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Leah - leah.j.carter@icloud.com

NCT Breastfeeding Counsellor

or

Infant Feeding Line

0300 330 0700 (Option 1)

Open 8am to Midnight Everyday

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Accessing local support services can make all the difference to your feeding journey.

NCT Kent Infant Feeding Peer Support offers friendly, non-judgmental, free, infant feeding support, for parents during pregnancy through to the early stages of parenthood, run by parents who understand the challenges it can bring.

Our trained peer supporters, with their own experiences, are committed to making sure parents feel supported and connected, during pregnancy and throughout those initial early weeks of parenthood. It's also a great way to meet other parents going through similar experiences. We're here to welcome you into our community.

Our groups start from 5th January 2026 across Kent. You can find details of where to find us on the below timetables:

Please also check Beside You for any changes to time and locations of the groups.

Connect with us on our social media channels below to be kept updated of where you will find us:

If you want to get in touch, email us at kentsupport@nct.org.uk.

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Kent Infant Feeding Peer Support | About us | NCT

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NCT Kent Infant Feeding Peer Support offers friendly, non-judgmental, free, infant feeding support, for parents during pregnancy through to the early stages of parenthood, run by parents who understand the challenges it can bring.

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What Infant Formula to Choose & Responsive Bottle Feeding

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What Infant Formula to Choose & Responsive Bottle Feeding

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Unicef

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How much formula does my baby need?

Newborn babies need quite small amounts of formula to start with. The amount will vary from baby to baby.

Although most babies settle into a feeding pattern eventually, they vary in how often they want to feed and how much they want to drink.

Feed your baby when they show signs that they want it. Babies tend to feed little and often, so they may not finish their bottle. Having a big feed does not mean your baby will go longer between feeds.

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

Your baby's weight gain and the number of wet and dirty nappies will tell you whether your baby is getting enough formula.

Your baby should have around 6 wet nappies a day from a few days after the birth. Nappies should be wet with clear or pale yellow urine, or feel heavy.

For the first day or two after birth, your baby will pass a dark, sticky substance known as meconium. Within the first week your baby should start to pass pale yellow or yellowish brown poo. They should be having at least 1 poo a day.

Your baby will usually be weighed at birth and again in the first week. After that, healthy babies only need to be weighed at 8, 12 and 16 weeks, and again at 1 year.

This information should be entered on a chart in your personal child health record (PCHR) or "red book".

Read more about the personal child health record (red book) in Your baby's health and development reviews.

If you have any questions or concerns about your baby's weight gain, speak to a midwife or health visitor.

How will I know if my formula-fed baby is hungry?

After a while, you'll get to know the signs that show your baby is ready to feed.

For example, your baby may:

start to get restless

begin to turn their head and open their mouth (rooting)

find something to suck - usually their fist or fingers

Try to feed your baby before they cry, as this is a late sign of hunger.

What do I need if I'm formula feeding away from home?

If you need to feed your baby away from home, take with you:

a measured amount of formula powder in a small, clean and dry container

a vacuum flask of hot water that's just been boiled

an empty sterilised feeding bottle with cap and retaining ring in place

The vacuum flask does not need to be sterilised, but it should be clean, and only used for your baby. The boiling water should kill any bacteria present in the flask. If the flask is full and sealed, the water will stay above 70C for several hours.

Make up a fresh feed only when your baby needs it. The water must still be hot when you use it, to destroy any bacteria in the formula powder.

Remember to cool the bottle (with the lid on) under cold running water before you feed it to your baby.

If you cannot follow the advice for making up a feed away from home

If it's not possible to follow the advice for formula feeding away from home, you should use a carton of ready-to-feed liquid formula.

If you have no other option, you might need to transport a feed as a one-off. To reduce the risk of infection, follow these instructions carefully, but do not do this regularly.

Prepare the feed at home, cool under a running tap or in a bowl of cold water, and put it in the fridge to cool.

Make sure the feed is cold. Take it out of the fridge just before you leave and carry it in a cool bag with an ice pack, and use it within 4 hours. If you do not have an ice pack, or access to a fridge, the made-up infant formula must be used within 2 hours.

If the formula that you made up at home is stored:

in a fridge - use within 24 hours

in a cool bag with an ice pack - use within 4 hours

at room temperature - use within 2 hours

Read more about how to make up baby formula

Can I use bottled water to make up infant formula?

Bottled water is not recommended for making up infant formula feeds for your baby. This is because it's not usually sterile and may contain too much salt (sodium) or sulphate.

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Information and advice on formula feeding, including how much formula to give your baby, how many wet nappies they should have and how to handle feeds away from home.

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Mixed feeding: combining breastfeeding and bottle feeding | NCT

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

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Skip to main content

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

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

Problems viewing this video? Contact us.

Find more resources

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Hand expression video - Baby Friendly Initiative

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

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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.

