of the breast.

Some experts recommend taking probiotics, or the food supplement lecithin. Check with your healthcare provider, a breastfeeding supporter, or LLL websites for current information.

Contact an LLL Leader or your local LLL group for more information and support.

Start treatment at the first signs of breast swelling or inflammation. It's often possible to deal with it at home without medical help.

Things to avoid

Rough massage of your breasts. This can increase inflammation - and really hurts! If you want to massage while feeding or expressing, use gentle touch, as if you were stroking a cat.

Applying a lot of heat, e.g. hot showers or compresses. Heat can increase inflammation. If a little warmth helps the milk to flow when you're feeding or expressing, or helps you feel more comfortable between feeds, use it for as short a time as possible. Don't direct a hot shower straight at your breast.

Trying to force milk out of the breast won't fix the inflammation and may make it worse.Electric toothbrushes, combs or other devices.

Trying to remove a lot more milk than usual. This can increase the amount of milk you're producing, increasing pressure in the breast. If you need to express more milk than your baby wants, aim to express just enough to be comfortable - not every available drop.

Some of the treatments that used to be recommended for mastitis don't help, and may even make things worse:

My breasts feel full but I can't get milk out - help!

Babies sometimes refuse to feed on a breast that has mastitis. The milk is safe for your baby but may taste different from usual. Your baby may also be objecting to a slower flow of milk - some people notice a temporary supply dip during mastitis. It usually goes back to normal when the breast has recovered. You will need to express milk from the affected breast until your baby is willing to feed on it again.

See Nursing Strikes for ideas to encourage your baby to feed.

Treat the inflammation by taking ibuprofen and perhaps applying a cold compress about 20-30 minutes before you feed or express.

If your baby is struggling to attach because the whole breast is engorged (full and tight), try expressing a little milk before offering the breast to your baby. Or try 'reverse pressure softening': press firmly around the nipple with fingertips or finger lengths for about one minute before feeding. This moves swelling away from the nipple.

Try gentle 'lymphatic drainage' massage (towards your armpit). See Further Reading.

What if your baby will feed, or you're trying to express, but little or no milk is coming out?

Don't panic! Engorgement or mastitis can act like a traffic jam in the breast . These tips can help you get the milk moving again:

Your symptoms are the same after 24 hours, or getting worse

You start to feel ill - shivery, shaky, like you have flu

You have a fever

A patch on your breast has changed colour and is getting larger, or you see streaks on your breast

You see signs of infection, such as a wound that looks crusty or oozes yellow, or your nipple is a different shape, size, or colour from normal.

If you're feeling okay in yourself (you don't have a fever or feel ill), you can try treating yourself at home for 24 hours. If by that time your symptoms are improving, you can continue for another 24 hours.

Get breastfeeding help if you need it. A breastfeeding supporter can help you get your baby deeply and comfortably attached at the breast.

Keep your milk flowing. Avoid too much milk building up in your breasts: feed or express as much as your baby wants, and offer extra feeds or express some milk if your breasts become uncomfortable at other times. If you have a lot more milk than you need, a breastfeeding supporter can help.

Check your breast comfort. Make sure nothing is pressing on the breast (see above, "Why does it happen?")

Watch out for early signs of mastitis and start self-help measures right away.

Contact NHS 111 or your GP straight away if:

You may need antibiotics. The NHS guideline on mastitis says that you should usually be given a 10-14 day course (if you have a shorter course, the mastitis is more likely to come back). If you need antibiotics, it's important to keep up with the self-help treatments above, as well as taking the medication. Let your doctor know if you're still not feeling any better by the third day after starting antibiotics.

Mastitis can be horrible, and make you question whether you can carry on breastfeeding. It's important not to suddenly stop removing milk while you've got mastitis, as this can lead to complications. You need plenty of practical and emotional support, and good medical care if necessary, until you're feeling better.

Written by Jayne Joyce and Justice Reilly

Last updated June 2024

My Baby Won't Breastfeed When a Mother is Unwell
Mastitis
La Leche League International article on mastitis: https://llli.org/breastfeeding-info/mastitis/

References

Baeza, C. et al. 2022. Re: "Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022" by Mitchell et al. Breastfeed Med 2022 17(11):970-971.

Douglas P. Re-thinking benign inflammation of the lactating breast: A mechanobiological model. Women's Health. 2022;18. doi:10.1177/17455065221075907

Mitchell, K.B. et al.; Academy of Breastfeeding Medicine. 2022. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med 17(5):360- 376. Erratum in: Breastfeed Med 2022 17(11):977-978.
Engorgement
NICE Mastitis and Breast Abscess (Clinical Knowledge Summary)
Blebs
Last revised in December 2023 Wilson, E. et al. 2020. Incidence of and risk factors for lactational mastitis: a systematic review. 36(4):673-686.

Zakarija-Grkovic I, Stewart F. Treatments for breast engorgement during lactation. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD006946. DOI: 10.1002/14651858.CD006946.pub4.

Douglas P. Re-thinking lactation-related nipple pain and damage. Womens Health (Lond). 2022 Jan-Dec;18:17455057221087865.
Over-the-counter medication
Mitchell KB, Johnson HM. Breast Pathology That Contributes to Dysfunction of Human Lactation: a Spotlight on Nipple Blebs. J Mammary Gland Biol Neoplasia. 2020;25(2):79-83.

O'Hara, M. A. Bleb histology reveals inflammatory infiltrate that regresses with topical steroids: A case series. Breastfeeding Medicine. 2012

NHS Specialist Pharmacy Service - UK Drugs In Lactation Advisory Service

Using paracetamol during breastfeeding , published November 2023

Using NSAIDS during breastfeeding , published February 2024

Other websites

Academy of Breastfeeding Medicine Clinical Protocol #36:The Mastitis Spectrum, 2022. https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf

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

Breastfeeding Answers Made Simple . Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.

This information is available to buy as a printed booklet from our .

Copyright LLLGB 2024

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Mastitis, blocked ducts, and engorgement - La Leche League GB

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Avoiding and treating mastitis and breast infections

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This information can also be viewed as a PDF by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.

