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Breastfeeding Network information around coronavirus and breastfeeding

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This information about coronavirus and breastfeeding is checked regularly and will develop in response to guidelines and evidence. This page was last updated on 31th August 2022.

BfN's Statement on COVID-19 Vaccines while breastfeeding

This statement aims to address the questions we are receiving. It is for information only and not intended to promote the vaccine or replace advice from a healthcare professional.

If you are breastfeeding or giving your expressed milk, you can have any of the vaccines currently available in the UK as long as you meet the other conditions for receiving the vaccine, as set out by the Medicines and Healthcare products Regulatory Agency (MHRA) and Joint Committee on Vaccination and Immunisation (JCVI). As with other vaccines, there is no evidence that anything other than antibodies passes into your breast milk. These antibodies are not harmful to your baby, and may give some protection against the virus. There is no need to avoid giving your baby your breast milk directly after you have the vaccine, either by missing breastfeeds, or expressing and dumping milk.

The JCVI has recommended that the vaccines can be received whilst breastfeeding. This is in line with recommendations from the USA and the World Health Organization.

FAQs - COVID-19, Vaccines and Breastfeeding, including information on the latest research

If you are feeling unwell and think you may have coronavirus, you can continue to feed and care for your baby as usual, if you are able to (see FAQ "Can I breastfeed if I have COVID-19?"). You should consider additional hygiene measures to avoid passing the infection to your baby.

The main points include:

Wash your hands before touching your baby, breast pump or bottles

Try to avoid coughing or sneezing on your baby while feeding, whether breastfeeding or giving a bottle.*

Consider wearing a face mask while breastfeeding, bottle feeding or caring for your baby. If your baby is older it may be safer to leave your mask off to avoid them pulling at it and touching your secretions. Discuss options with your midwife, health visitor or GP.

Follow manufacturers recommendations for pump cleaning after each use.

If you are feeling too unwell to breastfeed directly consider asking someone who is well to feed your expressed breast milk to your baby.

If you choose to feed your baby with formula or expressed milk, it is important that you follow the sterilisation guidelines https://www.nhs.uk/conditions/pregnancy-and-baby/sterilising-bottles/ (link checked 26/04/22).

If you are expressing breast milk in hospital, a dedicated breast pump should be used. The hospital may have guidance about bringing the bottles into the neonatal unit

*This is to ensure good respiratory hygiene when close to your baby such as when feeding, or changing their nappy.

If you are feeling unwell, and have symptoms of coronavirus, the general information provided in these links should be helpful.

The NHS has information on what to do if you have coronavirus symptoms here: https://www.nhs.uk/conditions/coronavirus-covid-19/ (checked 31.08.22)

England: https://www.gov.uk/guidance/people-with-symptoms-of-a-respiratory-infection-including-covid-19 (checked 30.08.22)

Wales: https://gov.wales/coronavirus (checked 31.08.22)

Scotland: https://www.gov.scot/coronavirus-covid-19/ (checked 31.08.22)

Northern Ireland: https://www.nidirect.gov.uk/campaigns/coronavirus-covid-19 (checked 31.08.22)

If you would like to know more about donor milk as an option while you are ill follow this link to find your nearest milk bank. Supplies are limited, they will do what they can. http://www.ukamb.org/

Some people report headaches, flu-like symptoms, general aches and pains, nausea, and gastrointestinal symptoms [1]. Taking paracetamol and drinking plenty of fluids to keep you hydrated may help alleviate symptoms. Paracetamol can be taken as normal when pregnant or breastfeeding. See our Drugs in Breastmilk factsheets for more details and information on taking other medicines whilst breastfeeding or the FAQ "Can I take medicines for COVID-19 symptoms while I am breastfeeding?"

As some people report feeling tired in the day or two after the vaccine, you might want to have your vaccine when someone is around to help you care for your baby and bring them to you for feeding. If you usually express milk, you could express some extra ahead of time in case you want to use it. Remember that missing feeds may lower your supply and could lead to blocked ducts or mastitis.

If you believe you have experienced an adverse reaction to a vaccine, you can report this via the yellow card system: https://coronavirus-yellowcard.mhra.gov.uk/ (checked 31.08.22)

[1] Coronavirus vaccine - weekly summary of Yellow Card reporting - GOV.UK (www.gov.uk) (Updated 04.08.22, checked 30.08.22)

If you are breastfeeding, you can have any of the licenced vaccines offered in the UK. The Pfizer and Moderna vaccines are recommended for people aged under 40 and pregnant women [1, 2]. Children aged under 18 will only be offered the Pfizer/BioNTech vaccine [1].

One study has found that the SARS-CoV-2-specific IgA antibodies (which could provide breastfed infants with protection against COVID-19) were present more frequently in breastmilk after vaccination with the Pfizer or Moderna mRNA-based vaccines, compared with the Astra-Zeneca and Johnson & Johnson/Janssen vector-based vaccine. After the second dose, almost all participants who had the Pfizer or Moderna mRNA-based vaccines had this type of antibody in their breastmilk, compared to less than half of those who had two doses of Astra-Zeneca vaccine, or the single dose Johnson & Johnson/Janssen vaccine.

Additionally, a second type of antibody, IgG, was present in all participants after receiving two vaccine doses, independent of vaccine type. The researchers suggest that an mRNA-based vaccine may be the optimal choice for lactating women when they want to transfer antibodies to their infants. However, all vaccines provide protection against COVID-19 for the mother and result in some antibodies in breastmilk for most women. [3]

[1] https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/ (updated 21.07.22, checked 30.08.22)

[2] Mahase E. Covid-19: Pregnant women should be offered Pfizer or Moderna vaccine, says UK advisory committee BMJ 2021; 373 :n1013 https://doi.org/10.1136/bmj.n1013

[3] Juncker, H. G., Mulleners, S. J., Coenen, E. et al.(2022). Comparing Human Milk Antibody Response After 4 Different Vaccines for COVID-19. JAMA pediatrics, e220084. Advance online publication. https://doi.org/10.1001/jamapediatrics.2022.0084

Vaccination is recommended during pregnancy and breastfeeding so you can have the jab, including boosters, as soon as you are invited. Vaccination during pregnancy may protect your baby from COVID-19 after birth, and vaccination whilst breastfeeding may provide passive antibody protection to your nursling via your breastmilk. See sections above on "Can vaccination in pregnancy protect my baby?" and "Can my breastmilk protect my baby from COVID-19?" for more information.

Pasteurised donor milk may be obtained from a milk bank. This remains safe during the COVID-19 pandemic. There is no evidence that COVID-19 is transmitted through breastmilk [1]. Milk banks use rigorous screening, hygiene measures and pasteurisation to ensure the safety of the milk they supply [2]. Pasteurisation has been shown to leave intact protective antibodies to COVID-19 that may be present in the milk [3].

Priority is given to the sickest, most premature babies. Mothers with their own breastfeeding challenges may be able to get donor breastmilk if there are sufficient supplies. For more information, see

https://ukamb.org/ (checked 31.08.22)

https://heartsmilkbank.org/ (checked 31.08.22)

[1] Pietrasanta, C., Artieri, G., Ronchi, A., et al. (2022). SARS-CoV-2 infection and neonates: Evidence-based data after 18 months of the pandemic. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 33 Suppl 27, 96-98. https://doi.org/10.1111/pai.13643

[2] https://heartsmilkbank.org/faqs/ (checked 31.08.22)

[3] Perez, S. E., Luna Centeno, L. D., Cheng, W. A. et al. (2022). Human Milk SARS-CoV-2 Antibodies up to 6 Months After Vaccination. Pediatrics, 149(2), e2021054260. https://doi.org/10.1542/peds.2021-054260

If your baby needs to be cared for in a Neonatal Unit (NICU) these links have general information and specific details about COVID-19.

Specific guidance can be seen on the British Association of Perinatal Medicine website, here: https://www.bapm.org/pages/182-perinatal-covid-19-resources (checked 31.08.22). It includes a document called "frequently asked questions within neonatal services" (last updated 13/01/22). This is detailed and written for clinicians.

The section "How do we manage provision of expressed breast milk (EBM) in the NNU when mother is SARS-Co-V positive?" states:

To date viral RNA has been reported only very rarely in fresh breast milk of COVID-19 confirmed mothers. The database is, however, small. The main risk of breastfeeding for the infant is the close contact with the mother, who is likely to share infective airborne droplets. National advice for well babies of COVID-19 suspected or confirmed mothers is that the benefits of breast feeding outweigh any theoretical risks.

For unwell or preterm babies in the NNU the evidence is less clear.

Practitioners should discuss with parents the pros and cons of provision of EBM to babies in the NNU, noting the current uncertainty. A joint decision should be informed by factors including the gestation and clinical condition of the baby, transfer of protective maternal antibodies, the availability of donor breast milk and parental choice. Other coronaviruses are destroyed by pasteurisation.

SARS-CoV-2 positive mothers who are expressing milk must be facilitated to practise excellent hand hygiene, and care taken to ensure that bottles containing EBM are not externally contaminated. The virus is deactivated by chlorine disinfectants. EBM of COVID-19 suspected or positive mothers should be stored in a separate fridge or freezer from that of non- suspected or negative mothers. NNUs should have clear guidelines around handling, storage and use of EBM in these circumstances and suspected/infected mothers should have exclusive use of a breast pump.

If it is decided to withhold mother's own breast milk, the mother should be encouraged to express and discard her milk, to maintain lactation until she is no longer considered infectious (10 days after onset of symptoms). Repeat testing of mother is not necessary. Parents should be signposted to appropriate feeding and emotional support during this period and reassured that breastfeeding can still take place after a period of using donor breast milk / formula if lactation is maintained.

Consider testing a sample of EBM for SARS-CoV-2 once lactation is established as this may help with future understanding of this virus.

Lactation is not a contra-indication to COVID-19 vaccination and breastfeeding mothers should be advised to continue breastfeeding after receiving vaccine.

Bliss has a detailed statement covering the care of babies in neonatal units during the pandemic, including what to do if a mother has symptoms of COVID-19 or tests positive. (Statement updated 22.04.22, link accessed 31.08.22). This statement may be of help when discussing the care of your baby with staff on a neonatal unit.

BAPM guidance states that ''it is essential that the mother and her partner are never considered to be visitors within the neonatal unit - they are partners in their baby's care and their presence should be encouraged and facilitated as much as possible.'' The guidance also stresses the importance of parents being present together, unless this is clearly detrimental to other babies or staff, and that mothers and their babies should be considered 'the same biological entity'. Their guidance also notes that parental involvement in the delivery of basic tasks and their baby's care may prove beneficial to units where there are staffing pressures.

The Bliss statement explains that parents who have tested positive for COVID-19 may not be able to access the neonatal unit until they have completed self-isolation, but this should be discussed with the individual neonatal unit. Some units may have solutions to this, particularly in the case of end of life care, when every effort should be made to facilitate parental presence.

If you want to talk through any worries you have related to breastfeeding and COVID- then you can contact the National Breastfeeding Helpline. Trained volunteers will be able to offer you information and support. You can also talk to your midwife, health visitor or doctor.

If your concern is linked to the vaccine or other medications, you can contact our Drugs in Breastmilk team, where trained volunteer pharmacists will be able to discuss your questions or worried with you.

There are a number of other organisations offering support to breastfeeding mothers, and many support groups are running again now. Details of peer support offered by The Breastfeeding Network can be found here. Information on other organisations offering support can be found here

Eye Infection and Breastfeeding
Eye Infection and Breastfeeding

Chickenpox and Breastfeeding
Chickenpox and Breastfeeding

Antibiotics and Breastfeeding
Antibiotics and Breastfeeding

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Coronavirus and breastfeeding - The Breastfeeding Network

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Information on coronavirus (corona virus/Covid-19) and breastfeeding for mums and families in the UK

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Wearing masks in hospitals (24 June 2020)

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Wearing masks in hospitals (24 June 2020)

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This paper written for the Royal College of Midwives and the Royal College of Obstetricians and Gyneacologists gives advice on whether masks are necessary when caring for your baby

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Focus on the first fortnight of breastfeeding, meet other expectant parents

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GBSN is offering expectant mothers and their support partners a virtual "Preparation for Breastfeeding Workshop". A small group, via Zoom, will give you the chance to meet others. It will be facilitated by a GBSN Breastfeeding Specialist Worker who is a Breastfeeding Counsellor trained by the NCT.
The focus will be on helping to get breastfeeding off to a good start, what breastfeeding looks like day by day and having self-help strategies if things don't go to plan. We'll concentrate on the first 10 days. You'll get the slides and information to read beforehand and we ask you to come to the first session ready to discuss what you've read. Then you'll get a chance to reflect upon this before the next session which will build upon the first.

You can attend this workshop at anytime during your pregnancy at a time to suit you and your partner.
These workshops are over two 1 hour sessions. We have two sets of dates available now - choose the first date from the list and you'll have entry to both sessions. Each Workshop (2 sessions) Cost £20 + Booking Fee
- PART 1 Tuesday 16th June 11am-12pm & PART 2 Friday 19th June 6-7pm

- PART 1 Tuesday 23rd June 6-7pm & PART 2 Thursday 25th June 6-7pm

- PART 1 Tuesday 30th June 6-7pm & PART 2 Thursday 2nd July 6-7pm

You'll be emailed a Zoom link prior to each session.
Book your place here

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GBSN is offering expectant mothers and their support partners a virtual "Preparation for Breastfeeding Workshop". A small group, via Zoom, will give you the chance to meet others. It will be facilitated by a GBSN Breastfeeding Specialist Worker who is a Breastfeeding Counsellor trained by the NCT.