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Global Health Media- Attaching your baby at the breast

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Global Health Media- Attaching your baby at the breast

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Attaching Your Baby at the Breast – Breastfeeding Series

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Many parents are concerned that their baby may be tongue-tied. Many breastfeeding problems are blamed on tongue-tie. Almost everyone has a lingual frenulum, or bit of tissue under the tongue that helps connect the tongue to the floor of the mouth. The most important thing is that the tongue can move properly.

Most breastfeeding problems are caused by misunderstanding what babies need. Help with positioning and latch is the first step to improving breastfeeding. LLL meetings, LC consultations, breastfeeding or baby cafs are all good resources for getting individualized help.

Some tongue-tied babies can make breastfeeding work. Even if your baby has an obvious tongue-tie, first get help from a lactation professional.

Most professionals agree that a tight frenulum that attaches to the tip of the tongue can make it more difficult for babies to feed. These tongue-ties can be easy to treat in a doctor or dentists office. Figure 3 shows a very tight frenulum that experts agree needs treatment.

There is more controversy about babies who do not have good tongue mobility but do not have a tight frenulum at the front of the tongue. New anatomy research suggests that tight fascia (the soft tissue that joins body structures) may be responsible. Depending on the cause of the tightness, therapy may be the best option. Physical therapy is best studied for neck muscle imbalances caused by the babys position during pregnancy, other body work may be helpful as well.

Heres how you can look at your own babys tongue movements:

The first thing to assess is whether your baby can stick out his or her tongue. If you touch your baby's lips, he will probably open his mouth. You can then touch the front of his lower gum with your fingertip. This makes him stick the tongue out. We want to see the tongue come out flat over the lip without denting or dimpling.

Next, we want to see if your baby can lift her tongue way up to the roof of the mouth. All the way up is perfect, half way is enough for most babies to be able to breastfeed. Again, her mouth should be open when you check if the tongue can lift up.

Tongue-ties:

This baby (figure 3) has an obvious tongue-tie. You can see the membrane right at the front of the tongue, and you can see how it makes it hard for him to lift his tongue up.

figure 3: obvious tongue-tie

Babies with a tight frenulum may have a notch in the tip of the tongue when they try to move the tongue (figure 4). This is also called a "heart-shaped" tongue. Some babies have a notch but can still lift the tongue normally. Remember we want to look at the whole baby and not just one feature.

Babies with a tongue-tie will often raise the sides of the tongue while the front of the tongue pulls downward toward the floor of the mouth. Professionals call this a "low tongue posture". See (figure 5)

figure 5: low tongue posture

Babies with restricted or weak tongue movements will have a high, narrow roof of the mouth (figure 6). This is an important "double check" or confirmation that the tongue is not moving well. There are other reasons to have a high or narrow palate too, such as being in a position during development that prevented the baby's head from expanding side to side.

Having a shorter lower jaw than average can affect tongue strength. This baby (figure 7) does NOT have a tongue-tie. Dividing the frenulum when the real reason for sucking problems is a short jaw or muscle tightness in the face or neck will not help and can often make the problem worse.

Again, if your baby does seem to be tongue-tied, please get lactation help first. Some tongue-tied babies are able to breastfeed without treatment with some special help latching on. An IBCLC should also be able to help determine whether a breastfeeding problem is from a tongue tie or is from poor latch or positioning, a short jaw or tight muscles and communicate these findings with your baby's primary health care provider.

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Many parents are concerned that their baby may be tongue-tied. Many breastfeeding problems are blamed on tongue-tie. Almost everyone has a lingual frenulum, or bit of tissue under the tongue that helps connect the tongue to the floor of the mouth. The most important thing is that the tongue can move properly.

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From Bump to Breastfeeding: Baby Graphic

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Skin-to-skin contact - Baby Friendly Initiative

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Skin-to-skin contact is important for babies and mothers to develop close, loving parent-infant relationships and to initiate breastfeeding.

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Getting off to the best possible start can play a key part in your breastfeeding journey.

Four key factors have been identified by WHO and UNICEF as being important in establishing and sustaining breastfeeding:

A breastfeed within the first hour of life - skin-to-skin contact after delivery can help to get this started.

Exclusive breastfeeding - breastfed babies do not need any other food or drinks, including water for at least the first six months.

Breastfeeding when your baby displays signs of being hungry, such as sucking fingers and licking lips, and for as long as your baby wants i.e. until your baby comes off the breast by themselves and has completed the feed.

Avoiding the use of bottles, teats or dummies, including nipple shields.

Some ideas to help you find more information include:

Read and download the NHS and UNICEF leaflet Off to the Best Start or the NHS Health Scotland leaflet Off to A Good Start for good general information including skin to skin and the first feed.
Think about going along to a local drop-in group where you can talk to other breastfeeding mums about their experiences. Find out here if there is a group near you.
Bookmark or favourite the BfN and National Breastfeeding Helpline websites on your phone, laptop or tablet so you can always find our helpline numbers or access our online chat facility. You could even give them a call if you would like to speak to someone while you are pregnant.