Optimal treatment choiceSwab mother's nipples and baby's mouth to confirm thrushEnsure breastfeeding and particularly latch are pain freeIf swabs positive:Topical treatmentMiconazole oral gel applied gently a small amount of time to baby's mouth four times a dayMiconazole cream applied sparingly to mother's nipples after every feedIf symptoms persistOngoing topical treatment plusOral fluconazole tablets 150-400mg as a start dose and 100-200mg daily

"I had been breastfeeding without problem for 5 months then suddenly developed terrible pains after every breastfeed. I hadn't changed anything and I was very confused. I noticed my baby's tongue was white. The doctor took swabs of my nipples and my daughter's mouth which confirmed we had thrush. It cleared up with treatment within a week" "I was told I had thrush when my baby was 4 weeks old but I could feel her clamping onto my nipple to slow my really fast flow. I went to see someone else who helped me to sort out my baby's attachment at the breast and the pain went without any medicines." "Who'd have thought such pain could stem from just an incorrect latch on. He fed for longer and it definitely didn't hurt as much afterwards. I'll keep on working to improve the attachment."
Signs of thrush in you

Thrush (Candida albicans) infection can affect a mother's breast while she is breastfeeding but it is being over-diagnosed at the moment. Symptoms of thrush are a sudden start of breast and/or nipple pain in BOTH breasts after some weeks of pain free breastfeeding - pain is severe and can last for an hour after EVERY breastfeed. It should be confirmed by a swab of your nipples.

Thrush should not be diagnosed if:

There is pain in only one breast/nipple

You have never had pain free breastfeeding

If your nipples are shaped oddly after breastfeeds

If your nipple is white at the tip after breastfeeds

If the pain is different at different times of the day

If your baby has a tongue tie which you are waiting to have snipped.

bfn.local/differential-diagnosis-of-breast-pain

Creamy white patches in your baby's mouth, on the tongue and may be far back or in the cheeks. Patches do not rub off.

Baby's tongue/lips may have a white gloss

It should be confirmed by a swab of the baby's mouth.

Before treating either you or your baby you should ask the person supporting you with breastfeeding to watch a full breastfeed from the moment the baby goes to the breast to the moment he/she comes away from the breast at the end of the feed. They need to look at your nipples at the end of the feed to look for change in colour and shape

If your baby has a white tongue but you are not experiencing pain, be aware of the risk of thrush but do not treat either of you immediately. Some babies have white tongues in the first few weeks after birth or this may be associated with tongue tie where the milk is not thrown to the back of the mouth.

Diagnosis should be confirmed by nipple swabs cultured for fungal and bacterial infection

BREASTFEEDING SHOULD BE PAIN-FREE from the point of attachment (the moment the baby goes to the breast) onwards. (Pain from thrush begins after a feed). There should be no change in the shape or colour of the nipple after a feed. Even good attachment can often be improved and help to relieve symptoms of pain.

attachment of the baby to the breast may need fine-tuning

eczema including reactions to breast pads or creams

tongue-tie in the baby

Reynaud's syndrome (associated with history of poor circulation and pain made worse when cold)

white spot which produces pin-point pain

bacterial infection which appears as a yellowy, thick discharge

vasospasm which is associated with less than perfect attachment of the baby at the breast and produces white nipples (particularly at the tip)after breastfeeds

Thrush can be passed between you and your baby - and also between you, your partner and other children

Anecdotally some mothers find acidophilus capsules can help to restore bacteria which can keep thrush under control (available from health food stores or chemists)

It is necessary to be very careful with hygiene in order to get rid of thrush completely - be sure to wash your hands well after each nappy change

Use a separate towel for each person in the family

Anecdotally some mothers find reducing the level of sugar and yeast in their diet helps

IMPORTANT - To make sure that you get rid of thrush infection, both you and your baby need treatment. Usually once treatment begins the pain and other symptoms will begin to improve within 2 or 3 days. It may take longer for full recovery.
If there is no improvement at all after 7 days, consult your breastfeeding helper again as the cause of the pain may not be thrush.

previous pain free breastfeeding

positive swabs for candida from maternal nipples and infant mouth

bilateral pain

pain which begins after a breastfeed has finished and continues for up to an hour afterwards

absence of red area on the breast

absence of pyrexia

If a mother reports sore nipples during breastfeeding the first action should ALWAYS be to re-examine and improve attachment. This needs to be carried out by a skilled practitioner.It is unethical to treat a mother and baby with medication inappropriately or unnecessarily, particularly if such use is outside of product licence.

The diagnosis of candidial infections on the breast is difficult. Swabs of the mother's nipples and the baby's mouth are useful to confirm the presence/absence of fungal or bacterial infection (commonly Staph. aureus).

Treatment of the surface of the nipple, the baby's mouth, and oral treatment for the mother (when necessary to treat deep breast pain), should be undertaken simultaneously to achieve relief from symptoms of confirmed candidial infection.

There is evidence that the use of miconazole oral gel is preferable to nystatin suspension with greater efficacy within a shorter period (Hoppe).

In a study the cure rates of nystatin suspension and miconazole gel were shown as:

The risk of using miconazole gel in babies under 4 months relates to the method application rather than the product bfn.local/miconazole

Use of miconazole gel in babies < 4 months is outside of licence application but is preferable due to the greater efficacy. https://pubmed.ncbi.nlm.nih.gov/9076817

Fluconazole oral suspension may be used to treat oral symptoms in the baby (Brent) but use is recommended for infections which do not respond to topical therapy (BNF).

Miconazole 2% cream applied SPARINGLY to the nipple & areola area after each feed. There is some anecdotally reported evidence that using 1% clotrimazole cream as an alternative is associated with allergic reactions and is less effective.

Miconazole gel and nystatin suspension have been reportedly applied to treat nipple candidiasis - they are not pharmacologically designed to penetrate the skin of the nipple and application is unlikely to be effective. Neither miconazole gel nor nystatin should be applied to the mother's nipples bfn.local/miconazole

For nipples which are very red and inflamed a mild steroid cream can be used to facilitate healing (Weiner). Miconazole 2% plus hydrocortisone cream 1% may be useful (Daktacort®)

S. aureus is significantly associated with nipple fissures and a topical antibiotic may be used concurrently with anti-fungal creams if swabs confirm both infections (Weiner).

If symptoms of pain do not improve or deep breast pain develops, oral treatment with fluconazole may be necessary in addition to topical treatment of mother and baby.

Treatment of thrush

Swabs

A swab should be taken using a sterile charcoal media swab and sent to the microbiology lab in a black swan tube requesting a culture for bacterial and fungal growth. The cost is under £5 (personal communication)

Ongoing care with attachment to the breast is vital if mothers and babies are to be treated effectively. Thrush is very frequently diagnosed when poor attachment is the cause of pain, resulting in inappropriate exposure to unlicensed drugs and delay in achieving pain free breastfeeding. Thrush can co-exist with poor attachment and it seems much harder to clear thrush when the nipple is continuing to be damaged at each feed. Attention to improving attachment will help thrush to clear.