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VOBSS Virtual online breastfeeding support and social groups (free)

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VOBSS Virtual online breastfeeding support and social groups (free)

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Come along to chat with other mothers with a Breastfeeding Counsellor and a Peer Supporter. Join via our Facebook group https://www.facebook.com/groups/vobss. Contact us if you do not have FB

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Breastfeeding the baby with faltering weight

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Breastfeeding the baby with faltering weight

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Shel Banks IBCLC

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Historically, babies and young children who have not gained weight or not grown at the expected rate, have been termed as 'failure to thrive' and various different ways of managing this situation would be tried, depending on the view of the medical professional working with the family, and any the local policies in force to govern this.

Recently the term 'Faltering Weight' has been used instead, to describe a baby whose weight gain is less than expected, because the word 'failure' was seen as suggesting a judgement on the family. 'Faltering Growth' is now used to describe a baby or child whose growth rather than weight was less than expected.

In 2015, the National Institute for Health and Clinical Excellence (known as 'NICE'), who provide guidance, advice, quality standards and information services for health, public health and social care, commissioned a NICE Guideline entitled 'Faltering Growth: recognition and management of faltering growth in children'. This guideline was published in September 2017 and covers 'recognition, assessment and monitoring of faltering growth in infants and children. It includes a definition of growth thresholds for concern and identifying the risk factors for, and possible causes of, faltering growth. It also covers interventions, when to refer, service design, and information and support.'

In the UK, normal healthy term babies are weighed according to the NICE Postnatal Care Guidelines and according to local practice, by the midwifery team at birth, then again by the midwifery team within the first week of life - usually about 5 days - and then again at around 10 days (by the Health Visitor at the 'Primary Visit') and around 3 weeks by the Midwife as they discharge the baby and mother from their care. Things may be slightly different for babies who are born preterm or who are unwell, and the timing of later weights is more variable.

Weights are recorded on the electronic systems used by hospitals, in the paper patient records, and in the Personal Child Health Record (PCHR) often known as the 'red book' - though in some areas the covers are no longer red. There is a table to record the weight and also other measurements, alongside the date, and there are weight and growth charts to plot the measurements against the age in weeks or months to make a graph showing weight and growth over time.

The weight charts for children from birth to four years of age which are used in the modern 'red book' are known as the UK-WHO Growth Charts and were first added to the PCHR in 2009. The new charts are based on the World Health Organisation (WHO) Child Growth Standards, which describe the optimal growth for healthy, breastfed children. Previous UK growth charts were based on data from studies on breast and formula fed children, so did not reflect normal weight fluctuations of breastfed children in the first few weeks - which is what we're aiming for, of course.

The NICE Faltering Growth Guidance outlines thresholds at which babies are to be diagnosed as having faltering growth and makes evidence-based suggestions about the management of the baby's feeding from there.

As an Infant Feeding Specialist, I often support families whose babies have been found not to have gained weight as expected. Sometimes this weight issue is picked up at day 3 or 5 when the babies lose a larger than desirable amount of their birth weight, sometimes it is picked up after a few weeks when baby has not got back to birth weight, and sometimes much later.

The NICE Guideline tells the reader that we should be aware that:

it is common for infants to lose some weight during the early days of life

this weight loss usually stops after about 3 or 4 days of life

most infants have returned to their birth weight by 3 weeks of age.

If your baby, in the first few days, loses more than 10% of her birth weight, your medical professional should first perform a clinical assessment of your baby, looking for evidence of dehydration, or of an illness or something else which might account for the weight loss. They should then ask you the right questions to gather a detailed feeding history, using the information provided in the NICE guideline on Postnatal Care to guide their questions.

Depending on whether the medical professional found something obvious to explain the weight loss, via either the clinical observation or the detailed feeding history, and whether the medical professional is appropriately skilled to conduct the observation of feeding and make useful suggestions to improve milk transfer from mother to baby, where applicable, they might then do a direct observation of the baby feeding.

If there isn't an obvious cause for the weight issue from the feeding history or clinical observation, then your health professional should ensure an observation of baby's feeding is done, crucially this must be conducted by a person with appropriate training and expertise - so if you are in this situation please seek out some expert and experienced breastfeeding support locally if possible, or remotely via telephone or social media if that is not possible. This might be from a -

midwife or health visitor with additional training and expertise in supporting breastfeeding

local breastfeeding peer supporter

IBCLC (internationally board-certified lactation consultant) who might also be a peer supporter, midwife or health visitor, or maybe in private practice.

The guidance says that medical professionals should perform further investigations (for example blood tests or hospital in-patient stays to monitor) only if they are indicated based on the clinical assessment.

The NICE guidance on faltering growth says that the mother of a baby who has been found to be weight faltering should be provided with feeding support, using the information in the NICE Postnatal Care Guideline.

If babies lose more than 10% of their birth weight in the early days of life, or they have not returned to their birth weight by 3 weeks of age, the NICE Faltering Growth guidance asks that the medical professional working with the family consider making a referral should be made to paediatric services (in the hospital), particularly if there is

evidence of illness

marked weight loss

failure to respond to feeding support

If no immediate referral if made because the infant is otherwise well, then a decision should be made about when to reassess your baby if she is not referred to paediatric services at this point.

If a baby loses more than 10% of their birth weight in the early days of life, then her weight should measure at appropriate intervals depending on the level of concern, but no more frequently than daily.
Example 1 - 5-day old baby needing improvement in feeding technique
A baby who is weighed by their midwife and found to have a weight loss by day 5 of over 10%, and whose clinical observations are acceptable but feeding history and feeding observations demonstrate that there is some improvement to be made in feeding technique: in this case the mother and baby should be supported to make those changes and the midwife call back in one or two days to check progress by weighing again.
Example 2 - an older baby with slow weight gain
In a situation with an older baby, where weight gain has slowed but clinical observation shows a baby who is otherwise healthy, but the feeding history or observation of feeding show an area for improvement, then again the mother should be supported to improve milk transfer to baby, and perhaps a plan should be to weigh again in a week or even longer, depending on the severity and the age of the baby.

The NICE Guideline for Faltering Growth suggests using the following as thresholds for concern in infants and children (a centile space being the space between adjacent centile lines on the UK WHO growth charts):

a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile

a fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles

a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile

when current weight is below the 2nd centile for age, whatever the birthweight.

The Guidance cautions that we should be aware that supplementary feeding with infant formula in a breastfed infant may help with immediate weight gain, but often results in breastfeeding ending before the mother planned, and sometimes in the allergic sensitisation of the baby.

If supplementation with an infant formula is given to a breastfed infant, we should support the mother to continue breastfeeding, advise her to express her breast milk to promote milk supply and then feed the infant with any available breast milk before giving any infant formula.

In the case of faltering weight in an otherwise healthy baby which does not respond to interventions to improve feeding technique, the NICE Faltering Growth guidance suggests that medical professionals might consider investigating for:

urinary tract infection (follow the principles of assessment in NICE's guideline on urinary tract infection in under 16s)

coeliac disease, if the diet has included gluten-containing foods (follow the principles of assessment in NICE's guideline on coeliac disease)

and then perform further investigations only if they are indicated based on the clinical assessment.
Other factors that might be associated with faltering growth include

preterm birth

neurodevelopmental concerns

maternal postnatal depression or anxiety

The NICE guidance suggests that in faltering growth, a range of factors may contribute, and it may not be possible to identify a clear cause, and that while there may be difficulties in the interaction between an infant or child and the parents or carers that may contribute to the problem, this may not be the primary cause.

Input from someone who is expert and experienced in providing evidence-based information and support to breastfeeding families can use the feeding history and any direct observation of feeding to determine whether:

ineffective suckling in breastfed infants

ineffective bottle feeding

any feeding patterns or routines being used

the feeding environment

feeding aversion

parent/carer-infant interactions, how the parents or carers respond to the infant's feeding cues

any physical disorders that affect feeding might be contributing to the faltering growth in milk-fed infants.

The NICE guidance recommends that you receive help in the community from a tells 'primary care team.' A primary care team includes your midwife or health visitor, and/or your GP.

Your primary care team may need access to the following healthcare professionals with expertise relevant to faltering growth,

an infant feeding specialist, plus a consultant paediatrician

paediatric dietitian

a speech and language therapist with expertise in feeding and eating difficulties

for older children perhaps a clinical psychologist or occupational therapist.

You may have a lead healthcare professional who coordinates your baby's care and acts as the first point of contact for you and your baby if several professionals are involved.

In practice this may mean that your midwife or health visitor begins the process by performing a clinical observation of your baby, talking through feeding history and observing a feed, or possibly calling in someone more experienced in supporting breastfeeding issues (or with the time to do it) to observe a feed, then making some initial suggestions to improve milk transfer to your baby which may include

improving the positioning of your baby at the breast

discussion of normal feeding behaviours

description of feeding cues

some enhanced methods for optimising milk transfer such as breast compressions or expressing your milk both to boost supply and also to have milk to supplement your baby with.

Together you would then agree on a plan for the next day or two, or for the next week if the baby is a little older or issue not as severe, and organise a time and date to return to re-weigh your baby to assess whether the improvements to breastfeeding management have met their target.

 Re-admission to hospital

There is no justification for automatic re-admission of baby to the paediatric service at the hospital for normal faltering growth when someone competent is managing the case in the community and plans have been made for improvement and reassessment, unless something is on offer in the hospital which cannot be provided in the community, for example, tube feeding the baby straight into its tummy, or an observation or monitoring in a potential safeguarding case.

NICE guidance goes on to say that we should only consider enteral tube feeding for infants and children with faltering growth when there are serious concerns about weight gain and an appropriate specialist multidisciplinary assessment for possible causes and contributory factors have been completed, and other interventions have been tried without improvement.

If tube feeding is to be used in an infant or child with faltering growth, make a plan with appropriate multidisciplinary involvement for the goals of the treatment (for example, reaching a specific weight target), and the strategy for its withdrawal once the goal is reached (for example, progressive reduction together with strategies to promote oral intake).

In most cases, the infant is simply not receiving enough milk because breastfeeding has not got off to a good enough start, either in terms of technique for supporting baby to attach to the breast, or other aspects of management like frequency of feeding and so on, perhaps because the mother has not been equipped with quite the right information and support to prepare her. Another reason for might be that there is some simple reason for the baby not being able to transfer milk sufficient to meet its needs for growth, for example, restricted oral function from a 'tongue tie', or some residual damage eg to neck or jaw during birth meaning it cannot get into an effective breastfeeding position.
The crucial messages therefore, are to provide good evidence-based information to mothers about how to feed effectively and the signs that things may not be going so well (signs including nappy output and signs of good attachment at the breast), and to ensure all families can access expert and experienced breastfeeding support if anything does not go as planned, so that they can get back on track properly, without needed to supplement with infant formula as this is not supportive of continued breastfeeding.

It's a steep learning curve for new mothers, but the hard work is worth it!

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Breastfeeding the baby with Faltering Weight

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Faltering Weight' is used to describe a baby whose weight gain is less than expected. If your baby has faltering weight she will need to be assessed and you may need specialist support from either a midwife or health visitor with additional training and expertise in supporting breastfeeding, a local breastfeeding peer supporter or an IBCLC (internationally board-certified lactation consultant).

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this website is the most comprehensive

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Sweet Pea Breastfeeding Support    St. Louis, MO

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Adoption : With adoption timing can be tricky: there may be little or no lead time between a match and meeting baby. Adoption plans can fall through. The key to success with nursing lies in a flexible plan.

Birthing Parent: Although this page is titled for the non-birthing parent, birthing parents may also relactate. In these cases, the first step is to identify and address the reasons for not initiating or for discontinuing breastfeeding. In most cases, birthing parents will just use step 3 since baby has already arrived.
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o-Nursing : Two parents may be sharing the role of breastfeeding. One or neither may be the birthing parent. With some planning and careful communication, this can be an extremely rewarding experience.
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Donor Milk : Because most parents who induce lactation or relactate need to supplement the milk they are able to produce in order to meet their babies' nutritional needs, donor milk is often considered as another option for providing human milk to their baby.

Dry Nursing : It is not necessary to bring in milk (induce lactation or relactate) in order to nurse a baby. Some parents may bottle-feed or their partner will breastfeed for nutrition, and they will nurse for comfort and connection and to meet baby's need for non-nutritive sucking (instead of using a pacifier). Other parents may feed baby at their breast/chest using an at-breast/chest supplementer.
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Foster Baby : The decision to nurse or to provide human milk for an infant in foster care is tricky. In some cases, however, nursing may be appropriate and extremely beneficial for the foster infant. Legal restrictions also need to be considered.
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Infertility : When the nursing parent has a history of infertility associated with hormonal issues, these same hormonal issues can also cause difficulties with making milk. Understanding health history can guide a plan for inducing lactation or relactation that addresses these underlying health issues in order to maximize milk production. Expectations for milk production may also require adjustment.
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Latching An Older Baby or Toddler : Older babies and toddlers are likely to have a more difficult time learning how to nurse than a newborn baby with newborn instincts to initiate breastfeeding. However, with patience, persistence, and creativity it is often possible for older babies and toddlers to begin to nurse.