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Getting started with breastfeeding - The Breastfeeding Network

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Getting off to the best possible start can play a key part in your breastfeeding journey. Four key factors have been identified by WHO and UNICEF as being important in establishing and sustaining breastfeeding: Some ideas to help you find more information include: Read and download the NHS and UNICEF leaflet Off to the Best [...]

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ABM-Using a nipple shield with breastfed baby

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ABM-Using a nipple shield with breastfed baby

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A nipple shield is a flexible silicone nipple that is worn over the mother's own nipple during breastfeeding.
When are they used?
Nipple shields can help establish breastfeeding with some babies who seem to have difficulty achieving and/or maintaining attachment to the breast. However, very few benefit from using a nipple shield. Please consult a breastfeeding counsellor or health professional for one-to-one support before you use a nipple shield. A nipple shield can be a temporary solution but not a permanent fix to an underlying problem. They may affect transfer of milk to the baby which may contribute to poor weight gain and health problems for both mother and baby.
What might cause my baby to have difficulty with attachment?

Events around labour and delivery.

Use of artificial nipples.

Baby's physiology.

Other reasons a shield could be used:

Flat or inverted i.e. non protractile nipples.

Breast refusal.

Sore, cracked, bleeding nipples.

Weaning a baby from bottle to breast.

Re-lactation or induced lactation (adoptive breastfeeding).

Before using a nipple shield, consider:

Accessing skilled breastfeeding support, ideally face-to-face.

Prolonged skin contact, and 'biological nurturing' i.e. laid-back breastfeeding techniques.

Hand expressing drops of milk onto the nipple to tempt the baby to attach.

Regular (2-3 hourly) hand expressing of colostrum to protect milk supply.

Regular (2-3 hourly) feeding of expressed breast milk (EBM) via syringe/cup.

Trying different positions/techniques e.g. cross cradle hold and exaggerated attachment, lying down feeding, underarm hold.

Applying cold to a soft nipple to firm it.

Use of nipple massage, gentle use of breast pump or other suction device to draw nipple out.

If milk is in, deal with any engorgement to soften areola to facilitate attachment.

When breastfeeding is uncomfortable, using a nipple shield can feel like a quick fix, but shields are not a substitute for finding qualified breastfeeding support. If there is an underlying latching problem, adding a shield on top can risk blocked ducts and mastitis, supply reduction, and a baby not getting enough milk. Feeds can end up being long and unsettled and baby may take in more air. When the shield is removed, the underlying problems remain, and may even be worse as the baby has become accustomed to using the shield. Always try and find qualified help if breastfeeding is uncomfortable or challenging.
Care
Wash the shield with hot soapy water, rinse with clean water, dry carefully and store in a clean container.
Choosing a shield
Nipple shields are sized according to the diameter of the base of the mother's nipple. A poorly fitting shield can cause problems including reduced milk transfer and pain.

In the U.K., the standard sizes are 16mm (small), 20mm (medium) and 24mm (large). A larger 28mm size is available online but can be difficult to find.

The size of shield you use is not the same size as the pump funnel you use. Shields are a closer fit. Many shops will only sell one size and you may have to shop online to get a wider selection.

A 'contact' nipple shield has a cut away piece that allows baby's nose or chin to remain close to the breast. This is preferable to a shield where the baby's nose is pressed against plastic.
How to use a nipple shield
It's often helpful to place your baby in skin to skin contact well before you attempt a feed. This will stimulate baby's instinctive feeding behaviours and make attachment to the breast more likely to be successful.

First, try latching the baby without the shield if you feel you can. How long you spend trying to latch effectively without the shield is a very personal decision and will depend on how long ago the baby fed, the support you have, and how breastfeeding has been going in the past.

A warm wet shield sticks to the breast better - run the shield under warm water prior to use.

Roll the wet, warm shield back about halfway down the shank of the shield.

It may adhere to the breast better if you apply a little water or breastmilk around the edge.

Roll the shield back onto the breast so the nipple is drawn into the teat of the shield.

There are some videos online that show you how to apply a shield with this 'slightly inside out' method.

Attachment
Attachment technique is still important with a shield. Don't just poke the shield teat centrally into baby's mouth. Baby should be held close, mouth wide open and chin in contact with the breast. Once attached, you should notice their chin moving deeply to show active swallowing and you will often hear some swallowing at the beginning of a feed.

Towards the end of the feed (when baby's swallowing slows) it is a good idea to use breast compression while baby suckles to increase the milk and fat transfer to the baby. Offering baby both breasts at each feed will mean baby gets more milk.

The nipple shield is a projection of the nipple so, when the baby unlatches, it should look well rounded, just as though baby had a good latch directly at the breast. You should see milk in the shield when baby comes off. As using a shield is often associated with reduced milk transfer, it can be recommended to express in addition, to help protect your supply. Your breastfeeding counsellor or health professional can support you to consider how often this is needed, depending on how things are going.