Oral treatment for the mother if the pain is severe or deep within the breast after topical treatmentFluconazole is not licensed to be given to lactating women. Practitioners are required to take full liability for use. The amount that gets through in breastmilk is 0.6mg/kg/day. The amount which could be given to the baby within the license is 6mg/kg/day (Hale). Studies on the use in premature babies weighing under 1000g have demonstrated successful outcomes (Kaufman).The dose of fluconazole is 150-400mg as a loading dose followed by 100-200mg daily for at least ten days (Hale, Amir). The World Health Organisation recognises fluconazole as compatible with breastfeeding (WHO) but see below.

The amount of fluconazole passing into breastmilk is less than that given to treat babies with Candida. However in babies under 6 weeks the half-life is 88 hours. Daily treatment of the mother could theoretically lead to accumulation in the baby. (Babies under 6 weeks are not treated with fluconazole daily for this reason). The author has had reports of young babies vomiting or suffering extreme stomach cramps after maternal use of fluconazole, it has also anecdotally led to weight loss due to vomiting.

The experience of the BfN Drugs in Breastmilk Helpline is that many mothers with young babies are treated for thrush without having problems with attachment addressed first.

This is unethical and potentially dangerous to the health of the baby and cannot be supported by BfN or the pharmacist responsible for compiling this information.

A 2004 paper by Francis-Morrill on the Diagnostic Value of Signs and Symptoms of Mammary Candidiasis (J. Hum Lact. 2004;20:288-95) recommended use of a swab moistened in sterile saline, wiped over the area after cleaning the breast with sterile saline. This is not current UK practice (personal communication)Currently the CASTLE study (Amir 2011) is investigating the micro-organisms involved in the development of mastitis and "breast thrush" among breastfeeding women. This study is the first longitudinal study of the role of both staphylococcal and candidial colonisation in breast infections and will help to resolve the current controversy about which is the primary organism in the condition known as breast thrush. This study will also document transmission dynamics of S. aureus and Candida species between mother and infant. In addition, CASTLE will investigate the impact of common maternal physical health symptoms and the effect of breastfeeding problems on maternal psychological well-being.Bibliography

Amir L, Hoover K. 2002, Candidiasis and Breastfeeding, LLLI Schaumberg.

Amir L et al The role of micro-organisms (Staphylococcus aureus and Candida albicans) in the pathogenesis of breast pain and infection in lactating women: study protocol (the CASTLE study) BMC Pregnancy and Childbirth 2011, 11:54

Ainsworth and Jones It sticks in our throats too.BMJ;2009;337:a3178

Andrews JI et al, The yeast connection: Is candida linked to breastfeeding associated pain? Am.J.Obstet Gynec. 2007 197:424.e-1

Brent N., Thrush in the Breastfeeding Dyad: Results of a survey on diagnosis and treatment, Clin Paed. 2001; 40:503-506.

CKS Library Breastfeeding problems - Management. Scenario: Nipple soreness/pain - management.

Francis-Morrell J, Heinig MJ et al, Diagnostic value of signs and symptoms of mammary candidosis among lactating women. JHL 2004; 20:288-95

Fraser DM, Cullen L., Post-natal management and breastfeeding, Current Obstet & Gynecol 2003; 13:127-133.

Hale TW, Bateman TL, Finkelman MA, Berens PD. The absence of Candida albicans in milk samples of women with clinical symptoms of ductal candidiasis Breastfeed Med. 2009 Jun; 4(2):57-61.

Hale T. 2012, Medications and Mothers Milk

Hoppe JE, et al., Treatment of oropharyngeal candidiasis in immunocompetent infants: a randomised multicentre study of miconazole gel vs nystatin suspension, Paed Infec Dis. 1997; 16:288-93.

Jones W Breastfeeding and Medication. 2018 Routledge

Kaufman D, et al., Fluconazole prophylaxis against fungal colonisation and infection in preterm infants, N Eng J Med 2001; 345(23):1660-6.

Morrill JF et al. Risk factors for mammary candidosis among lactating women. J.Obstet.Gynecol. Neon.Nurse. 2005;34:37-45

Hoover, K. The Link Between Infants' Oral Thrush and Nipple/Breast Pain in Lactating Women. Morton, Pennsylvania, 2002

Weiner S., Diagnosis and Management of Candida of the Nipple and Breast. J.Midwif. Women Health2006; 51:125-128

2002, Breastfeeding and Maternal Medication, WHO.

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network May 2020

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

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

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

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What does a let-down feel like?

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

Signs of a fast or forceful let-down

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

Choking, gasping and coughing at the breast

Coming on and off the breast during breastfeeding

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

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

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

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

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

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

Having trapped wind, needing to burp frequently

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

Refusal to breastfeed

Fast let-down and oversupply

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

Why does my baby struggle with the let-down?

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

Attachment and positioning

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

Coordinating suck, swallow and breathe

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

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

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

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

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

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

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

Tips for helping your baby with a fast let-down

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

Check positioning and attachment

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

Try leaning back in reclining positions

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

Try letting the fast flow subside

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

Feed frequently on demand

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

Look for early feeding cues

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

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

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

Burp baby regularly during and after a feed

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

Nipple shields?

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

Adjust your milk supply

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

Try a bottle or cup

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

Seek professional help

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

Summary

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

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

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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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Drugs in Breastmilk factsheets - The Breastfeeding Network

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These factsheets have been compiled by our Drugs in Breastmilk information service team of pharmacists. If you are unable to find the information you are looking for below, or you still have questions, you can contact the team by sending a private message via our Facebook page or via email. Please provide as much information as possible (age […]

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Is My Baby Getting Enough Milk? - La Leche League GB

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How can you tell if your baby is getting enough milk?

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Signs of Effective Feeding- Newborn Days

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Signs of Effective Feeding- Newborn Days

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Signs of effective feeding in the early days - La Leche League GB

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Most babies are keen to feed in the first 90 minutes after they are born especially if they are in skin-to-skin contact with their mum. If your baby is too sleepy to take this first feed or needs medical attention, it’s a good idea to ask your healthcare team to show you how to hand […]

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

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

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

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

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

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

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

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

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

Only swaddle your baby until he can roll over**

Always place your baby to sleep on his back

Do not swaddle tightly across your baby's chest

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

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

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

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

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

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

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

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

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**FREE** Online Safer Sleep For Babies Session-

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**FREE** Online Safer Sleep For Babies Session-

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Book your place on our free, 1 hour online session for more information on reducing the risks of Sudden Infant Death and making you babies sleep space as safe as possible.

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Session Booking - Breastfeeding Together

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Plan and Prepare for Parenthood - Online Session

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Reducing the Risks of Sudden Infant Death

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Reducing the Risks of Sudden Infant Death

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There is still a real stigma around talking about Safe Sleep and Sudden Infant Death. It's really important that families have all the information they need to make informed choices and to enable them to make their babies sleep space as safe as they can. Following Safe Sleep Guidance reduces the risk of Sudden Infant Death.