Medically Fragile Infant : Babies whose health and/or development are compromised, latching onto the breast/chest and transferring milk can be much more difficult. The help of a International Board Certified Lactation Consultant as well as other specialized may be necessary.
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Gestational surrogacy is often an ideal circumstance for inducing lactation or relactation because there is a long lead time and a secure arrangement. The gestational carrier may nurse or provide milk for the baby.
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Trans Feminine Parent : Expectations for milk production may be lower for parents who have not gone through a feminine puberty, because there is less mammary tissue. Fortunately, even smaller amounts of milk production benefit baby!

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Adoption : With adoption timing can be tricky: there may be little or no lead time between a match and meeting baby. Adoption plans can fall through. The key to success with nursing lies in a flexible plan. Birthing Parent: Although this page is titled for the non-birthing parent, birthing parents may also relactate.

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FREE virtual face to face one to one support sessions with our Breastfeeding Counsellors who are trained with NCT

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FREE virtual face to face one to one support sessions with our Breastfeeding Counsellors who are trained with NCT

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Please do book a session using the form on our website

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GBSN Virtual Support Registration Form – Gloucestershire Breastfeeding Supporters’ Network

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Welcome to the online booking form for our free one-to-one video call breastfeeding support service.

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Unicef UK plan to help you move to fully breastfeeding (March 23rd 2020)

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Unicef UK plan to help you move to fully breastfeeding (March 23rd 2020)

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Health Professional guidance to help mothers who wish to maximise the amount of breastmilk that their baby has

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23 March 2020
Maximising breastmilk and re-lactation guidance

Following the publication of the Unicef UK Baby Friendly Initiative statement on infant feeding during the Covid-19 outbreak, we have now produced a quick reference guide for health professionals on supporting mothers to maximise the amount of breastmilk they are able to give or to re-lactate if they have stopped breastfeeding and wish to re-start.

Maximising breastmilk and re-lactation guidance

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Maximising breastmilk and re-lactation guidance - Baby Friendly Initiative

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Following the publication of the Unicef UK Baby Friendly Initiative statement on infant feeding during the Covid-19 outbreak, we have now produced a quick reference guide for health professionals on supporting mothers to maximise the amount of breastmilk they are able to give or to re-lactate if they have stopped breastfeeding and wish to re-start.

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Reducing the amount of supplementation that you give to your baby (kellymom) NB very slowly! with help from a BFC or your health professional

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Reducing the amount of supplementation that you give to your baby (kellymom) NB very slowly! with help from a BFC or your health professional

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Put baby to breast often

Aim for 10 breastfeeding sessons per day. If baby is not breastfeeding well, work with your lactation consultant.

Method for weaning from supplements

Do not drop supplements suddenly - this should be a gradual process.

Prepare: Talk to baby's health care provider and get his/her input. Record supplement amounts for a few days to determine how much supplement baby is getting per day. Use expressed milk for supplements if available. If you don't have enough expressed milk, add banked milk or formula.

Days 1-3: Take the current supplement amount (#1) and reduce by 1 oz (30 mL). Note that you're not reducing 1 oz at every feeding, but 1 oz over the entire day. Monitor baby's wet & dirty diapers. If diaper count is good, then do not exceed this amount of supplement each day - keep putting baby back to the breast if he wants to eat more.

Days 4-6: Take the current supplement amount (#2) and reduce by 1 oz (30 mL). Monitor baby's wet & dirty diapers. If diaper count is good, then do not exceed this amount of supplement each day - keep putting baby back to the breast if he wants to eat more.

Days 7-9: Take the current supplement amount (#3) and reduce by 1-2 oz (30-60 mL) - try 2 oz if things are going well. Monitor baby's wet & dirty diapers. If diaper count is good, then do not exceed this amount of supplement each day - keep putting baby back to the breast if he wants to eat more.

Continue the above method, slowly reducing the amount of supplement every 2-3 days as long as baby's diaper count and weight gain indicate that he's getting enough milk. Once you get to the point that the supplements are only expressed milk (no formula), then you can usually proceed at a faster pace-at this point you are making enough milk for baby and just need to transition baby to getting milk only at the breast (when not separated from mom).

If baby's weight gain or diaper count are borderline or inappropriate, then spend several more days at the same supplement level, or return to the previous supplement level and proceed at a slower pace.

Monitor baby's growth. Weigh baby at least once a week to ensure that he is gaining appropriately. Get another weight check a week after baby is completely back to the breast, to reassure yourself that things are going well. Keep in touch with baby's health care provider throughout this process.

Pump to increase supply

Pumping will help you to increase supply faster, plus you will be able to use your milk instead of formula for any needed supplements. Your aim in pumping is to remove more milk from the breasts and/or to empty the breasts more often. The more milk you remove, the more milk you will produce.

A hospital-grade double pump will save time and maximize your pumping efforts.

Until supply is well established, it is important to get at least eight good nursing and/or pumping sessions per 24 hours. Ten sessions per day is better.

If baby does not breastfeed at a feeding, pump for 20-30 minutes, or for 2-5 minutes after the last drops of milk. If baby breastfeeds, but does not soften the breast well, pump for 10-15 minutes after nursing. If baby softens the breast well, then adding pumping sessions between breastfeeding sessions is most helpful.

Empty the breast as thoroughly as possible at each session. To ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. Use breast massage prior to pumping, and massage and compressions during pumping to better empty the breasts and increase pumping output.

This method of reducing supplements was adapted from the methods used by Kathy Kuhn - Thanks, Kathy!

Now infants can get
all their vitamin D
from their mothers' milk;
no drops needed with
our sponsor's
TheraNatal Lactation Complete
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Go to Breastfeeding Log - Weaning from supplements

Go to professional handouts to view handouts on weaning from supplements

More information on transitioning baby back to breastfeeding

@ other websites

The "Finish at the Breast" Method of Supplementation - Christina Smillie, MD, IBCLC, suggests an alternative way to use bottles for supplementation that she believes results in less supplementation, improved feeding at breast, less need for pumping, and an ultimately greater milk supply as a result of improved milk removal.

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Weaning from formula supplements * KellyMom.com

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Put baby to breast often Aim for 10 breastfeeding sessons per day. If baby is not breastfeeding well, work with your lactation consultant. Method for weaning from supplements...

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Using straightforward language and simple illustrations to aid understanding, these infosheets on breastfeeding and bottle feeding are available in multiple languages and can be used to support parents with the basics of feeding and responding to their baby.

The infosheets are free to download and print, and are currently available in:
Please note: Following feedback, these translations were updated in 2019 to ensure the language used was as straightforward as possible.
The English versions of these resources are available below for reference:

Breastfeeding guidance: English (for reference)

Bottle feeding guidance: English (for reference)

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Foreign language resources - Baby Friendly Initiative

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These infosheets are available in multiple languages and can be used to support parents with feeding and responding to their baby.

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good evidence based articles on sugar in baby foods, eating well etc

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Infants & new mums — First Steps Nutrition Trust

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First Steps Nutrition Trust is a charity which provides clear, evidence-based and independent information and support for good nutrition from pre-conception to five years of age.

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Gill Rapley's website on baby-led weaning. Books are held for loan in the GBSN groups libraries

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Gill Rapley's website on baby-led weaning. Books are held for loan in the GBSN groups libraries

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Welcome!

I'm Gill Rapley, generally acknowledged to be the pioneer of baby-led weaning, or BLW. I first started talking about it in 2001 and it's since taken off around the world. In November 2015 I qualified as Dr. Rapley (a PhD, not a medical doctor). My own research, together with that of others such as Professor Amy Brown, means that BLW is now being taken seriously by academics and professionals, as well as by parents - as it should be!

Breaking News! The book, Your Baby Can Self-Feed, Too, is out! At the moment it's only available in the US but you can pre-order it in the UK, in paperback and Kindle editions. An Audible edition is on its way, too. The book describes how to adapt BLW for babies who face feeding challenges. I've written it with Jill Rabin, a fantastic speech and language therapist from Chicago, who has been using this approach with her clients for many years - with amazing results! It's been written for the American market, so refers to the US healthcare system, but the information is relevant for babies everywhere.

I'm featured in a number of podcasts in Katie Ferraro's series, including one with Jill Rabin that is all about Adapted BLW. Be sure to check it out!

This website sets out to be a point of contact, with suggestions for where you can learn more and a means for you to contact me direct, rather than being THE place to find out everything you ever wanted to know about parenting and BLW. (One of these days I'll get around to giving it a revamp, honest!) Having said that, the books and leaflets Tracey Murkett and I have written are a great place to start! The best source of information about what BLW is and why it makes sense is the original Baby-led Weaning. Then there's the Baby-led Weaning Cookbook, which will help you get started with cooking for a family. The follow-up to this, The Baby-led Weaning Quick & Easy Recipe Book has yet more easy recipes for babies, children and adults to share. Baby-led Breastfeeding explains how breastfeeding works and how to get it to work for you, while Baby-led Parenting, offers a practical guide to understanding your baby and being the parent he or she really needs.

Check out my choices on www.shepherd.com for five great books about society's obstacles to breastfeeding. Shepherd is like wandering around your favourite bookstore but online, accompanied by authors pointing out their favourite books. They launched in April 2021 and are just getting started. They have some exciting features planned to help readers find books in new and unique ways, with topic pages, a search facility and a much-improved homepage, to make it a great place to start wandering. Shepherd is also working to promote Bookshop.org, which is a new online bookstore competing against Amazon. Bookshop.org is a B corporation that supports local indie bookstores, with 75% of their profits going back to indie bookstores, authors, and Bookshop's partners.

Back to this site ...

The buttons on the left will take you to:

Information on all our books

Two simple 'how to' leaflets, on BLW and breastfeeding, which you are welcome to download, print and share, as well as some basic guidelines for implementing BLW with a brief explanation of the rationale behind them

Details of two textbooks to which I have contributed chapters on BLW

A useful info page, with my responses to common queries about BLW

Information about DVDs on BLW

Information about a few products that you may find useful when implementing BLW

A bit about me

Links to just a few of the many websites and blogs about BLW, which are jam-packed with tips and ideas

The email address for this site, where you can get in touch with me

Follow me on Twitter! Follow @gillrap

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I'm Gill Rapley, generally acknowledged to be the pioneer of baby-led weaning, or BLW. I first started talking about it in 2001 and it's since taken off around the world. In November 2015 I qualified as Dr. Rapley (a PhD, not a medical doctor).

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Welcome! This website was developed to provide evidence-based information on breastfeeding and parenting.

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Friendly breastfeeding support from pregnancy onward.

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Browse support in our Information Library by stage, need, family member. Our most popular leaflet is Relactation: restarting breastfeeding after a gap.

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Whether you are pregnant or you have just had a baby and are thinking of breastfeeding getting off to the best possible start is so important.

This section includes information you may find useful to help you prepare and may also help to answer some of the questions you might have.

You might also find our leaflets and publications useful. If you want to talk about any of the topics covered here in more detail, you could phone the National Breastfeeding Helpline to speak to a registered Breastfeeding Supporter. The National Breastfeeding Helpline is available from 9:30 am to 9:30 pm, 365 days a year, on 0300 100 0212.
Page last updated August 2014

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Thinking of Breastfeeding? - The Breastfeeding Network

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Whether you are pregnant or you have just had a baby and are thinking of breastfeeding getting off to the best possible start is so important. This section includes information you may find useful to help you prepare and may also help to answer some of the questions you might have.

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When should I feed my baby?

As a rough guide, babies need to feed at least eight to 12 times (sometimes more) over 24 hours during the first few weeks (NHS, 2019a; UNICEF, 2010). That means they'll probably need to feed every two to three hours.

Watch our video for tips on how often and how long to breastfeed your baby for.

It's best to feed babies responsively or in a baby-led way rather than sticking to a feeding schedule (WHO, 2009; Entwistle, 2013; Fallon et al, 2016). Letting your baby feed when they want will help them get the milk they need. It will also stimulate your milk supply (Infant and Young Child Feeding, 2009).

What if I'm struggling or worried about the number of feeds?

We know from the experiences of new mums that breastfeeding responsively can feel emotionally and physically challenging (Fallon et al, 2016).

A baby that breastfeeds frequently can give parents a sense of reassurance but it can also cause worry. Some people may think frequent feeding is a sign of insufficient milk, or that baby isn't getting enough breastmilk during feeds. This sometimes leads to women supplementing feeds with formula milk or deciding to stop breastfeeding (Leurer, 2015).

Try and keep in mind that a newborn baby's stomach is really small. They need to feed little and often (NHS, 2020). It's really common for babies to have a good feed and then appear to be hungry again quite quickly. This doesn't mean something is wrong or that they're not getting enough milk. It's just the way newborn babies feed (Kent et al, 2012).

All of this also means that newborn feeding is frequent. In fact, much of the time, it's not really a question of clearly-defined 'feeds' with clear beginnings and endings (WHO 1998).

Your baby knows your voice, your smell and your taste but they are much less familiar with the 'world' outside your womb. Staying close to you gives them a vital sense of safety and reassurance. This builds their confidence that they are loved and cared for (Crenshaw, 2007).