It's a good idea to keep an especially close eye on baby's bowel movements and urine output while you're using a nipple shield, as these give an indication of milk intake. Baby should have about three tablespoon-sized yellow, grainy stools in 24 hours (after the fifth day) and have at least six wet nappies.

If baby is discharged from hospital using nipple shields, their progress should be closely monitored by the community midwife or health visitor.
Weaning from a shield
Be sure not to make this a battle with your baby, or they will resist more. Don't obsess with weaning off the shield to the point that you are unhappy with breastfeeding. As long as your baby is gaining weight well, there is no need to rush into trying to wean them from the shield. Don't cut down a shield to wean a baby off it - this practice is no longer recommended.

You may be able to remove the shield part way through a feed and continue without. You may only use a shield on one breast, or for the first few minutes. Some babies need only one or two sessions with the nipple shields, while others may need more.

Keep trying as often as you can and give it some time. Your baby might be more receptive to feeding without the shield when they are less hungry or sleepy. Some continue to use a shield for the duration of their breastfeeding experience, but most are able to stop using the shield after only a short time if they wish to.

Be patient while you work through this time of transition. Breastfeeding with a shield is still breastfeeding.

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Using a nipple shield with a breastfed baby - ABM

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Nipple shields can help establish breast-feeding with some babies who seem to have difficulty achieving and/or maintaining attachment to the breast.

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During pregnancy your body is preparing to give birth and your breasts are getting ready to feed your baby. If you are told you need to have a caesarean birth you may wonder if you will still be able to breastfeed as you planned. Mothers successfully breastfeed after a caesarean birth and you can expect your healthcare professionals to support you with getting breastfeeding established straight away.

Whichever way we give birth, our bodies need time to recover and to adjust to feeding a new baby. Birth by caesarean usually means a longer hospital stay, and a longer recovery time because this is major abdominal surgery so practical support from friends and family can make a big difference to you.

Before the birth
Common concerns
A good start for breastfeeding
Practical help and support

Before the birth

Whichever way you will be giving birth, find out as much as you can beforehand about labour and breastfeeding. Whilst some aspects will be out of your control, choosing your place of birth and your caregiver can reduce your chance of a caesarean.

An induced birth can lead to more interventions, increasing the chance you'll need a caesarean.

Continuous support during labour from a woman you feel comfortable with and trust can reduce the risk of a caesarean birth.

Simple things like eating and drinking, moving around and relaxation can improve your experience of labour.

Tell hospital staff beforehand that you plan to breastfeed and to emphasise:

You want to keep your baby with you, provided neither of you needs special care.

You don't want your baby to be given bottles or dummies without your permission, because this will interfere with breastfeeding.

An unplanned caesarean
A caesarean after a long or difficult labour can leave you feeling extremely tired and frustrated. However the hormones released during labour have already prepared you and your baby for breastfeeding.

A planned caesarean
Knowing in advance that you will be having your baby by caesarean can let you prepare, both emotionally and practically. When possible, going into labour first can help get breastfeeding off to an easier start. If you have had a previous caesarean, it is not always necessary to have one the next time. Discuss your options with your health professionals.

After an caesarean
Whether or not your caesarean was planned, you may still feel upset or sad about what happened and mourn the loss of the birth experience you were hoping for. It is quite understandable to feel this way and these feelings may affect the way you feel about your baby and breastfeeding at first.

Breastfeeding can give you confidence in your body's abilities. When you breastfeed, your baby needs you. The close physical contact can also help you to feel better emotionally. Breastfeeding helps your womb to contract, which will help you heal more quickly. And it's nature's way of ensuring you spend time sitting or lying down, resting and recovering.

Common concerns

IVs or drips
To make holding and feeding your baby easier, ask that your IV drip be inserted into your forearm, rather than in the back of your hand (and without the supporting board if one is used). You can request that your catheter be inserted after your spinal anaesthetic has taken effect, to make the procedure more comfortable.

The extra fluid from an IV can increase engorgement. Before breastfeeding, you can easy any swelling back by pressing your fingers around the nipple area (reverse pressure softening) and see Engorged Breasts-Avoiding and Treating for suggestions.

IV fluid will also transfer to your baby. This can lead to an artificially high brith weight which may result in a higher percentage weight loss in the early days. Weighing your baby at 24 hours old may give a more accurate baseline weight.

Anaesthetic
Any anaesthetic in your system will not be harmful to your baby. However the anaesthetic may make your baby very sleepy during the first few days-you may have to wake them up and encourage them to nurse. Keep them close and offer the breast whenever they stir.

Antibiotics and pain relief
Pain relief and antibiotics are routinely given after a caesarean. Pain relief will be essential to help you through the early days. Over the counter pain medications, such as paracetamol and ibuprofen, are considered safe for breastfeeding. If you need something stronger, then discuss this with your health care team, who can check which drugs are compatible with breastfeeding. You may need further antibiotics, but be aware that these increase the risk of a thrush infection for you and your baby.