Please speak to your Health Care Provider if you have any worries or concerns about Safe Sleep.

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The safest cot is a clear cot

The safest cot for a baby is a clear cot. That means removing anything that isn't essential. Babies need just two items in their cot:

It's important to remove anything that isn't essential because items such as toys, blankets and bumpers could cover their face and obstruct their breathing.

When preparing your baby's sleep space, remember:

No pillows or duvets

No cot bumpers

No soft toys or comforters

No weighted or bulky bedding

No products designed to keep your baby in one sleeping position, such as wedges or straps

No pods or nests, rolled up towels or anything soft placed on top of the mattress.

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Safer sleep overview - The Lullaby Trust

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An easy guide to practicing safer sleep for your baby and reducing the risk of sudden infant death syndrome (SIDS, or cot death).

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https://www.lullabytrust.org.uk/safer-sleep-advice

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To reduce the risk of sudden infant death syndrome (SIDS) the safest place for a baby to sleep is in their own clear, flat, separate sleep space, such as a cot or Moses basket. However, we know that many parents find themselves co-sleeping whether they mean to or not. Wherever you're planning for your baby to sleep we recommend making your bed a safer place for baby. Our advice on co-sleeping with your baby will tell you how.

When not to co-sleep

Whether you choose to co-sleep or it is unplanned, there are some key risks you should avoid.
Co-sleeping with your baby is very dangerous if:
In these scenarios, it is always best to put baby in their own safe sleep space, such as a cot or Moses basket. Keeping the cot or Moses basket next to your bed might make this easier.
Never fall asleep on a sofa or armchair with your baby. The risk of SIDS is 50 times higher for babies when they sleep on a sofa or armchair with an adult. They are also at risk of accidental death as they can easily slip into a position where they are trapped and can't breathe.
Co-sleeping more safely

Keep pillows and adult bedding away from your baby or any other items that could cover their head or cause them to overheat. A high proportion of babies who die as a result of SIDS are found with their head covered by loose bedding.

Follow all The Lullaby Trust's other safer sleep advice to reduce the risk of SIDS such as sleeping baby on their back

To reduce the risk of accidents, do not bring other children or pets into bed with you.

Try to make sure or check that baby cannot be trapped, wedged or fall out of bed or get trapped between the mattress and the wall

Never leave your baby unattended in an adult bed

For more info on co-sleeping and safer sleep read our guide for parents
If you are bedsharing with your baby you should consider any risks before every sleep. It is easy for your situation to change if you are unwell or have drunk any alcohol, which means your baby will be safest in a separate sleep space such as a cot or Moses basket on that occasion.

Co-sleeping with your baby: FAQs

I am worried I might fall asleep while I breastfeed my baby at night, is this ok?

Click here to open this question

Breastfeeding reduces the chance of SIDS. If you feel you might fall asleep we would recommend you prepare the bed as described above so it is safer for baby if this happens.

Make sure you know the advice on when never to co-sleep so you know when to take particular care. It is really important that you do not accidentally fall asleep with your baby on a sofa or armchair. If you think you might fall asleep on a sofa or armchair, put the baby down in a safe place to sleep.

Should I co-sleep with my baby?

Click here to open this question

The safest place for a baby is their own separate sleep space, such as a cot or Moses basket. We would just advise you to read all the information on co-sleeping and how to reduce the risks, so you can make an informed decision for you and your baby.

However, there are some circumstances where we would strongly recommend against co-sleeping such as on a sofa or armchair, if anyone in the bed smokes or has drunk alcohol or your baby was premature or a low birth weight.

Can I co-sleep with twins or multiples?

Click here to open this question

If you choose to bedshare with twins or multiples we would advise not to bedshare with more than one baby at a time due to risk of accidents associated with bedsharing with more than one baby or child.

Is it safer to co-sleep using a nest or pod than with a baby just lying on the adult bed?

Click here to open this question

No. We do not recommend that babies sleep on soft surfaces such as pods or nests. If you choose to co-sleep with your baby the safest place is a clear space on a firm flat mattress the same as we would advise with a cot.

Why do you advise against co-sleeping in certain scenarios?

Click here to open this question

It is estimated that around half of SIDS deaths occur whilst co-sleeping, and that most of these are in high risk situations. We do not know the cause of SIDS and why these deaths happen but we do know what some of the risk factors are and that removing those risks greatly lowers the chance of SIDS occurring.

For that reason we strongly advise against co-sleeping when there are risk factors such as a baby being premature or a parent having drunk alcohol.

What bedding should I use for my baby when we co-sleep?
The Lullaby Trust has worked with Public Heath England, Unicef UK Baby Friendly and Basis on two publications to support families with safer sleep advice and advice on co-sleeping more safely. We have also collaborated on a guide for health professionals to have more open and productive discussions with families about safer sleep and co-sleeping. These can be downloaded below.

Click here to open this question

Adult bedding should be kept well away from your baby along with any belts or cords from clothing. Keep adult bedding at your waist height and add an extra layer of clothing if you are cold

A baby sleeping bag is a good way of giving your baby their own bedding when bedsharing.

Baby sleeping bags should be well fitted, so the baby can't wriggle down inside. Most sleeping bags are fitted according to a baby's weight, rather than age.

You might also be interested in reading the two Unicef Baby Friendly publications, which are both endorsed by The Lullaby Trust:

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Some parents choose to share a bed (known as co-sleeping) with their babies. Read our advice on how to co-sleep more safely.

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"In most parts of the world... babies sleep close to their mothers, as they have through most of history." - The Womanly Art of Breastfeeding
A baby is born expecting to stay in close contact with his mother night and day, in order to keep safe, warm and well-fed.
It is perfectly normal for babies-especially breastfed babies-to wake and feed at night throughout at least the first year. Bedsharing when breastfeeding is a traditional way of caring for a baby at night-breastfeeding at night can be a whole lot easier when you take your baby into bed with you and feed lying down.

Breastfeeding mothers who bedshare get more sleep than bottlefeeding mothers and breastfeed for longer. Alternatively, co-sleeping may give your baby the closeness he craves and make breastfeeding easier without sharing the same sleep surface as you.

It is possible to bedshare with twins, but co-sleeping rather than bedsharing is recommended if they were premature or low birth-weight.

Infant sleep-what are the risks?

Accidents

Babies sleep in a variety of places at different times. Wherever a baby sleeps an accidental injury is possible. A baby could become wedged between furniture or against a parent's body, fall off the sleep surface or risk suffocation or strangulation by pillows, cords or blankets.