If you're worried, it can really help to talk through your concerns with a breastfeeding counsellor. So call our Infant Feeding Support line on 0300 330 0700.

Will I produce enough milk?

The more you breastfeed your baby, the more milk you will produce (Daly & Hartmann, 1995). If your baby is attached properly, and you're both comfortable and feeding them when they ask for it, you will make enough milk for them (Kent et al, 2012; WHO 2019).

How do I know when to feed my baby?

When your baby is hungry they may give you little signals, known as early feeding cues (NHS, 2019a,b). They might:

* get restless

* suck their fist or fingers

* make murmuring sounds

* turn their head and open their mouth (rooting).

Looking out for and responding to these cues is important. It can help prevent your baby from becoming upset and frustrated, which will make it more difficult to feed them (WHO, 2009). Here's what you might see...

How long should each feed last?

Every baby is different and they will go through different patterns of feeding as they grow (Kent et al, 2012). How much milk a baby needs per breastfeeding session will vary. It's best to be guided by your child (Kent et al, 2012).

Some feeds will seem to last a long time, with your baby dozing for short periods before wanting more. And more. And still more! It's normal for a young baby to be on the breast many times a day and night. 12-15 'visits' to the breast is well within a normal range (Entwistle, 2013).

As a general rule, babies who are feeding well will feed for between five and 40 minutes at each feed (UNICEF, 2010). Your baby will let you know when they've had enough milk. They will usually come off the breast themselves, look sleepy or calm, and look around (UNICEF, 2010).

During each breastfeed, your milk changes slightly. So the milk at the end of the feed is more creamy and filling than the milk at the beginning of the feed (Ballard and Morrow, 2013). Offer one breast and let your baby feed until they stop drinking. If they still appear hungry, offer the second breast - allowing them to drink as much as they want (NICE, 2015).

Should I wake my baby up to feed?

In most cases, healthy, thriving newborns will wake up for feeds and, provided they are well latched on, get all the milk they need (Australian Breastfeeding Association, 2017). But there might be reasons why a newborn might be more sleepy and therefore need to be woken up for feeds.

This includes medical reasons, such as jaundice, infection or a heart problem, or perhaps because the pain relief used during birth is still affecting them (Australian Breastfeeding Association, 2017). If you're worried your baby might be sleeping too much and this is affecting their feeding, talk to your health visitor or call our Infant Feeding Support line on 0300 330 0700.
This page was last reviewed in March 2021
Further information

We support all parents, however they feed their child. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

National Breastfeeding Line (government funded): 0300 100 0212.

Australian Breastfeeding Association. (2017) Do I need to wake my baby for feeds? Available at: https://www.breastfeeding.asn.au/bfinfo/do-i-need-wake-my-baby-feeds [Accessed 20 March 2021].

Ballard O, Morrow AL. (2013) Human milk composition: nutrients and bioactive factors. Pediatric Clinics of North America. 60(1):49-74. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/ [Accessed 20 March 2021].

Crenshaw J. Care practice #6: No separation of mother and baby, with unlimited opportunities for breastfeeding. Journal of Perinatal Education2007;16(3):39-43. Available at: doi:  10.1624/105812407X217147 (Accessed 26 Apr 21)

Daly SEJ, Hartmann PE (1995). Infant Demand and Milk Supply. Part 1: Infant Demand and Milk Production in Lactating Women. Journal of Human Lactation. 11(1):21-26. doi:10.1177/089033449501100119 Available at https://journals.sagepub.com/doi/10.1177/089033449501100119 [Accessed 13 April 2021]

Entwistle FM. (2013) The evidence and rationale for the UNICEF UK Baby Friendly Initiative standards. UNICEF UK. Available at: https://www.unicef.org.uk/babyfriendly/about/evidence-and-rationale-for-the-baby-friendly-standards/ [Accessed 20 March 2021].

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D. (2016) Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database of Systematic Reviews. (9):CD009067. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009067.pub3/full [Accessed 20 March 2021].

Kent JC, Prime DK, Garbin CP. (2012) Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 41(1):114-121. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1552-6909.2011.01313.x [Accessed 20 March 2021].

Leurer MD, Misskey E. (2015) "Be positive as well as realistic": a qualitative description analysis of information gaps experienced by breastfeeding mothers. International Breastfeeding Journal. 10(10):2-11. Available at: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0036-7 [Accessed 20th March 2021].

NHS. (2019a) Breastfeeding: the first few days. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-first-days.aspx#building [Accessed 20 March 2021].

NHS. (2019b) Breastfeeding: is my baby getting enough milk? Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 20 March 2021].

NHS. (2020) Your breastfeeding questions answered. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 20 March 2021].

NICE (2015) Postnatal care up to 8 weeks after birth. CG37. Available at: https://www.nice.org.uk/guidance/cg37 [Accessed 20 March 2021].

UNICEF. (2010) Baby Friendly Initiative. Breastfeeding checklist for mothers - How can I tell that breastfeeding is going well? Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf [Accessed 20 March 2021].

World Health Organization. (1998) Evidence for the Ten Steps to Successful Breastfeeding. Geneva: World Health Organization.

World Health Organization. (2009) Session 2 The physiological basis of breastfeeding. In: Infant and Young Child Feeding. Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Available at: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 20th March 2021].
Further reading
Hoddinott P, Craig, LCA, Britten J, McInnes RJ. (2012) A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open 2:1-14. Available at: https://bmjopen.bmj.com/content/2/2/e000504 [Accessed 20 March 2021].

Martin CR, Ling PR, Blackburn GL. (2016) Review of infant feeding: key features of breast milk and infant formula. Nutrients, 8(5):279. Available at:   https://www.mdpi.com/2072-6643/8/5/279 [Accessed 20th March 2021].

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

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

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Ask any breastfeeding mother why she's chosen to breastfeed. She'll probably tell you about the benefits to herself, her baby and her family, as well as the joy and satisfaction of meeting her baby's needs for food, protection and security through breastfeeding. Mothers who give up after a difficult start may miss this experience. And when a much-longed-for baby is adopted or born by surrogacy, the reasons for breastfeeding can be just as powerful and compelling.

Breastfeeding is more than the provision of milk, with its protective and nourishing qualities. An adoptive mother may choose to nurture her baby at the breast, regarding any breastmilk as an added benefit. And mothers who relactate often do so to re-establish the breastfeeding relationship.

Will I make enough milk?
Relactation-a second chance at breastfeeding
Breastfeeding an adopted baby
Milk Production
Getting Started
Supplementation
Increasing Milk Supply By Breastfeeding
When a baby is reluctant to breastfeed
Moving away from supplements
Expressing breastmilk
Galactogogues
Define your own success
Maintaining Milk Production

Will I make enough milk?

This will depend on your individual situation. Many mothers find they can produce enough milk to be able to give up supplements totally. While there is no guarantee that you will be able to meet all of your baby's needs, you can maximise the amount of breastmilk he receives. Any amount of breastmilk is beneficial. Even if you haven't managed to cut out supplements totally by the time your baby is over six months old, solid foods can gradually start to replace any formula supplements

Relactation-a second chance at breastfeeding

It can be easy to give up breastfeeding, even if things are going fairly well. Many mothers fail to establish breastfeeding because of difficult circumstances such as lack of access to accurate information and/or lack of support. They end up giving up breastfeeding, but then regret their decision.

Vicky's story
An induced birth and separation led to feeding difficulties and Toby losing too much weight. He had to be treated for jaundice and was later hospitalised with an infection. Vicky started to bottle-feed her baby with infant formula to ensure he started gaining weight. After all she had been through, she felt sad and guilty but also slightly relieved.

"Back home we settled into a routine of bottle-feeding, but day by day I became more and more upset by my decision. My baby would turn to me to try to breastfeed and I couldn't believe that I couldn't do it. After a week of not breastfeeding I deeply regretted my decision and contacted La Leche League, where I was offered the support and encouragement I needed. At the time I had no idea it was possible to restart breastfeeding once you had given up. I started by putting my baby to the breast as often as possible and before every formula feed.

It was only a couple of days before I felt the milk coming in and my breasts started to feel full before feeds. I found I didn't really have time to express as I was breastfeeding a lot of the time. Some afternoons I spent hours breastfeeding but I didn't let this worry me and just sat down with a good book or a movie. I continued to supplement with formula, writing down the amount I was giving at each feed and gradually started to reduce it. In fact, as I was reducing the last bit Toby suddenly jumped up in weight so I realised he actually didn't need the top-ups and I just needed confidence that I had enough milk to feed him.

I am so pleased that I made the decision to give it another go. It has been hard work but never a chore. Every day I continue to feed Toby I feel amazed at what I've achieved. He's now four months old and is a big, healthy baby."
From LLLGB's Breastfeeding Matters issue number 178.

Breastfeeding an adopted baby

It is possible to establish milk production for an adopted baby, even if you have never been pregnant or given birth.

Ginny's story
"Carly came to us at 12 weeks. Her foster mother from day two had been lovely to her. She had Carly on infant formula feeds. The first time I put Carly to my breast she happily latched on, even though there was no milk and no supplementer.* Wow! I'd forgotten the strength of a baby's suck. It didn't make me sore and soon I was used to it and loved having another baby to nurse.

Her big brother (who was home-made) had fully weaned three years before. My attempts to assemble the supplementer were hopeless for the first day or two. Not that it's difficult, but I was anxious, so her dad got it ready for me to just hang round my neck. Carly easily did the switch from bottle to breast with supplementer. Pretty soon I noticed her dirty nappies showing breastmilk stools (yellow, runny, sweeter smell) along with the artificial infant milk ones. I soon had a thirst at feeding times and needed a glass of water next to me.

Then a couple of weeks or so on I had a go at expressing and saw some drops of real live breastmilk! I knew a lot of theory but still doubted my body's ability to lactate without childbirth. Nearly three months on, Carly didn't need any more infant formula than she had at 12 weeks old, so my breasts were making the rest of her requirements. Her skin glowed in that breastmilk way. I really felt like I was her mum.

The breastfeeding, along with using a baby carrier lots of the day and keeping her nearby at night, helped me bond. Certainly it wasn't just as easy and convenient as fully breastfeeding, but it was worth the effort. I shall always be thankful for such a good start to mothering our adopted child."
* Nursing supplementer-a device worn by a mother through which her baby receives other milk whilst nursing at the breast. For more information, see Supplementation (below) and our page on Nursing Supplementers.

Milk Production

During pregnancy, hormones cause the milk-making cells and milk ducts in the breast to enlarge and multiply. Colostrum (low volume milk, high in protein and antibodies) is produced from late in pregnancy. After birth, milk is produced and released in response to the baby's suckling and the hormones prolactin and oxytocin. For a mother who has previously breastfed, stimulating the breasts to produce milk without pregnancy and childbirth is called relactation. If you have never had a baby before, this process is called induced lactation.

Milk production depends upon a number of factors, including:
* Your baby's age and willingness to breastfeed effectively.
* Frequency of breastfeeding and/or milk expression.
* Whether you have ever been pregnant, and how long ago.
* Effective treatment of any medical conditions you have, eg thyroid problems or diabetes.
* Extent of any previous damage to your chest/breasts/nipples eg surgery, burn or other injury.
* Extent of any previous damage to the pituitary gland in your brain (where the necessary hormones are produced).
* Reason for any infertility.
* Practical and emotional support available to you

Getting Started

It's possible to induce lactation successfully and increase milk production just by breastfeeding frequently and/or expressing. It can take anything from a few days to a few weeks to be able to express a few drops of milk. You can express as you prepare for the arrival of your baby and/or while you encourage him to the breast. Certain hormonal, herbal, pharmacological and dietary treatments can also help stimulate milk production (see Galactagogues below).

If you are adopting, you can also stimulate breast development and induce lactation using oral contraceptives. www.asklenore.info describes various protocols, depending upon how long it will be before you are likely to welcome your new baby into your family. However these methods are not suitable for mothers who can't take oral contraceptives or are taking medications to suppress oestrogen levels.

Medical conditions and breastfeeding
If you have a medical condition and/or are taking any medication, tell your doctor that you are planning to breastfeed. Lactation can affect the management of certain medical conditions. Mothers often find medical conditions improve or are easier to manage while they are lactating. If a medication you are taking is incompatible with breastfeeding or may affect milk production there are usually alternatives. An LLL Leader can research information about any medications you take and about breastfeeding with specific medical conditions.

Learning to breastfeed
Your baby will probably have already experienced bottle-feeding, and breastfeeding may be a totally new experience for him. He may take to it quickly or need time and patience to get used to this new way of feeding. Mothers have found that even babies older than three or four months can still learn to breastfeed. Breastfeeding may be a new experience for you too so finding good support and information on the basics of breastfeeding, including comfortable positioning and attachment will be invaluable. Check out the Further Reading section on p20. If you are relactating it may also help to talk to an LLL Leader about the issue that caused you to stop breastfeeding in the first place. If possible attend your local LLL group. You can be sure of support and information, even if you attend while bottle-feeding.

Close contact really helps
Offer lots of close contact and carrying, either skin-to-skin or lightly dressed, to help your baby associate close contact with pleasure and comfort. Offering to breastfeed before he is too hungry or when he is sleepy may help him respond instinctively to the sensations of being held at the breast. Breastfeeding, rather than using a dummy, when your baby needs to comfort suck can encourage him to nurse more too.