A good start for breastfeeding

Express your milk
Separation or feeding problems are more likely if your baby is born early, if you have an induced birth, or if you have a health problem such as diabetes. It can be very helpful to express and store colostrum before the birth so that your milk will be available for your baby if separation occurs. See Antenatal Expression of Colostrum.

If your baby is a bit sleepy at first you can hand express drops of colostrum and give it on a spoon. You partner could help with this.

It can sometimes take a little longer to have a plentiful milk supply after a caesarean birth. Hand expressing frequently will encourage this process. If you baby needs a supplement offer it with a spoon, syringe, feeding cup or supplementer.

Breastfeed as soon as possible
You can breastfeed as soon as you are alert enough to hold your baby, in the recovery room or even on the delivery table. At this stage you will be free from pain as the anaesthetic will not have worn off. Although you may be lying flat on your back and may need some help positioning your baby, you don't need to be sitting up to breastfeed. Simply lying there, skin-to-skin is enough to prompt a baby to nuzzle onto your breast themself. If you are drowsy your partner can help by holding your baby close to you.

Skin-to-skin contact with your baby
It's important and never too late, to enjoy skin-to-skin contact with your baby. Tuck a blanket over both of you to keep warm. Skin-to-skin

Encourages your baby to latch on and feed frequently.

Helps colonise your baby's skin with your own individual 'good' bacteria.

Calms your baby and regulates their temperature.

Encourages bonding.

If your need for medical care prevents this happening straight away, your birth partner can step in. Babies still benefit from sking-to-skin contact even when they can't be with you.

Get comfortable for breastfeeds
Getting your baby attached well at the breast helps them to feed effectively and helps prevent nipple damage. Lying down, laid back or using the underarm position may be easiest at first. Use extra pillows for support and comfort-behind your back, under your arms or between your knees. A rolled up towel or small pillow can cover and protect your incision. . See Positioning & Attachment for tips. Be aware that pain relief can mask pain during breastfeeding. If your nipples are squashed or flattened after feeds, or look sore or damaged, seek help without delay.

Baby feeding cues
Mothers often find they need help responding to their babies' early feeding cues. If you feel groggy after birth, it helps if the people supporting you are aware of the signs your baby needs to feed. These include, in increasing urgency:

Opening their mouth, making sucking motions and turning their head (rooting) looking for the nipple.

Moving their tongue.

Furrowing their eyebrows-perhaps showing tension in their face.

Clenching and unclenching their fists.

Flexing their arms.

Moving their hands to their mouth.

Followed by restless movement.

Then crying-the last resort.

Practical help and support

It is useful to check hospital policies on visitors, so you can arrange as much help as possible. Even in hospital, it will be much easier with your partner, family member or friend to help you care for your baby. If you are on your own, ring for help from hospital staff when you need it.

Once at home, extra help will be essential. You will be recovering from major abdominal surgery and need to rest, recover and concentrate on nursing your baby. You may be advised not to drive for about six weeks. Organise as much help as possible with meals, laundry and essential housework, and with caring for any older children. Drink enough fluids to keep your urine pale, and eat a balanced diet. Simple meals will be easier to prepare.

See Supporting a Breastfeeding Mother and Adjusting to Motherhood include practical tips on making life easier after birth.

Support for breastfeeding
Try to contact an LLL Leader, attend an LLL meeting or join an LLL Facebook group before your baby arrives to establish your support network. The LLL Leaders and other mothers will be able to give you ongoing support and enouragement, along with useful practical ideas. You can find your local LLL group here.

Written by Sara Walters, Karen Butler, Sue Upstone, Bronwyn Davies and mothers of LLLGB.

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
NICE Clinical Guidance: Caesarean Section. www.nice.org.uk/guidance/ng192

Antenatal Expression of Colostrum
Birth and Breastfeeding
Beginning Breastfeeding
Comfortable Breastfeeding
Engorged Breasts - Avoiding and Treating
Hand Expression of Breastmilk
My Baby Won't Breastfeed
Positioning and Attachment
Sleepy Baby - Why and What to do
Supporting a Breastfeeding Mother
Treating Thrush

References
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.
Impacts of Birthing Practices on Breastfeeding 2nd edition, Smith, LJ. Jones and Bartlett Publishers, 2010.

You can buy this information in a printed leaflet from the LLLGB Shop here

Updated March 2022

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Caesarean Birth and Breastfeeding - La Leche League GB

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Kent tongue tie service information leaflet 

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Kent tongue tie service information leaflet 

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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.
Smoking whilst breastfeeding is not advised. However the benefits of breastfeeding and smoking are still greater than formula feeding. Smoking only after feeding and away from the baby is recommended to limit the baby's exposure.