Anything that reduces your alertness or ability to respond to your baby, such as alcohol, drugs or certain medications, can pose a risk and may impair your judgement.

Breastfed babies orient themselves near their mother's breast in bed. Research shows that mothers who bedshare with their breastfed babies adopt a naturally protective position, making smothering unlikely. This has been referred to as the 'cuddle curl' position.

SIDS

Sudden Infant Death Syndrome (SIDS), or cot death, is a sudden unexpected infant death (usually occurring during sleep) that can't be explained by a medical condition, infection, intentional harm, or accidental causes.

What makes a baby vulnerable
SIDS can happen in any sleep situation, but research has shown that SIDS only happens to baby who are vulnerable. We don't know exactly which factors cause vulnerability, but they include:

baby being less than four months old

prenatal exposure to harmful chemicals including smoke and alcohol

preterm or low brith weight baby (under 2.5kg).

SIDs risk factors
The following factors increase the risk of SIDS for a vulnerable baby, wherever they sleep.

1. Exposure to smoke can affect a baby's ability to rouse from sleep. The risk is related to how much exposure a baby has. It is always a good idea to reduce your baby's exposure to smoke wherever they sleep, but if you are a smoker you should not share a sleep surface with your baby. Smoking is the biggest SIDS risk.

2. Placing a baby on his front to sleep may affect his ability to arouse and to breathe. 'Back to Sleep' campaigns have reduced SIDS in many Western countries. Bedsharing breastfeeding mothers often nurse in a side-lying position-when a baby comes off the breast they naturally rolls onto their back. A baby who can roll back and forth can choose his own sleep position.

3. Being unattended.
During all sleep (daytime and nightime), a baby's risk of SIDS is lower if they are in the same room as you.

4. Formula-feeding (including combi-feeding) imposes a statistically significant higher risk of SIDS.

The Safe Sleep Seven

Breastfeeding mothers who meet the criteria below are statistically low risk and can bedshare with confidence.
You need to be:

1. A non-smoker

2. Sober (no drugs, alcohol, or medications that could make you drowsy)

3. Breastfeeding

Your baby needs to be:

1. Healthy and full term (with a birth weight above 2.5kg)

2. Sleeping on their back when they are not breastfeeding

3. Unswaddled and lightly dressed

You both need to be:

On a safe surface. Never sleep with your baby on a sofa or armchair.

Make an informed decision
Use the information above along with our checklist below to evaluate your baby's different sleeping places and your own family circumstances, to reduce the risk of an accident or SIDS wherever you and your baby sleep.

Meeting Everyone's Needs

If you are struggling to reconcile your own sleep needs with those of your baby, then talking with an LLL Leader may be helpful. At an LLL meeting you can find out how other families meet the sleep needs of their sleep needs in different ways and at different stages.
Find local support here. Call our helpline: 0345 120 2918

Co-sleeping or bedsharing?

Bedsharing: adults and infants sharing the same surface for sleep.

Co-sleeping: parents and infants sleeping in close proximity, but not necessarily on the same surface eg in a bedside cot or a sidecar cot attached to the bed.

Some studies combine sofa sleeping with bedsharing, making it more difficult to separate the risk factors for each scenario. See Further Reading for more details, or for more information on these definitions, see here.

Sleep safely

Sleep tips

Do
✔ Place your baby to sleep on their back.
✔ Keep your sleeping baby close day and night, not in a room alone.
✔ Avoid exposing your baby to cigarette smoke at any time as this increases the risk of SIDS.
✔ Place your baby with his feet to the foot of any cot, crib or pram.
✔ Sleep facing your baby in bed (your thigh should prevent him slipping under the covers).
✔ Check your baby's sleeping place for hazards:

Choose a firm, flat, clean, well-fitting mattress and cover with a close-fitting sheet.

Check for gaps that they might get trapped in..

Ensure they can't fall out.

Choose clothes without strings or ties that could cause strangulation.

✔ Check your baby does not get too hot or too cold whilst sleeping. In hot weather, open a window or use a fan.
✔ Keep pets out of your baby's bed.

NEVER leave your sleeping baby:

✘ Near a fire or radiator, or in full sun.
✘ Wearing warm outdoor clothing when indoors.

NEVER sleep with your baby:

✘ On a sofa or armchair.
✘ If he is swaddled.

Bedsharing tips

Once you can safely and comfortably feed your baby while lying down, you've elimated much of the work of mothering for eight of the 24 hours in a day.

Easy Nights

You may find that different sleeping arrangements work at different times. Being inventive and focusing on how you and your family can get the most sleep tonight can help. Some of these ideas may work for you, but because only you know your own circumstances, always keep safety in mind.

Avoid tumbles by:
* Using a mesh guard rail - but make sure there is no gap between the rail and the bed.
* Taking the legs off the bed or putting the mattress on the floor.

Learn to feed lying down by:
* Practising in the daytime!
* Keeping a low light on.
* Going to a La Leche League meeting and learning from other mothers.
* Watching our video on breastfeeding while lying on your side:

These safety tips apply to healthy full-term breastfed infants. Preterm and low birth weight babies are more vulnerable. If your baby seems unwell, seek medical advice promptly. Remember that safety tips can help reduce the risk of SIDS and accidents wherever your baby sleeps, but cannot eliminate the risk altogether.

Written by Sue Cardus, Karen Butler, Sue Upstone, Bronwyn Davies & mothers of La Leche League GB.

Further Reading

Sweet Sleep: Nighttime & Naptime Strategies for the Breastfeeding Family Wiessinger, West, Smith, Pitman, LLLI. London: Pinter & Martin, 2014.
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Why Your Baby's Sleep Matters, Ockwell-Smith, S. London: Pinter & Martin, 2016.

LLL links:
Rhythms & Routines
Smoking & Breastfeeding
I need some sleep
Other Online information:
Baby Sleep Info Source
UNICEF: Caring for your baby at night. (link to UNICEF PDF)
References
1Sleep patterns and fatigue in new mothers and fathers. Gay et al, 2004.
2Ball, H. L. et al (2016). Bed-sharing by breastfeeding mothers: who bed-shares and what is the relationship with breastfeeding duration? Acta
Paediatrica, DOI: 10.1111/apa.13354.
3Ball, H. L. Parent-infant bed-sharing behaviour: Effects of feeding type, and presence of father. Human Nature 2006; 17(3):301-18.
4Basis. The Triple Risk Model, www.basisonline.org.uk/hcp-the-triple-risk-model/ (accessed 16 Feb 2022)
5SWEET SLEEP: NIGHTTIME AND NAPTIME STRATEGIES FOR THE BREASTFEEDING FAMILY, LLLI. London: Pinter & Martin, 2014; 345-348.
6SWEET SLEEP: NIGHTTIME AND NAPTIME STRATEGIES FOR THE BREASTFEEDING FAMILY, LLLI. London: Pinter & Martin, 2014; 9.
7Basis. Definitions of Terms Used on This Site, www.basisonline.org.uk/hcp-definitions-of-terms-used-on-this-site/ (accessed 16 Feb 2022)

ACADEMY OF BREASTFEEDING MEDINCINE. ABM Clinical Protocol #6: Bedsharing and Breastfeeding 2019., Accessed 16th Aug 2020

You can buy this information in printed form from the LLLGB shop .