Supplementation

At first you will probably need to supplement some breastfeeds with your expressed breastmilk or infant formula. Alternatives to using a bottle can help your baby with the transition to breastfeeding, depending on his age and previous feeding experiences. Nursing Supplementers has details of how to use supplemental nursing systems. Nursing supplementers are devices worn by a mother through which her baby receives other milk whilst nursing at the breast. For older babies, cups are also an option. There is more information on managing and reducing supplements in My Baby Needs More Milk.

If bottles are used
If you choose to use a bottle to give supplements, the following tips can help your baby switch to breastfeeding.
* A smaller teat hole prevents a baby being overwhelmed with milk; a larger one means he has to suck less strongly.
* Hold him in an upright position, using your hand to support his neck and head.
* To encourage your baby to open wide, place the teat across his upper and lower lips with the tip at the ridge between the upper lip and nose.
* Allow your baby some control. Let him take the bottle teat into his mouth himself. Avoid pushing the teat into his mouth.
* Tip the bottle just enough to give a gentle flow so your baby isn't overwhelmed with milk. As the bottle empties, you'll need to gradually tip the bottle more and lean your baby back.
* Encourage frequent pauses to mimic breastfeeding.
* Allow your baby to decide when he has had enough.

Different supplements
If you have expressed breastmilk, give this first, before you give your baby any infant formula supplement. To make the most of your precious milk avoid mixing the two together. Infant formula supplements need to be prepared just before use and according to current safety guidelines (see below). Allow prepared powdered formula to cool to body temperature or below so as to avoid burns. Although expensive, using ready-to-feed formula may be more convenient when you are out and about or at home without help. Concentrated and ready to feed forms of infant formula are less likely to clog nursing supplementer tubing than powdered forms.

Monitoring weight gain
Monitor your baby's weight gain and keep a check on his wet and dirty nappies to reassure yourself he is getting enough milk.

Using infant formula
You will probably need to use infant formula whilst you work to increase your milk production. Powdered infant formula is not a sterile product. To reduce health risks associated with using infant formula, follow carefully the NHS guidelines for preparing it.

Increasing Milk Supply By Breastfeeding

Breastfeed often
It may take a little patience to get your baby to nurse effectively. If your baby is willing, offer the breast every one to two hours and at least 10-12 times in every 24 hours. Cut out any dummy use and let him breastfeed for comfort as well as food to help stimulate milk production. Be prepared to encourage night-time and frequent evening nursing, as this can be particularly good at increasing milk production. Laid back breastfeeding positions also boost the levels of the hormones that increase your milk. A soft carrier or sling can be a handy way of keeping your baby close and encouraging breastfeeding.

Start and finish at the breast
Babies expect fast flowing milk at the start of a feed when they are thirsty. So: 1. Breastfeed first from both breasts, using breast compression (see box below) to encourage flow, until your baby begins to fuss. 2. Offer a supplement until he is not quite satisfied. 3. Then finish the feed at the breast, using breast compression again. This can work well even if you need to give larger amounts of supplement. If your milk production is very low you can start feeds at step 2 until it increases a little.

Try breast compression
This technique can encourage a baby to breastfeed actively and take more milk.
1. Support your breast with one hand-thumb on one side, fingers on the other.
2. Wait while your baby breastfeeds actively, his jaw moving all the way to his ear. When he stops swallowing, compress your breast firmly to increase milk flow and prompt swallowing. Hold it squeezed while he continues nursing actively then release your hand.
3. Rotate your hand around the breast and repeat step 2 on different areas of the breast.

Go gently-this should not hurt. Experiment to find what works best for you. Try switching breasts at least two or three times during each feed-when he comes off the first breast on his own, or when breast compression no longer keeps him breastfeeding actively. With time, your baby will need less and less breast compression to keep him actively nursing, until you will find that you no longer need to do this.

A deep, comfortable latch
Attention to positioning and attachment will help ensure your baby is feeding effectively. You can try experimenting

with different feeding positions. Many mothers find laid back or Biological Nurturing™ a good way of encouraging a baby to nurse really well. Many babies instinctively seek the breast and attach deeply and comfortably if they can snuggle up close to their mother's chest for periods of time. Try letting your baby lie on your body, skin-toskin or lightly dressed, as you recline so both his chest and tummy are against you. As your body supports your baby, this leaves your hands free to help with latch on. See Positioning & Attachment for more information.

Some babies who are accustomed to taking a dummy or supplements from a bottle may not take a big enough mouthful of breast and might need to be coached to get a wide enough mouth. Try opening your own mouth very wide and encouraging your baby to look at and imitate you. If you can't get comfortable speak to an LLL Leader who can give you further suggestions.

Take a 'baby moon'
Get some help with household jobs, ignore the dust and eat simple, easily prepared meals for a week or two so you can concentrate on breastfeeding your baby. A couple of days' bed rest together with your baby can really boost your milk production. Even if you can't manage this, do plan some time each day to sit or lie down with your baby.

Positive signs
Signs that your milk is increasing include:
* Hormonal changes, such as a brief slump in mood before your milk appears.
* Breasts feeling hotter, tingling, fuller or heavier.
* Feeling thirsty when breastfeeding.
* Leaking milk and/or being able to express more milk.
* Your baby gains weight and produces more wet and dirty nappies, especially yellow, mustard-coloured poos.
* Your baby starts to refuse supplements.

When a baby is reluctant to breastfeed

Some babies don't take to breastfeeding straight away. It can be enormously frustrating if he refuses but patience and gentle persistence can work wonders.

Ideas to try
* Offer close contact skin-to-skin or lightly dressed for sustained periods of time each day even if your baby is reluctant to latch on at all.
* Letting your baby doze on your chest in Biological Nurturing™ or laid-back positions may prompt him to seek out the breast instinctively. Bathing and sleeping together can also have the same effect.
* Express a little milk to stimulate your let-down so your milk flows as soon as he latches on.
* Or offer a little supplement to take the edge off his hunger and help calm him before you attempt to breastfeed.
* If he will latch on, use breast compression to help maintain your milk flow. You can switch sides to maintain his interest too.

For more ideas see My Baby Won't Breastfeed and Nipple Confusion?

Keeping calm
Encouraging a reluctant baby to nurse can become stressful. Try to keep calm and avoid conveying anxiety to your baby. Some mothers find relaxation exercises helpful. It's quite possible that, once your baby is comfortable and relaxed with the closeness, he may latch on when you least expect it, especially if you are expressing to increase your milk production. And even if he doesn't, you will still have pleasant memories of times spent in close contact together. Remember that you are spending time expressing as well as feeding and caring for your baby. You are doing far more than a mother who is simply bottlefeeding or breastfeeding alone. Be gentle on yourself and take time to meet your own needs for food and rest.

Moving away from supplements

While your baby is slow to gain weight or not breastfeeding well, keep offering the same amount of supplement. If you get to a point when you are expressing enough milk each day to meet your baby's needs then you can encourage your baby to get all his milk at your breast instead and gradually cut out the expressed milk supplements. Offer frequent feeds making sure he is latched on well, and use breast compression to help maintain milk flow if his suckling slows or stops. Switching sides several times during a feed can help maintain his interest in nursing and maximise the amount of milk he takes.

Reduce supplements gradually
Once he is nursing and gaining weight steadily, and you are producing more milk, you can start reducing supplements gradually.
* Reduce the amount of supplement every few days so your baby continues to get plenty of milk.
* It's best to reduce all or several of the day's supplements by very small amounts, about 5-15ml for each one.
* At times of the day when you feel as though you have more milk, for example, in the morning, you may be able to reduce a supplement by 20-30ml.
* Keep an eye on your baby's wet and dirty nappies so you know that he's taking plenty of milk.
* Keep in touch with your health visitor or GP for regular weighing, and to discuss reducing supplements. Be prepared to take things more slowly if your baby becomes fussy or seems hungry. You may need to slow or temporarily stop reducing supplements.

Expressing breastmilk

Before your baby is breastfeeding
The more frequently you express, the more milk you are likely to make. Express at least 8 times each 24 hours, including once during the night if possible. Try to establish a routine you can sustain on a day-to-day basis, and fit in extra sessions on days when you have more time. Milk you express before your adopted baby arrives can be frozen for later use. Even a little breastmilk, however small, is beneficial for a baby. An actively nursing baby is more effective at stimulating milk production than any pump, so you can continue to work to induce and increase your milk supply once your baby arrives and/or is breastfeeding.

In addition to breastfeeding
You can express between feeds to stimulate milk production if your baby is reluctant to take the breast or is sleepy and not feeding effectively. You can also express after breastfeeds (either immediately or after a short break) to help stimulate milk production. Expressing even small amounts after feeding boosts milk production. You can give any milk you express as a supplement before you give formula. If your baby will go to the breast frequently, breastfeeding really is the best way of increasing your milk. Expressing milk is an extra, to give your milk production a boost. Mothers who breastfeed frequently (10-12 times a day or more) and don't have the time to express any milk often increase their milk and establish breastfeeding fastest. Don't be surprised if you don't notice any increase in the amount of milk you can express. If you are nursing your baby frequently, he will take the extra milk directly at the breast without you realising.

Hand expression
Hand expression is very effective, especially for mothers producing small amounts of milk. The skin contact helps stimulate milk flow. Hand expression also works well when combined with pumping. Use it to stimulate your milk flow before pumping, to maintain flow whilst you are actually pumping and/or after pumping to express milk the pump has not reached.

Pumping
Hospital-grade pumps are considered the most effective for mothers needing to induce or increase their milk supply. Pumping both breasts at the same time saves time, stimulates milk production and boosts milk-producing hormones better than single pumping. When pumping one breast at a time, try switching back and forth between breasts as your milk flow slows. Sterilise equipment once a day if your baby is healthy. Just like your milk, pumping equipment can safely be left at room temperature for short periods and refrigerated in a clean container for longer periods, giving you more time for your baby. See Storing Your Milk for details.

Making time to express
It can help to think of expressing time as an enjoyable break to have with a drink, snack or treat. Put your feet up and listen to, watch or read something you enjoy. Find something that makes you relax and smile. The less you think about the process, the more you may be able to express.
Try expressing your milk:
* In the evening if your baby sleeps-to 'put in an order' for more milk tomorrow.
* During or after skin-to-skin contact.
* Little and often-as frequently as you can manage.

More information about expressing your milk.

Galactogogues

Medicinal herbs such as fenugreek or prescription medications such as domperidone can increase milk production in conjunction with breast stimulation. Galactogogues are effective only when combined with frequent nursing or expressing to ensure breasts are kept well drained.

Many mothers can increase their milk by nursing and expressing alone and don't need galactogogues. Galactogogues can have side effects. They also need to be taken regularly and in sufficient doses. Even then, not all mothers respond to them. Milk production can drop if you suddenly stop taking a galactogogue so it's best to cut back gradually and only once you feel confident you are producing more milk than your baby currently needs.

Fenugreek
Take three 500mg capsules, three times a day (nine per day in total). It takes 24-72 hours to see an increase in milk production. Possible side effects include perspiring more profusely and sweat and urine smelling like maple syrup. A few mothers have developed diarrhoea and a few mothers with asthma have reported aggravation of their symptoms. Two cases of fenugreek allergy have been reported (fenugreek is closely related to peanuts). Be cautious if you have diabetes, since fenugreek lowers blood sugar. If you develop any worrying symptoms, stop taking fenugreek and consult your doctor if necessary.

Domperidone
You will need a prescription from your GP. The dose usually recommended is one or two 10mg tablets three times a day. Domperidone is not licensed for use as a galactogogue.

From UK Medicines Information (document will download for viewing):
'As there are limited alternative options for the stimulation of lactation, the use of domperidone can be considered provided there is evidence of thorough evaluation for treatable causes such as poor attachment, and when increased frequency of breastfeeding, pumping or hand expression of milk has not been successful. A maternal dose of 30mg daily for a maximum of 1 week should not be exceeded.

Domperidone should not be used if the mother or infant:

have conditions where the cardiac conduction is, or could be, impaired

have underlying cardiac diseases such as congestive heart failure

are receiving other medications known to prolong QT or potent CYP3A4 inhibitors e.g. ketoconazole or erythromycin. If this is the case, metoclopramide is the preferred alternative.

have severe hepatic impairment'

Define your own success

Relactation or adoptive breastfeeding can be a big commitment. Some mothers consider it but decide it is not for them. Whether or not you choose to go ahead with it, just knowing that it is a possibility can help you come to terms with what you have experienced and to feel in control.

Relactation or adoptive breastfeeding is probably best entered into with equal measures of optimism and realism. You might find it helpful to define your own level of success in what you aim to achieve. You may be able to bring in a full milk supply, but even small amounts of breastmilk are beneficial. If your main purpose is to enjoy the closeness of breastfeeding, you can aim to nurse for comfort whenever possible and use a nursing supplementer for feeds. Any breastmilk you produce is a bonus for your baby.