Nicotine is found in breastmilk.

The flavour of breastmilk collected 30-60 minutes after smoking was identified as tasting more like cigarettes than samples taken at any other time.

The levels of cotinine (the chemical into which nicotine is changed in the body) in the urine of breastfed babies whose mothers smoked were ten times higher than those of formula fed babies of smoking mothers. It appears that this is due to passage through breastmilk and not through exposure to smoke in a room.

Babies of mothers who smoke appear to be more likely to suffer from colic.

Smoking appears to lower breastmilk production - more women who smoke believe that they have insufficient milk

Mothers who smoke are likely to breastfeed for a shorter length of time

Many women continue to smoke whilst breastfeeding perceiving that it is the only time that they have for themselves, to overcome tiredness or to reduce their appetite.

Passive smoking is related to early onset of wheezing - breastfeeding may reduce the severity of bronchial asthma.

Research shows exposure to smoke increases the risk of cot death in babies.

There have been recent reports linking smoking during breastfeeding with risk of obesity and endocrine dysfunction in the baby in later life (Lisboa 2012, 2015)

Mothers and fathers should stop smoking - or not restart after pregnancy

The use of nicotine replacement therapy exposes the baby to less nicotine than smoking does

There appears to be no current research on "e cigarettes". Although there is some vapour release the risk would probably be less than with smoking.

It is safer to use nicotine replacement therapy whilst breastfeeding than to smoke.

NRT products are not licensed to be used by breastfeeding mothers. This means that the manufacturers have not included a statement on their use when they first made the product available. It does not mean they are not safe.

Babies will be exposed to less nicotine through NRT than through smoking. Smoking produces blood levels of nicotine of 44ng/ml whilst NRT patches produce around 17 ng/ml

NRT avoids exposure to the other chemical compounds in tobacco smoke.

Mothers should not use NRT and continue to smoke

Patches applied over a 24 hour period may produce vivid dreams in the mother; it might be advisable to remove the patch overnight so that the baby is exposed to less during night time feeds.

NRT products do not cause breastmilk to smell of cigarettes.

Nicotine gum produces large variations in nicotine levels whilst patches produce a sustained but lower level. If gum is used it should be chewed immediately after feeds to reduce the baby's exposure. NRT nasal sprays similarly produce rapid high levels and may best be used after feeds.

Exposure of the baby to NRT products is safer than exposure to cigarettes and with appropriate support may help the mother (and ideally her partner) to quit smoking permanently.

NB - Research shows exposure to smoke increases the risk of cot death in babies.

Oral medication to help with smoking cessation Varenicline (Champix ®) and Bupropion (Zyban ®) should be avoided during breastfeeding.

These suggestions are based on my experience of running a smoking cessation clinic as in independent prescribing pharmacist.

Think about why you want to stop smoking - is it for you, for your baby or older children, because somebody says you OUGHT to? If the latter you are unlikely to succeed long term, you need to decide that it is what YOU want to do and have a clear reason to do so.

Set a date when you plan to stop smoking and work towards that date.

Decide on what NRT you wish to use - it is much easier than trying to go cold-turkey. Can you get support from your local community pharmacy, practice nurse or smoking cessation service? They may well prescribe for you so the NRT is free if your baby is under 12 months of age. They will also monitor your carbon monoxide level in your breath showing you how your lungs clear quickly.

Think about when you smoke - is it a routine e.g. after a meal, with a cup of coffee, when you are tired or hungry? Think about each cigarette you have over several days - what made you decide to light this cigarette? Do you really want it?

Think about where you smoke - is it always in the same place e.g. a chair you sit in, outside the kitchen door so in sight or sound of your baby but not with him/her.

Decide how you can change each time you smoke - can you distract yourself for 20 minutes? This is the time it usually takes a craving to subside. Could you wash the floor, sing a song to your baby, make everything ready for the next meal, paint your nails or something else that works for you? Can you change where you sit?

On the day you decide to stop you may want to tell everyone so that you elicit their support or you may want to keep quiet so no-one tries to tempt you because they haven't made their own decision.

Put away the cash you would have spent on the cigarettes and spend it after 6 weeks of being cigarette free on a treat for YOU - not the family, not the baby, this is YOUR celebration of overcoming the addictive habit called smoking.

If you smoke to give yourself "5 minutes peace" think about how else you could spend that time.

Have strong tasting sweets around to suck - traditionally these are mints but could be anything you like. Also have lots of healthy snacks so you don't resort to chocolate instead.

Be proud of yourself - stopping smoking is not easy! Take every day as it comes and celebrate. If you have one cigarette it doesn't mean you failed, think why it happened and plan how to avoid that situation again. Do not give up giving up!