Copyright LLLGB 2022 (updated March 2022)

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Safer Sleep & the Breastfed Baby - La Leche League GB

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"In most parts of the world... babies sleep close to their mothers, as they have through most of history." - The Womanly Art of Breastfeeding A baby is born expecting to stay in close contact with his mother night and day, in order to keep safe, warm and well-fed.

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Pregnant mums, and those giving/wanting to give breastmilk to their babies, are welcome to drop-in to socialise and meet other mums and access breastfeeding support if they need it. Our groups are friendly and welcoming and there's no need to book- just turn up!

Free parking available at all sites, with refreshments and plenty of toys out for older children/siblings.

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But there are lots of things you can do to help.

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Some parents bond with their baby immediately, while others find it takes more time...

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Some parents bond with their baby immediately, while others find it takes more time...

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5 ways to make feeding comfortable for you and your baby

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"As long as you are comfortable and your baby is nursing successfully, use what works for you."

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Positioning Baby at the Breast- La Leche League

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Positioning Baby at the Breast- La Leche League

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Breastfeeding is a gift you can give your baby. A healthy, full term baby is likely to know instinctively what to do at the breast.

During the early weeks skin-to-skin contact helps your baby connect to their instinctive breastfeeding skills and helps you and your baby enjoy breastfeeding. Each person discovers what works for them, and what works for one may not work for another. Mary Renfrew wrote in Journal of Human Lactation that learning to breastfeed is like mother and baby learning a dance. Use what works in these suggestions and tailor them for you and your baby. Trust that you know what works for you and your baby. You will know when the positioning is ideal for you, when you and your baby are comfortable. When positioning is right for you, your nipples stay healthy and your baby can feed most efficiently. Concern about sore nipples or breastfeeding comfortably is a common reason to contact La Leche League. Improving positioning helps eliminate many cases of sore nipples.

You may have noticed this description is long. Be assured that many nursing parents have successfully accomplished breastfeeding their babies for centuries and you too will learn how to best position your baby. These suggestions are not meant to tell you that if you follow all the steps the position will be "right". The suggestions are meant to gives you ideas on how you and your baby can learn to breastfeed and enjoy the breastfeeding experience.

However, like other seemingly simple tasks, it takes a lot of words to describe what other mothers have found works well for them. LLL Leaders are experienced in guiding mothers and other nursing parents through the positioning process. If you feel overwhelmed by preparing to breastfeed your baby, contact your local Leader for information and support. They will be happy to simplify matters for you.

In the first three to five days after birth, if you experience nipple soreness beyond a slight tenderness when your baby latches on, it may be a sign that something isn't right with the baby latch, position, or suck. An adjustment to the latch or positioning can help your baby be more comfortable. When you have mastered the "dance" of breastfeeding, sore or cracked nipples are allowed to heal.

If nipple pain worsens after the early days of breastfeeding your nipple pain may be due to other causes like thrush, bacterial infection, or tongue-tie. Contact an LLLeader for help if you need further assistance to improve your sore nipples. See information on sore nipples for more information.

Learn to recognize your baby's early feeding cues so you have time to get in a good position before he becomes desperately hungry. Early cues include your baby opening their mouth, moving their head side to side - also known as the rooting reflex or sucking on hands and fingers. Don't wait for baby to cry to let you know they are hungry. Crying is a very late hunger cue.

Basic Steps for Positioning

We will discuss several different positions. If you have pain or feel uncomfortable, try a different position. Adjusting the position can significantly improve breastfeeding pain.
Some general tips are:

1. Position yourself comfortably with back support, pillows supporting your arms and your baby, and your feet supported by a footrest or a large book.

2. Position your baby close to you, with their hips flexed, so that they do not have to turn their head to reach your breast. Their mouth and nose should be facing your nipple. Their body should be so close that they is touching you. If possible, ask a helper to hand you your baby once you are comfortable.

3. Support your breast so it is not pressing on your baby's chin. Your baby's chin should touch your breast, then the baby's nose.

4. Attach or latch your baby onto your breast. Encourage your baby to open their mouth wide and pull your baby close by supporting their back (rather than the back of their head) so that your baby's chin touches your breast first. His nose will be touching your breast. Your hand forms a "second neck" for your baby.

5. Enjoy! If you are feeling pain, detach your baby gently and try again.

These steps may need to be repeated frequently during the early weeks. You and your baby will find a technique that works for you after some practice.

Going Beyond the Basics

As you and your baby become more experienced at breastfeeding, you will find that breastfeeding positions can be altered in many ways, even from feeding to feeding. As long as you are comfortable and your baby is nursing successfully, use what works for you. Try experimenting with the four positions below.

Remember, in any of these positions, it is usually important to bring your baby to your nipple height.

Leaning over your baby can often cause backaches, neck/shoulder strain or sore nipples.

Laid-back Breastfeeding or Biological Nurturing

Laid-back breastfeeding, or Biological Nurturing, means getting comfortable with your baby and encouraging you and your baby's natural breastfeeding instincts.

Dress yourself and your baby as you choose. You and your baby skin-to-skin is good option too.

Position yourself comfortably in bed, on the couch, or in a recliner with back support, and pillows to also support your head, shoulders, arms. Lean back, with your pillows for support. When you comfortably lean back, and put your baby on your chest, gravity will keep your baby in position with their body molded to yours.

Let your baby's cheek rest somewhere near your bare breast. Rub your nipple on your baby's upper lip to encourage them to open wide. Bring your baby close. Have their chin touch your breast first, and then their nose will touch your breast.

Position your baby close to you, with hips flexed, so that they do not have to turn their head to reach your breast. Your baby's feet need to be supported by your body so they don't dangle in the air.

Use one hand to hold your breast as needed and the other hand to support baby's thigh or bottom.

If you feel pain, detach your baby gently by using your finger to touch the corner of your baby's mouth and try again.

Relax and enjoy each other.