Maintaining Milk Production

Every drop of breastmilk counts To maintain milk production as long as possible while supplementing with formula:
* Breastfeed often and as long at each feed as your baby is willing to, including nursing for comfort between feeds.
* Avoid going longer than eight hours without breastfeeding or expressing.
* Use breast compression to maximise the milk your baby receives each time he goes to the breast, and to help keep your breasts well drained.
* Give formula only after he has nursed. * Offer the breast again if he is willing after taking a formula supplement.
* Whilst your baby's weight gain is steady, avoid increasing the amount of formula he receives.

Menstruation
Some mothers find their milk production drops temporarily just before or when they are menstruating. If you continue to breastfeed and/or pump, milk production will increase in a few days.

Out at work?
You could:
* Compensate for lack of daytime nursing by encouraging some night-time nursing.
* Make extra efforts to increase your milk on days when you are off work. As your milk production increases, or after days at home, your breasts may feel fuller. Be prepared to express milk while at work to keep comfortable, to prevent engorgement and to reduce the risk of mastitis.

There may come a point when you decide to stop because establishing breastfeeding isn't working out. Pumping to keep up milk production takes a lot of time and is not a long-term option for many mothers when a baby doesn't take to the breast easily. But whatever happens, be proud because every single drop of breastmilk you have given your baby will have been beneficial. You know that you did everything possible to make breastfeeding an option. If you have another baby, don't hesitate to get in touch with La Leche League again. Making contact with LLL before your baby arrives means you can share your concerns and gather information to help avoid problems. Knowing who to contact means you'll be able to get help quickly to prevent any minor problems in those early weeks from escalating.

Support network
LLL groups are a great source of support for all mothers who are working to establish breastfeeding, whatever their circumstances. If you plan to adopt or have a baby born by surrogacy, you can attend LLL meetings before your baby arrives just like other expectant mothers.

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

Further Reading

The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
The Breastfeeding Answer Book. Schaumburg, IL: LLLI, 2003.
Breastfeeding an Adoptived Baby & Relactation. Hormann, E. Schaumburg, IL:LLLI, 2006.
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.
The Breastfeed Mother's Guide to Making More MilkK. West, D. and Marasco, L. McGrawHill, 2009.
Exclusively Pumping Breastmilk Casemore. S. Gray Lion Publishing 2013

Comfortable Breastfeeding
Dummies and Breastfeeding
Expressing Your Milk
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won't Breastfeed
Nipple Confusion?
Nipple Pain
Nursing Supplementers
Positioning & Attachment
Safe Sleep & The Breastfed Baby
Storing Your Milk
Sharing Breastmilk
This information is available to buy in printed form from the LLLGB Shop

Copyright LLLGB 2016

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Relactation and Induced Lactation - La Leche League GB

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Sometimes after a difficult start to breastfeeding it may be necessary to build up your milk supply and encourage your baby tp breastfeed. We also look at induced lactation

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Does your baby need more milk?
How to know your baby is getting enough breastmilk
Increasing your milk production
If supplements are needed
Feeding methods
Expressing your milk

Does your baby need more milk?

Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk production. Perhaps you and your baby had a difficult start, or were not given the support you needed to establish breastfeeding. Or maybe things were going well until your baby's weight gain faltered.

If others question your milk production and your baby is fussy, wants to feed much of the time, seems small, or gains weight slowly, you may be wondering whether you have enough milk.

Follow your baby not the book

Young babies need to nurse frequently to get enough milk and establish their mother's milk production. Following feeding schedules, using regular supplements, nipple shields, or a dummy can really reduce your milk production.

Breastmilk is also a drink and frequent nursing is normal. Adults rarely go longer than two hours without a drink, snack or meal. Your baby's tummy is tiny and breastmilk is quickly digested, so they need frequent feeds to help them grow. It is recommended that your baby is weighed no more than once a month for the first six months, unless there are concerns.

Sleepy Baby
A baby who sleeps a lot rather than waking to feed every 2-3 hours may need to be woken up to nurse, particularly if they have jaundice or aren't gaining enough weight. If this is difficult or your baby is lethargic, ask your midwife, health visitor or GP to check that all is well.

See our article Sleepy Baby - why and what to do for more information.

How to know your baby is getting enough breastmilk

Weight gain
It is normal for newborns to lose up to 7% of their birth weight in the first few days. Once your milk production increases, usually on day 3-4, expect your baby to begin gaining weight. Most babies regain their birth weight by the age of 10-14 days. You may also find it helpful to see Is my baby getting enough milk?

Plot your baby's weight gain on a UK-WHO growth chart based on the growth rates of breastfed babies (see examples below and Further Reading). Although they will be growing at their own individual rate, it will give you an indication of how they are doing.

Monitor your baby's weight over a period of time rather than week by week. Your baby's weight may generally follow the chart, or climb up, crossing the percentile lines. A gradual drop from one percentile line to the next (or the equivalent distance) is unlikely to be a problem unless their weight is low for their age. Heavier newborns often show 'catch-down' growth - they gain weight steadily but drop gradually against the chart lines.

Dropping against the chart is more of a worry for lower weight babies
If your baby's growth curve drops across two lines of the chart (or the equivalent distance), or if their weight is below the lowest line of the chart:

Follow the suggestions here to ensure they get more milk.

Seek help from your GP to rule out an underlying medical reason for your baby's slow weight gain.

If you have doubts about your baby's growth, you may find it reassuring to talk to an LLL Leader.

Wet and dirty nappies
If your baby receives enough milk, the thick and sticky black meconium poos will be passed within three days of birth, followed by at least 6-8 wet and 3-5 dirty nappies in each 24 hours. Expect yellow, loose, unformed poos at least the size of a 2p coin. From about six weeks, some babies have abundant poos once every few days. This isn't a problem when a baby has plenty of wet nappies.

Look at your baby
You may instinctively know how your baby is doing. Are they nursing vigorously? Is their skin firm? Do they look healthy and seem active and alert? Are they meeting developmental milestones?

Remember
Even if your breasts feel empty, there's always some milk there. Full breasts and engorgement slow milk production - you may need to nurse more often. Removing even small amounts of milk from soft breasts increases milk production.

Babies nurse for comfort as well as for food. Those little 'snack' comfort feeds can really increase your milk production and their calorie intake.

Expect your baby to want to breastfeed very often from time to time. Your breasts will quickly adjust to making more milk if you follow your baby's cues.

Every baby has a unique feeding pattern. If your baby is gaining weight adequately, following their own feeding pattern is the best way of ensuring you are meeting their needs. It's rare that a mother cannot produce enough milk for her baby, and there are lots of ways to increase the amount of breastmilk your baby gets.

Increasing your milk production

After the first few weeks, supply and demand drives milk production. To increase your milk supply, focus on feeding more often and getting more milk out at each feed. For more information about how breasts make milk, see our article How milk production works and also How to increase your milk supply.
Breastfeeding basics

Breastfeed as often as possible - at least 10 times in 24 hours. Wake your baby if necessary.

Switch sides when your baby's suck-swallow pattern starts to slow. Continue to switch sides (four times or more) until they reject the breast.

Use breast compression (see below).

Instead of breastfeeding at set intervals, encourage 'cluster feeding' - breastfeeding very often at times when your baby is willing to.

Encourage breastfeeding for comfort as well as for food. It can really help your milk production. Stop using dummies - breastfeed instead.

Ensure you are meeting your baby's needs for milk during the night, feeding at least once every four hours.

Cut back a little on your baby's solid foods if your milk production is dropping (see below).

An effective latch
A baby may spend a long time at the breast but not get very much milk if they are not latched on effectively. Check your baby is well attached - watch and listen for swallowing which is frequent at the start and then slows down.

Contact an LLL Leader for one-to-one support and see Further Reading for more information. It's important to seek skilled help early on if you are finding breastfeeding difficult, uncomfortable or painful.

Take a 'baby moon'
Get some help with the housework and eat simple, easily-prepared meals for a week or two so you can concentrate on breastfeeding your baby. A couple of days' bed rest together, feeding your baby on demand can really boost your milk production. Or at least take some time each day to rest with them and concentrate on breastfeeding.

Try laid-back breastfeeding
Many babies instinctively seek the breast and feed frequently if they can snuggle up close to their mother's chest.

Try letting your baby lie on your body, skin to skin (with a blanket if needed) as you recline, so both their chest and tummy are against you. This close body contact gives your baby lots of opportunity to breastfeed, even in a light sleep, and boosts levels of the hormones that increase your milk. A soft carrier or sling helps to keep your baby close and encourages breastfeeding. (see Positioning and Attachment for more on laid back breastfeeding)

Breast compression
This technique puts pressure on the milk ducts and can help to make feeding more efficient:

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

Wait while your baby breastfeeds actively, their jaw moving all the way to their ear. When their swallowing slows, compress your breast firmly to increase milk flow and encourage swallowing. Hold it squeezed while they continue nursing actively, then release your hand.

Rotate your hand around the breast and repeat step 2 on different areas of the breast.

Go gently - this should not hurt.

Other foods
Babies need only human milk for the first six months (human milk is higher in calories than many weaning foods). Too much solid food replacing human milk can affect weight gain in older babies. Breastfeed before offering solid foods if your baby is under 12 months old. Even at 12 months, both human milk and solids are equally important. Breastfeed frequently and, rather than spoon-feeding, offer your baby a variety of foods, letting them feed themselves to ensure they take only what they need.

Continued low milk production
If you've tried all these suggestions and your milk production has not increased enough, there may be a medical reason. Some medical conditions can lead to low milk production, though appropriate treatment can reduce the impact. These situations are rare, but you can discuss possibilities with an LLL Leader. For more information see our article How to increase your milk supply and Further Reading.

Signs your milk is increasing
Watch for weight gain and an increase in your baby's wet and dirty nappies. Your breasts may feel fuller before feeds and begin to leak.

Looking after yourself
Don't forget to be kind to yourself, especially if you're feeling under pressure. Now is the time to call in favours from friends and relatives so you can concentrate on your baby. If your baby needs more milk, talking to your local LLL Leader will help. You can share your concerns with other mothers at an LLL meeting, who will be able to give you encouragement and support.

If supplements are needed

It can be a challenge fitting in breastfeeding, supplementing and expressing. You could try the following approach, aiming for at least 8 feeds in 24 hours. At each feed:

Start with breastfeeding, observing your baby's swallowing pattern. Use breast compressions to maximise the flow. When swallowing slows, switch sides and repeat. If your baby has enough energy, you can repeat this process (known as 'switch nursing'). This part of the feed might take 10-30 minutes, but use swallowing as your guide. A baby who is not swallowing isn't taking in any milk so move to step 2.

Give your supplement with a spoon, syringe, nursing supplementer, finger feeding tube, or bottle. Give stored breastmilk first, then supplement with other milk. Follow your baby's lead until they are satisfied. A baby who is underweight may become extra hungry for a while. By giving them extra milk, you will help them gain weight and get the energy they need to breastfeed better. To save time, this step could be done by your support person while you express. For more on ways to give your baby more milk, see our article on Bottles and other tools.

Express both breasts using a combination of pumping and hand expression, switching back and forth as milk flow slows. Store this milk in the fridge ready for the next feed. By removing the milk your baby couldn't, you build your future milk production and have milk to supplement the next feed. This is an important step, especially if you are working to eliminate formula supplements.

Finish at the breast. The whole feed may take 60-90 minutes. If it works for you, you might offer the breast at the end of the feed so your baby associates the breast with being calm, happy and satisfied. Suckling can help them settle to sleep, too.

Keep a record of the amounts of each supplement your baby takes at each feed and also what you express. This can help you see your progress and maybe useful for anyone supporting you with breastfeeding.

Feeding methods

Cup, spoon and syringe feeding can work when small amounts are needed.

A nursing supplementer can be used to give larger amounts while your baby is at the breast. Another option is finger feeding, using an infant feeding tube. One end of the tube is taped to your finger. As your baby sucks on your finger, milk flows along the tube from a container which can be raised or lowered to change flow. An LLL Leader can help you find out more and choose an option that works best for you.

If using a bottle, paced bottle feeding can help ensure your baby doesn't take more milk than they need.

A smaller teat hole prevents a baby taking milk too quickly.

Hold them in an upright position, using your hand to support their neck and head.

To encourage your baby to open wide, place the teat across their lips with the tip between the upper lip and nose.

Allow your baby some control. Let them take the bottle teat into their mouth themself. Avoid pushing the teat into their mouth.

Tilt the bottle just enough to fill the tip of the teat and give a gentle flow so your baby isn't overwhelmed with milk. As the bottle empties, gradually tilt the bottle more and lean your baby back.

Encourage frequent pauses to mimic breastfeeding, and allow your baby to decide when they have had enough.

For more information see Bottles and other tools.

Expressing your milk

A baby nursing well at the breast is more effective than any pump. But while your baby isn't breastfeeding well or you're giving supplements, expressing your milk will stimulate milk production. Give any expressed milk before you give infant formula, so none of your precious breastmilk is wasted.

Nurse your baby frequently so they get the extra milk you make. An increase in the amount you can express is a sign that you can reduce supplements if your baby is nursing well and often.

Hospital-grade pumps are the most effective for mothers needing to increase their milk, but any pump that works well for you is fine.

Try hands-on pumping: use breast massage and breast compressions while pumping, then hand express afterwards to get the last few drops of milk. For more on hand expressing see our article: Hand expression

Pumping on both sides at the same time boosts milk-producing hormones. When pumping one side at a time, switch back and forth several times as milk flow slows.