Amir LH, Donath SM. Does maternal smoking have a negative physiological effect on breastfeeding? The epidemiological evidence. Breastfeed Rev. 2003 Jul; 11(2):19-29. www.ncbi.nlm.nih.gov/pubmed/14768313?dopt=Abstract

British National Formulary

Dahlström A, Ebersjö C, Lundell B Nicotine exposure in breastfed infants. Acta Paediatr. 2004 Jun;93(6):810-6 .www.ncbi.nlm.nih.gov/pubmed/15244232?dopt=Abstract

Hale T. W Medications in Mothers Milk

Ilett KF, Hale TW, Page-Sharp M, Kristensen JH, Kohan R, Hackett LP. Use of nicotine patches in breast-feeding mothers: transfer of nicotine and cotinine into human milk. Clin Pharmacol Ther. 2003 Dec; 74(6):516-24. www.ncbi.nlm.nih.gov/pubmed/14663454?dopt=Abstract

Jones W Breastfeeding and Medication 2018 Routledge

Lactmed website http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Lisboa PC et al Effects of maternal nicotine exposure on thyroid hormone metabolism and function in adult rat. J Endocrinology posted online 4 February 2015 http://joe.endocrinology-journals.org/content/early/2015/02/04/JOE-14-0473.abstract?sid=6e1733c0-0501-4c8f-ad40-d4f493cfafc2

Lisboa PC, Elaine de Oliveira E, and de Moura E G Obesity and Endocrine Dysfunction Programmed by Maternal Smoking in Pregnancy and Lactation. Front Physiol. 2012; 3: 437 www.ncbi.nlm.nih.gov/pmc/articles/PMC3500832/

NICE Smoking Cessation services PH10 2008 http://publications.nice.org.uk/smoking-cessation-services-in-primary-care-pharmacies-local-authorities-and-workplaces-ph10

Reijneveld SA ,Brugman E , Hirasing RA Infantile colic: maternal smoking as potential risk Factor Arch Dis Child 2000;83:302-303

Shenassa ED, Brown MJ. Maternal smoking and infantile gastrointestinal dysregulation: the case of colic. Pediatrics. 2004 Oct; 114(4):e497-505. http://pediatrics.aappublications.org/content/114/4/e497.full

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019

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Smoking, Smoking Cessation 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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This information can also be viewed as a PDF by clicking here.
Breastfeeding mothers can have occasional, small amounts of alcohol but should not drink regularly or heavily (e.g. binge drinking) without considering how to limit the baby's exposure. If you drink any alcohol DO NOT bed share with your baby or fall asleep in the sofa/chair. If you do binge drink, your baby should be cared for by an adult who has not had any alcohol. It is not necessary to express breastmilk to clear it of alcohol.

Never share a bed or sofa with your baby if you have drunk any alcohol. Doing this has an increased association with sudden infant death syndrome (SIDS).

Alcohol passes freely into breastmilk reaching approximately maternal levels BUT maternal blood levels have to reach 300mg/100ml before mild sedation is reached in the baby (this compares with a level of 80mg/100ml needed to fail the police breath test in England, Wales and N. Ireland; 50mg/100ml Scotland.

To reduce exposure of the baby to alcohol, avoid breastfeeding for 2-3 hours after drinking.

Peak levels in the milk appear after 30-90 minutes but this does not mean that social drinking of small amounts of alcohol mean that you cannot breastfeed.

Excess levels of alcohol in milk may lead to drowsiness, deep sleep, weakness and decreased growth in the infant. Reduction of let-down is reported when the mother drinks heavily. Alcohol may reduce the baby's sucking time at the breast but not the volume of milk consumed.

It is not necessary to express breastmilk to clear it of alcohol; as the mother's blood levels fall, the level of alcohol in the breastmilk will decrease.

Binge drinking (more than 6 units of alcohol in one period), may make you less aware of your baby's needs. If you have drunk enough alcohol to make you feel disorientated or cause vomiting you should not be caring for your baby without supervision from a sober adult. You should ideally express for comfort and to maintain your supply - although this may be the last thing on your mind!

Chronic consumption of alcohol is more likely to cause harm than occasional social drinking.

NB It is vital that mothers who have been drinking alcohol should never let themselves be in a situation where they might fall asleep with the baby; on a bed, chair or settee (this would also apply to other carers who have been drinking alcohol). The place of sleep is a bigger risk than the fact that the mother has been drinking unless her consumption has been very high.

Drinking alcohol reduces the ability of the mother to be aware of her baby's needs, whether she is breastfeeding or not. It is safest to ask someone else to care for the baby.

Other websites

NHS Breastfeeding and drinking alcohol. - Your pregnancy and baby guide www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-alcohol/

Guidelines from the NHS

Anything you eat or drink while you're breastfeeding can find its way into your breast milk, and that includes alcohol.

If you regularly drink as much as 14 units per week, it's best to spread your drinking evenly over 3 or more days.

If you wish to cut down the amount you drink, a good way to help achieve this is to have several drink-free days each week.