Cradle Position

The cradle position is most commonly used after the first few weeks. The cross-cradle position (see below) gives you more control.

To nurse your baby while cradling or holding them across your lap, your baby should be lying on their side, resting on their shoulder and hip with their mouth level with your nipple. The whole front of their body should touch the front of your body.

Use pillows to lift your baby and support your elbows to bring your baby up to nipple height, especially during the first few weeks.

Support your breast with either the "U" hold" or "C" hold as described in the "Breast Support Techniques" section below.

Your baby's head will be on your forearm and their back will be along your inner arm and palm. When you look down, you should see his side.

Your baby's mouth should be covering at least a half inch of the dark area around your nipple. Make sure your baby's ear, shoulder and hips are in a straight line. As a newborn, your baby's head and bottom should be level with each other.

Cross-cradle Position

During the early weeks, many mothers find a variation of the cradle position, called the cross-cradle position to be useful.

To nurse your baby in this position, your baby is supported on a pillow across your lap to help raise them to your nipple level. Pillows should also support both elbows so your arms don't hold the weight of your baby; they will tire before the feeding is finished.

If you are preparing to breastfeed on the left breast, your left hand supports that breast in a "U" hold. If you are breastfeeding on the opposite breast, reverse hand used. (See the "Breast Support Techniques" section of this FAQ for a description of this hold.)

Support your baby with the fingers of your right hand.

Do this by gently placing your hand behind your baby's ears and neck with your thumb and index finger behind each ear. Your baby's neck rests in the web between the thumb, index finger and palm of your hand, forming a "second neck" for baby. The palm of your hand is placed between your baby's shoulder blades.

As you prepare to latch your baby on to you, be sure their mouth is very close to your nipple from the start.

When your baby opens their mouth wide, you push with the palm of your hand from between the shoulder blades. Their mouth will be covering at least a half-inch from the base of your nipple.

Clutch or Football/Rugby Position

This is a good position if you have had a Cesarean birth, as it keeps the baby away from the incision. Most newborns are very comfortable in this position. It also helps if you have a forceful milk ejection reflex (let down) because your baby can handle the flow more easily.

In the clutch position you support your baby's head in your hand and their back along your arm beside you. You support your breast with a "C" hold. (See "Breast Support Techniques" section of this FAQ for a description of this hold.) Your baby is facing you, with their mouth at nipple height. Your baby's legs and feet are tucked under your arm with their hips flexed and their legs resting along your back so the soles of their feet are pointed toward the ceiling. (This keeps your baby from being able to push against your chair.) Pillows help bring your baby to your level.

Side-lying Position

For some people, this position works best after the early days of breastfeeding. The other positions may be easier to learn first. Practicing this position during the daytime can be very helpful.

You may find lying down to nurse is a comfortable position, especially at night. Both you and your baby lie on your sides facing each other. You can use pillows behind your back and behind or between your knees to help get comfortable. A pillow or rolled blanket behind your baby's back will keep them from rolling away from you. Your baby can be cradled in your arm with their back along your forearm. Having your baby's hips flexed and their ear, shoulder and hip in one line helps your baby get milk more easily.

Breast Support Techniques

As you hold your baby in any of the above positions, you may need to support your breast with your free hand. This removes the weight of your breast from your baby's chin, allowing them to breastfeed more effectively.

"C" hold-See the cradle hold illustration above. Support your breast with your thumb on top, away from your areola (the darker skin surrounding the nipple) and the fingers underneath. Your fingers should also be well back from your baby's mouth. This hold is helpful when breastfeeding in the clutch or football position as well as the cradle position.

"U" hold-Place your fingers flat on your ribcage under your breast with your index finger in the crease under your breast. Drop your elbow so that your breast is supported between your thumb and index finger. Your thumb will be on the outer area of your breast and your fingers will be on the inner area. This hold is helpful when breastfeeding in the cradle and cross-cradle positions.

Is My Baby Latched on Well?

When latching on your baby, use your nipple to tickle the center of your baby's bottom lip. This will encourage your baby to open their mouth wide (like they are yawning). Aim your nipple slightly towards the roof of their mouth, bringing your baby to you, chin first.

Good latch-on checkpoints for your baby include:

Your baby's nose is nearly touching your breast, that is, no further away than a credit card edge

Your baby's lips are flanged

At least ½ inch of your breast around the base of your nipple is in your baby's mouth.

If the latch is uncomfortable or painful, gently place your finger in your baby's mouth, between his gums, to detach him and try again.

A baby who is offered the breast will suck without swallowing as they position the nipple in their mouth and tells your breast they are ready for the milk to let down. When your baby begins to receive milk, you will see their jaw working all the way back to their ear. your baby's temples will wiggle. You will also hear them swallowing, quickly at first, then more slowly, as their appetite is satisfied.

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Breastfeeding Positions, Latch, and Positioning

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Learn about breastfeeding positions, including the importance of the latch, steps for positioning, and common breastfeeding positions with images and tips.

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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. Expressing small amounts […]

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There are lots of different ways you contact us, please get in touch for support!

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Pregnant mums, and those giving/wanting to give breastmilk to their babies, are welcome to drop-in to socialise and meet other mums and access breastfeeding support if they need it. Our groups are friendly and welcoming and there's no need to book- just turn up!

Free parking available at all sites, with refreshments and plenty of toys out for older children/siblings.

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Log on to our Website every evening between 7pm-10pm to chat with our experienced and knowledgeable Peer Supporters. They can support you with any questions you may have about infant feeding.

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Simply search 'Breastfeeding Together Connect and Share UK

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Closed Facebook Page- Join for Pregnancy and Infant Feeding Support

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Closed Facebook Page- Join for Pregnancy and Infant Feeding Support

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Don't forget to answer the joining questions!

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There is still a belief that it's normal for breastfeeding to hurt. Well...breastfeeding SHOULDN'T hurt. If it does hurt, then there's usually a reason why, it's not normal!

The first thing to look at is your positioning, and how we bring baby to the breast. Sometimes the smallest of tweaks can make a huge difference. When a baby breastfeeds, we need them to open their mouth wide, take in a mouthful of breast tissue as well as the nipple, to get the nipple to the soft bit of the palette at the back of the throat. Nothing should touch a nipple when a baby latches and sucks, hence why breastfeeding shouldn't hurt. It's important to enable baby to open their mouth wide, not pushing the head into the breast.

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Paced bottle feeding is a technique used to mimic a babies behaviour at the breast so some of those benefits we discuss can be carried over to bottle feeding-

*Reduces overfeeding

*Leaves baby more in control of the feed

*Less instances of wind

*Less instances of vomiting after feeds

*Baby is more settled after feeds

*Reduces the risk of baby developing a preference for the bottle

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We offer lots of free services to support families through pregnancy and once their baby arrives.