Consider power pumping: experiment with pumping very frequently for short periods to mimic cluster feeding.

Wash your pump with hot soapy water, or sterilise it once a day. Pump equipment can be left at room temperature for short periods, or stored in the fridge for longer periods. For more information, see our article Expressing Your Milk.
Good times to express milk

After feeds while your baby sleeps - 'putting in an order' for more milk later. Milk expressed after a feed may be small in quantity, but is high in calories.

Between feeds if your baby is too sleepy to nurse frequently.

While holding your baby, or with them nearby. Expressing little and often can be better than long sessions. Try some 'power pumping' during the evening, or fit in some extra pumping sessions one day. You should notice an increase in milk production a couple of days later.

Using donor milk and formula to support breastfeeding
The use of donor milk or infant formula is sometimes essential to meet a baby's nutritional needs. You may need to use donor milk or formula as a short-term measure while you work to increase your milk production. See our article Using donor milk & formula to support breastfeeding for more information.

Supplementing with donor milk or formula without protecting your milk supply may reduce the duration of your breastfeeding journey.

Powdered infant formula is not a sterile product. To reduce health risks associated with using infant formula, carefully follow the NHS guidelines for preparing it. La Leche League does not recommend the use of homemade formula. The NHS guide to bottle feeding is available online (see Further Reading).

Written by Karen Butler and mothers of LLLGB

Further Reading

How to increase your milk supply
How milk production works
Using donor milk and formula to support breastfeeding
Dummies and Breastfeeding
Hand expressing of breastmilk
Comfortable Breastfeeding
Is my baby getting enough milk?
Nursing Supplementers
Positioning & Attachment
Rhythms and Routines
Safe sleep and the Breastfed Baby
Sleep baby - why and what to do
Storing your milk
After a difficult start

Books
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Making more milk, second edition, Marasco, L. and West, D. New York: McGraw-Hill Education, 2019.
Other websites
Natural (laid-back) breastfeeding naturalbreastfeeding.com
Biological nurturing™ www.biologicalnurturing.com
Maximising milk production when expressing https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html
UK-WHO Growth Charts These charts are based on the growth rates of breastfed babies and can be found in your baby's Personal Child Health Record (red book). Further copies, the more detailed hospital 0-4 charts and specialised charts for low weight babies can all be downloaded from: www.rcpch.ac.uk/growthcharts
NHS guide to bottle feeding

This information is available to buy in printed form from our shop.

Copyright LLLGB 2022

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My baby needs more milk - La Leche League GB

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Does your baby need more milk? How to know your baby is getting enough breastmilk Increasing your milk production If supplements are needed Feeding methods Expressing your milk Does your baby need more milk? Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk [...]

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La Leche League - my baby needs more milk

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La Leche League - my baby needs more milk

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Does your baby need more milk?
How to know your baby is getting enough breastmilk
Increasing your milk production
If supplements are needed
Feeding methods
Expressing your milk

Does your baby need more milk?

Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk production. Perhaps you and your baby had a difficult start, or were not given the support you needed to establish breastfeeding. Or maybe things were going well until your baby's weight gain faltered.

If others question your milk production and your baby is fussy, wants to feed much of the time, seems small, or gains weight slowly, you may be wondering whether you have enough milk.

Follow your baby not the book

Young babies need to nurse frequently to get enough milk and establish their mother's milk production. Following feeding schedules, using regular supplements, nipple shields, or a dummy can really reduce your milk production.

Breastmilk is also a drink and frequent nursing is normal. Adults rarely go longer than two hours without a drink, snack or meal. Your baby's tummy is tiny and breastmilk is quickly digested, so they need frequent feeds to help them grow. It is recommended that your baby is weighed no more than once a month for the first six months, unless there are concerns.

Sleepy Baby
A baby who sleeps a lot rather than waking to feed every 2-3 hours may need to be woken up to nurse, particularly if they have jaundice or aren't gaining enough weight. If this is difficult or your baby is lethargic, ask your midwife, health visitor or GP to check that all is well.

See our article Sleepy Baby - why and what to do for more information.

How to know your baby is getting enough breastmilk

Weight gain
It is normal for newborns to lose up to 7% of their birth weight in the first few days. Once your milk production increases, usually on day 3-4, expect your baby to begin gaining weight. Most babies regain their birth weight by the age of 10-14 days. You may also find it helpful to see Is my baby getting enough milk?

Plot your baby's weight gain on a UK-WHO growth chart based on the growth rates of breastfed babies (see examples below and Further Reading). Although they will be growing at their own individual rate, it will give you an indication of how they are doing.

Monitor your baby's weight over a period of time rather than week by week. Your baby's weight may generally follow the chart, or climb up, crossing the percentile lines. A gradual drop from one percentile line to the next (or the equivalent distance) is unlikely to be a problem unless their weight is low for their age. Heavier newborns often show 'catch-down' growth - they gain weight steadily but drop gradually against the chart lines.

Dropping against the chart is more of a worry for lower weight babies
If your baby's growth curve drops across two lines of the chart (or the equivalent distance), or if their weight is below the lowest line of the chart:

Follow the suggestions here to ensure they get more milk.

Seek help from your GP to rule out an underlying medical reason for your baby's slow weight gain.

If you have doubts about your baby's growth, you may find it reassuring to talk to an LLL Leader.

Wet and dirty nappies
If your baby receives enough milk, the thick and sticky black meconium poos will be passed within three days of birth, followed by at least 6-8 wet and 3-5 dirty nappies in each 24 hours. Expect yellow, loose, unformed poos at least the size of a 2p coin. From about six weeks, some babies have abundant poos once every few days. This isn't a problem when a baby has plenty of wet nappies.

Look at your baby
You may instinctively know how your baby is doing. Are they nursing vigorously? Is their skin firm? Do they look healthy and seem active and alert? Are they meeting developmental milestones?

Remember
Even if your breasts feel empty, there's always some milk there. Full breasts and engorgement slow milk production - you may need to nurse more often. Removing even small amounts of milk from soft breasts increases milk production.

Babies nurse for comfort as well as for food. Those little 'snack' comfort feeds can really increase your milk production and their calorie intake.

Expect your baby to want to breastfeed very often from time to time. Your breasts will quickly adjust to making more milk if you follow your baby's cues.

Every baby has a unique feeding pattern. If your baby is gaining weight adequately, following their own feeding pattern is the best way of ensuring you are meeting their needs. It's rare that a mother cannot produce enough milk for her baby, and there are lots of ways to increase the amount of breastmilk your baby gets.

Increasing your milk production

After the first few weeks, supply and demand drives milk production. To increase your milk supply, focus on feeding more often and getting more milk out at each feed. For more information about how breasts make milk, see our article How milk production works and also How to increase your milk supply.
Breastfeeding basics

Breastfeed as often as possible - at least 10 times in 24 hours. Wake your baby if necessary.

Switch sides when your baby's suck-swallow pattern starts to slow. Continue to switch sides (four times or more) until they reject the breast.

Use breast compression (see below).

Instead of breastfeeding at set intervals, encourage 'cluster feeding' - breastfeeding very often at times when your baby is willing to.

Encourage breastfeeding for comfort as well as for food. It can really help your milk production. Stop using dummies - breastfeed instead.

Ensure you are meeting your baby's needs for milk during the night, feeding at least once every four hours.

Cut back a little on your baby's solid foods if your milk production is dropping (see below).

An effective latch
A baby may spend a long time at the breast but not get very much milk if they are not latched on effectively. Check your baby is well attached - watch and listen for swallowing which is frequent at the start and then slows down.

Contact an LLL Leader for one-to-one support and see Further Reading for more information. It's important to seek skilled help early on if you are finding breastfeeding difficult, uncomfortable or painful.

Take a 'baby moon'
Get some help with the housework and eat simple, easily-prepared meals for a week or two so you can concentrate on breastfeeding your baby. A couple of days' bed rest together, feeding your baby on demand can really boost your milk production. Or at least take some time each day to rest with them and concentrate on breastfeeding.

Try laid-back breastfeeding
Many babies instinctively seek the breast and feed frequently if they can snuggle up close to their mother's chest.

Try letting your baby lie on your body, skin to skin (with a blanket if needed) as you recline, so both their chest and tummy are against you. This close body contact gives your baby lots of opportunity to breastfeed, even in a light sleep, and boosts levels of the hormones that increase your milk. A soft carrier or sling helps to keep your baby close and encourages breastfeeding. (see Positioning and Attachment for more on laid back breastfeeding)

Breast compression
This technique puts pressure on the milk ducts and can help to make feeding more efficient:

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

Wait while your baby breastfeeds actively, their jaw moving all the way to their ear. When their swallowing slows, compress your breast firmly to increase milk flow and encourage swallowing. Hold it squeezed while they continue nursing actively, then release your hand.

Rotate your hand around the breast and repeat step 2 on different areas of the breast.

Go gently - this should not hurt.

Other foods
Babies need only human milk for the first six months (human milk is higher in calories than many weaning foods). Too much solid food replacing human milk can affect weight gain in older babies. Breastfeed before offering solid foods if your baby is under 12 months old. Even at 12 months, both human milk and solids are equally important. Breastfeed frequently and, rather than spoon-feeding, offer your baby a variety of foods, letting them feed themselves to ensure they take only what they need.

Continued low milk production
If you've tried all these suggestions and your milk production has not increased enough, there may be a medical reason. Some medical conditions can lead to low milk production, though appropriate treatment can reduce the impact. These situations are rare, but you can discuss possibilities with an LLL Leader. For more information see our article How to increase your milk supply and Further Reading.

Signs your milk is increasing
Watch for weight gain and an increase in your baby's wet and dirty nappies. Your breasts may feel fuller before feeds and begin to leak.

Looking after yourself
Don't forget to be kind to yourself, especially if you're feeling under pressure. Now is the time to call in favours from friends and relatives so you can concentrate on your baby. If your baby needs more milk, talking to your local LLL Leader will help. You can share your concerns with other mothers at an LLL meeting, who will be able to give you encouragement and support.

If supplements are needed

It can be a challenge fitting in breastfeeding, supplementing and expressing. You could try the following approach, aiming for at least 8 feeds in 24 hours. At each feed:

Start with breastfeeding, observing your baby's swallowing pattern. Use breast compressions to maximise the flow. When swallowing slows, switch sides and repeat. If your baby has enough energy, you can repeat this process (known as 'switch nursing'). This part of the feed might take 10-30 minutes, but use swallowing as your guide. A baby who is not swallowing isn't taking in any milk so move to step 2.

Give your supplement with a spoon, syringe, nursing supplementer, finger feeding tube, or bottle. Give stored breastmilk first, then supplement with other milk. Follow your baby's lead until they are satisfied. A baby who is underweight may become extra hungry for a while. By giving them extra milk, you will help them gain weight and get the energy they need to breastfeed better. To save time, this step could be done by your support person while you express. For more on ways to give your baby more milk, see our article on Bottles and other tools.

Express both breasts using a combination of pumping and hand expression, switching back and forth as milk flow slows. Store this milk in the fridge ready for the next feed. By removing the milk your baby couldn't, you build your future milk production and have milk to supplement the next feed. This is an important step, especially if you are working to eliminate formula supplements.

Finish at the breast. The whole feed may take 60-90 minutes. If it works for you, you might offer the breast at the end of the feed so your baby associates the breast with being calm, happy and satisfied. Suckling can help them settle to sleep, too.

Keep a record of the amounts of each supplement your baby takes at each feed and also what you express. This can help you see your progress and maybe useful for anyone supporting you with breastfeeding.

Feeding methods

Cup, spoon and syringe feeding can work when small amounts are needed.

A nursing supplementer can be used to give larger amounts while your baby is at the breast. Another option is finger feeding, using an infant feeding tube. One end of the tube is taped to your finger. As your baby sucks on your finger, milk flows along the tube from a container which can be raised or lowered to change flow. An LLL Leader can help you find out more and choose an option that works best for you.

If using a bottle, paced bottle feeding can help ensure your baby doesn't take more milk than they need.

A smaller teat hole prevents a baby taking milk too quickly.

Hold them in an upright position, using your hand to support their neck and head.

To encourage your baby to open wide, place the teat across their lips with the tip between the upper lip and nose.

Allow your baby some control. Let them take the bottle teat into their mouth themself. Avoid pushing the teat into their mouth.

Tilt the bottle just enough to fill the tip of the teat and give a gentle flow so your baby isn't overwhelmed with milk. As the bottle empties, gradually tilt the bottle more and lean your baby back.

Encourage frequent pauses to mimic breastfeeding, and allow your baby to decide when they have had enough.

For more information see Bottles and other tools.

Expressing your milk

A baby nursing well at the breast is more effective than any pump. But while your baby isn't breastfeeding well or you're giving supplements, expressing your milk will stimulate milk production. Give any expressed milk before you give infant formula, so none of your precious breastmilk is wasted.

Nurse your baby frequently so they get the extra milk you make. An increase in the amount you can express is a sign that you can reduce supplements if your baby is nursing well and often.

Hospital-grade pumps are the most effective for mothers needing to increase their milk, but any pump that works well for you is fine.