Fourteen units is equivalent to: 6 pints of average-strength beer, 10 small glasses of low-strength wine

Use Alcohol Change's alcohol calculator to check your units: https://alcoholchange.org.uk/alcohol-facts/interactive-tools/unit-calculator
©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network March 2021

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Alcohol and Breastfeeding - The Breastfeeding Network

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This information can also be viewed as a PDF by clicking here. Breastfeeding mothers can have occasional, small amounts of alcohol but should not drink regularly or heavily (e.g. binge drinking) without considering how to limit the baby's exposure. If you drink any alcohol DO NOT bed share with your baby or fall asleep in [...]

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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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Many mothers of twins or more breastfeed their babies successfully and we're here to support you.

Multiples are more likely to be born early and we know that very small or premature babies can find it difficult to breastfeed at the beginning. If you are unable to feed your babies straight away it doesn't mean that you won't be able to breastfeed.

Spending time with your babies, giving them skin-to-skin time with you or your partner and expressing breastmilk regularly, can all help babies to get going with breastfeeding. Talk to the hospital staff and your midwife about how they can support you to feed your babies in the way you want to.

To help you prepare for breastfeeding Twins Trust suggest that you:

Personal stories

Our work with peer-to-peer breastfeeding supporters has been made possible thanks to the National Lottery Community Fund.

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Many mothers breastfeed their twins, triplets or more. Twins Trust is here to support you with whichever feeding choice is best for your family.

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It can take several weeks for you and your baby to feel happy and confident with breastfeeding.
Once you've both got the hang of it, it's usually possible to offer your baby bottles of expressed milk or formula alongside breastfeeding.

This is sometimes called mixed or combination feeding.

Why combine breast and bottle?

You may want to combine breastfeeding with bottle feeding if you:

are breastfeeding and want to use a bottle to offer your baby some expressed breast milk

want to breastfeed for some of your baby's feeds, but give bottles of formula for 1 or more feeds

are bottle feeding your baby and want to start breastfeeding

need to leave your baby and want to make sure they have some milk while you're away

Introducing formula feeds can affect the amount of breast milk you produce. There is also a small amount of evidence to show babies may not breastfeed as well because they learn to use a different kind of sucking action at the bottle than at the breast.

Introducing formula feeds

If you're combining breastfeeding with formula feeds both you and your baby can carry on enjoying the benefits of breastfeeding.

If you choose to introduce infant formula:

it's best to do it gradually to give your body time to reduce the amount of milk it makes - this helps lower your chance of getting uncomfortable, swollen breasts, or mastitis

if you're going back to work, start a few weeks beforehand to give both of you time to readjust

if your baby is 6 months old or more and can drink milk from a cup, you may not need to introduce a bottle at all

For more information, see drinks and cups for babies.

Giving your baby their first bottle

It may take a while for a breastfed baby to get the hang of bottle feeding.

it usually helps to give the first few bottles when your baby is happy and relaxed - not when they're very hungry

it may help if someone else gives the first bottle feeds, so that your baby is not near you and smelling your breast milk

you might want to try using a different position for bottle and breastfeeding

See more advice on how to bottle feed.

Breastfeeding more and giving fewer bottles

If you want to start breastfeeding more and give your baby fewer bottles, it's a good idea to ask your midwife, health visitor or breastfeeding supporter for support.

These tips may help too:

Hold and cuddle your baby as much as possible, ideally skin to skin. This will encourage your body to make milk and your baby to feed.

Express your breast milk regularly. Expressing releases the hormone prolactin, which stimulates your breasts to make milk. About 8 times a day, including once at night is ideal. It may be easier to express by hand to begin with - your midwife, health visitor or breastfeeding supporter can show you how.

Try bottlefeeding while holding your baby skin to skin and close to your breasts.

If your baby is latching on, feed often. Do not worry if your baby does not feed for long to begin with. See tips on how to get your baby properly positioned and attached.

Choose times when your baby is relaxed, alert and not too hungry, and do not force your baby to stay at the breast.

Decrease the number of bottles gradually, as your milk supply increases.

Consider using a lactation aid (supplementer). A tiny tube is taped next to your nipple and passes into your baby's mouth so your baby can get milk via the tube as well as from your breast. This helps to support your baby as they get used to attaching to the breast. Your midwife, health visitor or breastfeeding supporter can give you more information.

See more tips on boosting your milk supply.

Help and support with mixed feeding

If you have any questions or concerns about combining breast and bottle feeding:

talk to your midwife, health visitor or breastfeeding supporter

call the National Breastfeeding Helpline 24 hours a day on 0300 100 0212

find breastfeeding support near you

Video: Why combine breast and bottle feeding?

In this video, 3 mothers discuss ways to combine breast and bottle feeding.

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How to combine breast and bottle feeding

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Find tips on combining breastfeeding and bottle feeding (mixed feeding), including how to introduce a bottle to a breastfed baby.

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Some parents decide that a combination of breastfeeding and bottle-feeding will work best for them.