Please contact us for more information.

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Peer Support is recommended by the World Health Organisation

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Breastfeeding Peer Support aims to fill a gap by linking mothers who want to breastfeed to others who have personal experience and some training.

Peer support is recommended by the World Health Organisation and forms part of UK NICE guidance on maternal and child nutrition and on routine postnatal care.

The UNICEF UK Baby Friendly Initiative standards require that additional support such as peer support is provided and that services work together to ensure that mothers can get additional help as needed.

All of our Peer Supporters are mothers, they have given breastmilk to their own child/ren and have undertaken additional support to enable them to support others.

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Colostrum Harvesting

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Babywearing is a great way to bond with your baby, helps you get out and about, and brings comfort to your baby.

However, it is important that you do so safely. You should always follow the T.I.C.K.S. rule and speak to a qualified Babywearing Consultant for fit checks. If you are breastfeeding whilst babywearing it is vital that you return baby to the original position after the feed and monitor baby at all times.

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It is normal for babies to cry, as upsetting as it can be for parents.

Comforting methods may help (babywearing, breastfeeding, bathing, going for a walk in the pram, etc).

It’s ok to walk away if you have checked the baby is safe and the crying is getting to you. After a few minutes when you are feeling calm, go back and check on the baby.

Never shake a baby.

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Our Peer Supporters provide emotional support as well as practical support. Getting out of the house, meeting other new mums and being able to talk can provide some much needed respite.

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In addition to our indoor groups, we also run walking groups across Bolton and Wigan. Being active is great for your wellbeing, the walks are taken at a leisurely pace and our Peer Supporters are on hand with emotional and practical support.

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In addition to having information about baby development, the Tiny Happy People website has a collection of articles regarding parental mental health and wellbeing.

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We caught up with The Psychology Mum, Dr Emma Hepburn for a set of practical ideas parents can use to help with feelings of stress, anxiety and generally feeling overwhelmed. Read on for some useful ideas you can build into your day to day life as a parent - just click on the images and then click the labels to explore the activities.

Capacity Cup

Have you had a cup of tea or coffee recently? There's only so much you can fit in the cup until it overflows. Just like our cup, we all have limited capacity and if we take on too much we overflow, resulting in feeling overwhelmed, stressed, anxious, and irritable. Too much stress for too long can impact on our mental and physical health, so it's important to be aware of your stress levels and manage this when you can. You can visualise how much you're able to take on as a cup that's filling up.

As a parent, there are lots of demands on you. It's important to notice how full your cup is and take action to manage this before it overflows. What are your signs that you are in the different zones? How do you know you are in the red zone and close to spilling over?
Click on the labels to explore ways in which you can take action to increase the space in your cup:

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Compassionate thoughts

Parenting young children can be stressful, and every parent is learning on the job. It seems that when you become a parent, guilt and worry come along as part of the picture. This is partly because your brain has an instinct to pick up threats, and this is heightened when it comes to your children. When we add stress, uncertainty and sleep deprivation into the mix this can result in us being more sensitive to negative information and more critical of ourselves.

Critical thoughts about ourselves make us more stressed. However, kind thoughts about ourselves help to reduce stress. Most of us have an inner critic waiting to punish us, so how can we look at developing more kind thoughts instead?
Click on the labels to find ways to manage your critical thoughts and develop more compassionate thoughts:

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Tiny Moments of Relaxation

Parenting is a demanding job, that means we are busy nearly all the time and can have very little time to think about ourselves or our own needs. This can create stress and have an impact on how we feel. However, because we are so busy, doing things to look after your mental health can feel like another thing to add to the already overwhelming to-do list, so it gets forgotten about.

However, looking after your mental health doesn't require big tasks and doesn't need to take lots of time. Even adding tiny moments of relaxation into your day can help manage stress and have a positive impact on how you feel. These tiny moments can help us respond better to stress and calm us down. They can also create positive emotions that help us feel good in our mind and body, and the effects can last longer than the moment itself.

Tiny moments can also be about taking time to nurture yourself - drink some water, take a nap if possible, or eat something that gives you the boost you need. Fitting in or planning for a few tiny moments throughout the day is a simple and manageable way to help you look after your mental health proactively.
Click on the labels to explore different types of relaxation that are good for your mind, body and soul:

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For more ideas, check out The The Psychology Mum on Instagram.

If you're struggling with your mental health, the BBC Action Line has links to organisations that may be able to provide help.

More wellbeing advice for parents and early years children

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Mental health tips and coping strategies for parents

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You can't pour from an empty cup. Try out three well-being activities for parents from Dr Emma Hepburn.

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Families Together offers families in Bolton support with parenting.

The Solihull Approach Parenting Groups are designed for parents who would like a better understanding of responsive and effective parenting techniques - this is open to all parents or carers in Bolton with a child under 3.

Through the iThrive programme Families Together offer peer support to parents whose children may be having mental health difficulties (either diagnosed or not). This support is via a drop in group or one to one sessions and can be tailored to meet your needs.

For more information please call 07514 484157.

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Empowering Families Through Peer Support

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Parenting can be one of the most rewarding journeys, but it can also feel overwhelming at times. That’s where Family Hubs come in. Across Bolton, Family Hubs are creating welcoming spaces where families can access support, build connections, and find everything they need in one place.

What are Bolton Family Hubs?

Bolton Family Hubs are community-based centres designed to support families from pregnancy through to young people aged 19 (or up to 25 for those with additional needs). They bring together a wide range of services under one roof, making it easier for families to get the help they need, when they need it.

Rather than navigating multiple services in different locations, Family Hubs provide a “one-stop shop” approach, supporting not just children, but the whole family.

What support is available?

Family Hubs offer a wide variety of services tailored to different stages of family life. These include:

Antenatal support and preparation for new parents

Infant feeding and breastfeeding support

Stay-and-play sessions and activities for babies and children

Health visiting and wellbeing support

Parenting advice and guidance

Support for children with Special Educational Needs and Disabilities (SEND)

Help with housing, finances, and cost of living challenges

Many hubs also provide access to digital support, including free internet access and devices, helping families stay connected and access essential services.

A network across Bolton

Bolton now has a full network of Family Hubs located across the borough, making support accessible in local communities. These include:

Alexandra

Bright Meadows

Farnworth

Great Lever

Harvey

Oldhams

Oxford Grove

Tonge

Each hub offers its own timetable of activities, from baby groups and walking sessions to wellbeing clinics and peer support groups.

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Bolton Council's website provides information, advice and services for residents, businesses and visitors to Bolton.