Try hands-on pumping: use breast massage and breast compressions while pumping, then hand express afterwards to get the last few drops of milk. For more on hand expressing see our article: Hand expression

Pumping on both sides at the same time boosts milk-producing hormones. When pumping one side at a time, switch back and forth several times as milk flow slows.

Consider power pumping: experiment with pumping very frequently for short periods to mimic cluster feeding.

Wash your pump with hot soapy water, or sterilise it once a day. Pump equipment can be left at room temperature for short periods, or stored in the fridge for longer periods. For more information, see our article Expressing Your Milk.
Good times to express milk

After feeds while your baby sleeps - 'putting in an order' for more milk later. Milk expressed after a feed may be small in quantity, but is high in calories.

Between feeds if your baby is too sleepy to nurse frequently.

While holding your baby, or with them nearby. Expressing little and often can be better than long sessions. Try some 'power pumping' during the evening, or fit in some extra pumping sessions one day. You should notice an increase in milk production a couple of days later.

Using donor milk and formula to support breastfeeding
The use of donor milk or infant formula is sometimes essential to meet a baby's nutritional needs. You may need to use donor milk or formula as a short-term measure while you work to increase your milk production. See our article Using donor milk & formula to support breastfeeding for more information.

Supplementing with donor milk or formula without protecting your milk supply may reduce the duration of your breastfeeding journey.

Powdered infant formula is not a sterile product. To reduce health risks associated with using infant formula, carefully follow the NHS guidelines for preparing it. La Leche League does not recommend the use of homemade formula. The NHS guide to bottle feeding is available online (see Further Reading).

Written by Karen Butler and mothers of LLLGB

Further Reading

How to increase your milk supply
How milk production works
Using donor milk and formula to support breastfeeding
Dummies and Breastfeeding
Hand expressing of breastmilk
Comfortable Breastfeeding
Is my baby getting enough milk?
Nursing Supplementers
Positioning & Attachment
Rhythms and Routines
Safe sleep and the Breastfed Baby
Sleep baby - why and what to do
Storing your milk
After a difficult start

Books
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Making more milk, second edition, Marasco, L. and West, D. New York: McGraw-Hill Education, 2019.
Other websites
Natural (laid-back) breastfeeding naturalbreastfeeding.com
Biological nurturing™ www.biologicalnurturing.com
Maximising milk production when expressing https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html
UK-WHO Growth Charts These charts are based on the growth rates of breastfed babies and can be found in your baby's Personal Child Health Record (red book). Further copies, the more detailed hospital 0-4 charts and specialised charts for low weight babies can all be downloaded from: www.rcpch.ac.uk/growthcharts
NHS guide to bottle feeding

This information is available to buy in printed form from our shop.

Copyright LLLGB 2022

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My baby needs more milk - La Leche League GB

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Does your baby need more milk? How to know your baby is getting enough breastmilk Increasing your milk production If supplements are needed Feeding methods Expressing your milk Does your baby need more milk? Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk [...]

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By Kelly Bonyata, BS, IBCLC

Is your milk supply really low?

First of all, is your milk supply really low? Often, mothers think that their milk supply is low when it really isn't. If your baby is gaining weight well on breastmilk alone, then you do not have a problem with milk supply.
It's important to note that the feel of the breast, the behavior of your baby, the frequency of nursing, the sensation of let-down, or the amount you pump are not valid ways to determine if you have enough milk for your baby.
What if you're not quite sure about baby's current weight gain (perhaps baby hasn't had a weight check lately)? If baby is having an adequate number of wet and dirty diapers then the following things do NOT mean that you have a low milk supply:

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Your baby nurses frequently. Breastmilk is digested quickly (usually in 1.5-2 hours), so breastfed babies need to eat more often than formula-fed babies. Many babies have a strong need to suck. Also, babies often need continuous contact with mom in order to feel secure. All these things are normal, and you cannot spoil your baby by meeting these needs.

Your baby suddenly increases the frequency and/or length of nursings. This is often a growth spurt. The baby nurses more (this usually lasts a few days to a week), which increases your milk supply. Don't offer baby supplements when this happens: supplementing will inform your body that the baby doesn't need the extra milk, and your supply will drop.

Your baby nurses more often and is fussy in the evening.

Your baby doesn't nurse as long as she did previously. As babies get older and better at nursing, they become more efficient at extracting milk.

Your baby is fussy. Many babies have a fussy time of day - often in the evening. Some babies are fussy much of the time. This can have many reasons, and sometimes the fussiness goes away before you find the reason.

Your baby guzzles down a bottle of formula or expressed milk after nursing. Many babies will willingly take a bottle even after they have a full feeding at the breast. Read more here from board-certified lactation consultant Kathy Kuhn about why baby may do this and how this can affect milk supply. Of course, if you regularly supplement baby after nursing, your milk supply will drop (see below).

Your breasts don't leak milk, or only leak a little, or stop leaking. Leaking has nothing to do with your milk supply. It often stops after your milk supply has adjusted to your baby's needs.

Your breasts suddenly seem softer. Again, this normally happens after your milk supply has adjusted to your baby's needs.

You never feel a let-down sensation, or it doesn't seem as strong as before. Some women never feel a let-down. This has nothing to do with milk supply.

You get very little or no milk when you pump. The amount of milk that you can pump is not an accurate measure of your milk supply. A baby with a healthy suck milks your breast much more efficiently than any pump. Also, pumping is an acquired skill (different than nursing), and can be very dependent on the type of pump. Some women who have abundant milk supplies are unable to get any milk when they pump. In addition, it is very common and normal for pumping output to decrease over time.

See also Is my baby getting enough milk?

Who to contact if you suspect low milk supply

If you're concerned about your milk supply, it will be very helpful to get in touch with a trained breastfeeding counselor or a board certified lactation consultant. If your baby is not gaining weight or is losing weight, you need to keep in close contact with her doctor, since it's possible that a medical condition can cause this. Supplementing may be medically necessary for babies who are losing weight until your milk supply increases. If supplementing is medically necessary, the best thing to supplement your baby with is your own pumped milk.

Potential causes of low milk supply

These things can cause or contribute to a low milk supply:

Supplementing. Nursing is a supply & demand process. Milk is produced as your baby nurses, and the amount that she nurses lets your body know how much milk is required. Every bottle (of formula, juice or water) that your baby gets means that your body gets the signal to produce that much less milk.

Bottle preference. A bottle requires a different type of sucking than nursing, and it is easier for your baby to extract milk from a bottle. As a result, giving a bottle can either cause your baby to have problems sucking properly at the breast, or can result in baby preferring the constant faster flow of the bottle.

Pacifiers. Pacifiers can affect baby's latch. They can also significantly reduce the amount of time your baby spends at the breast, which may cause your milk supply to drop.

Nipple shields can be a useful tool in some cases, but they can also reduce the stimulation to your nipple or interfere with milk transfer, which can interfere with the supply-demand cycle.

Scheduled feedings interfere with the supply & demand cycle of milk production and can lead to a reduced supply, sometimes several months later rather than immediately. Nurse your baby whenever she is hungry.

Sleepy baby. For the first few weeks, some babies are very sleepy and only ask to nurse infrequently and for short periods. Until baby wakes up and begins to breastfeed well, nurse baby at least every two hours during the day and at least every 4 hours at night to establish your milk supply.

Cutting short the length of nursings. Stopping a feeding before your baby ends the feeding herself can interfere with the supply-demand cycle. Also, your milk increases in fat content later into a feeding, which helps baby gain weight and last longer between feedings.

Offering only one breast per feeding. This is fine if your milk supply is well-established and your baby is gaining weight well. If you're trying to increase your milk supply, let baby finish the first side, then offer the second side.

Health or anatomical problems with baby (including, jaundice, tongue-tie, etc.) can prevent baby from removing milk adequately from the breast, thus decreasing milk supply.

Mom's health (uncontrolled anemia or hypothyroidism, retained placenta, postpartum hemorrhage...), previous breast surgery/injury, hormonal problems (e.g. PCOS), anatomical problems, medications she is taking (hormonal birth control, sudafed...), or smoking also have the potential to affect milk supply.

Increasing your milk supply

Milk production is a demand & supply process. If you need to increase milk supply, it's important to understand how milk is made - understanding this will help you to do the right things to increase production.

To speed milk production and increase overall milk supply, the key is to remove more milk from the breast and to do this frequently, so that less milk accumulates in the breast between feedings.

OK, now on to things that can help increase your milk supply:

Make sure that baby is nursing efficiently. This is the "remove more milk" part of increasing milk production. If milk is not effectively removed from the breast, then mom's milk supply decreases. If positioning and latch are "off" then baby is probably not transferring milk efficiently. A sleepy baby, use of nipple shields or various health or anatomical problems in baby can also interfere with baby's ability to transfer milk. For a baby who is not nursing efficiently, trying to adequately empty milk from the breast is like trying to empty a swimming pool through a drinking straw - it can take forever. Inefficient milk transfer can lead to baby not getting enough milk or needing to nurse almost constantly to get enough milk. If baby is not transferring milk well, then it is important for mom to express milk after and/or between nursings to maintain milk supply while the breastfeeding problems are being addressed.

Nurse frequently, and for as long as your baby is actively nursing. Remember - you want to remove more milk from the breasts and do this frequently. If baby is having weight gain problems, aim to nurse at least every 1.5-2 hours during the day and at least every 3 hours at night.

Take a nursing vacation. Take baby to bed with you for 2-3 days, and do nothing but nurse (frequently!) and rest (well, you can eat too!).

Offer both sides at each feeding. Let baby finish the first side, then offer the second side.

Switch nurse. Switch sides 3 or more times during each feeding, every time that baby falls asleep, switches to "comfort" sucking, or loses interest. Use each side at least twice per feeding. Use breast compression to keep baby feeding longer. For good instructions on how to do this, see Dr. Jack Newman's Protocol to manage breastmilk intake. This can be particularly helpful for sleepy or distractible babies.

Avoid pacifiers and bottles when possible. All of baby's sucking needs should be met at the breast (see above). If a temporary supplement is medically required, it can be given with a nursing supplementer or by spoon, cup or dropper (see Alternative Feeding Methods).

Give baby only breastmilk. Avoid all solids, water, and formula if baby is younger than six months, and consider decreasing solids if baby is older. If you are using more than a few ounces of formula per day, wean from the supplements gradually to "challenge" your breasts to produce more milk.

Take care of mom. Rest. Sleep when baby sleeps. Relax. Drink liquids to thirst (don't force liquids - drinking extra water does not increase supply), and eat a reasonably well-balanced diet.

Consider pumping. Adding pumping sessions after or between nursing sessions can be very helpful - pumping is very important when baby is not nursing efficiently or frequently enough, and can speed things up in all situations. Your aim in pumping is to remove more milk from the breasts and/or to increase frequency of breast emptying. When pumping to increase milk supply, to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. However, adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.

Consider a galactagogue. A substance (herb, prescription medication, etc.) that increases milk supply is called a galactagogue. See What is a galactagogue? Do I need one? for more information.

Additional information

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@ other websites

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Increasing Low Milk Supply * KellyMom.com

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First of all, is your milk supply really low? Often, mothers think that their milk supply is low when it really isn't. If your baby is gaining weight well on breastmilk alone, then you do not have a problem with milk supply.

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Relactation is when someone restarts breastfeeding after a gap. She may have not breastfed for several days, weeks, months or years.
Why do it?

You might have stopped breastfeeding earlier than you wanted, or you may have changed your mind.

You might have been separated from your baby or your baby might have been ill.

You may have adopted a baby and want to re-start your milk supply in order to breastfeed them.

Someone could also breastfeed an adopted baby if they have never breastfed previously or has never been pregnant - this is called 'induced lactation'.

What are the benefits?
Breastmilk has numerous health benefits. Even small amounts given alongside formula can make a difference. When a baby feeds directly at the breast, there are additional benefits for both mum and baby. If this is not possible, then breastmilk can be expressed and offered in a bottle or cup.
How do you do it?
Breast stimulation alone sends hormonal signals to switch milk production back on. It may be easier if you only stopped breastfeeding a short time ago and you had a full milk supply in the past. But every individual is different, so you may not know how your body will respond until you try.

Learning the basics of breastfeeding is a great place to start. Breastfeeding works on a supply and demand basis, so the more milk is removed (either by baby feeding or expressing), the more milk the mother produces.

Learn how to recognise if your baby is getting enough milk. Are they producing six wet nappies in 24 hours and if under five weeks, are they pooing two or more times a day? Are they gaining weight? Do you know what swallowing looks like on the breast?
If the baby will latch onto the breast:
Try to put the baby to the breast as often as possible (every 2-3 hours at least). Even before any milk is being produced, nipple stimulation will release the hormone prolactin which we need to make milk.

Learn how to recognize a deep latch. A baby that latches on effectively will stimulate your supply in a way that a baby latching on in a shallow way won't. Has the baby got a big mouthful of breast?

Is it pain free? If breastfeeding feels uncomfortable, do get support.
Ways of stimulating your milk supply whether or not the baby will latch on:

Even if the baby isn't feeding, have skin-to-skin time.

Keep the baby on or close to your body as much as possible (perhaps using a sling).

You can bottle feed skin-to-skin and near the breast.

Pumping/hand expressing:

Use a pump or hand express for 10-15 minutes on each breast several times a day. Ideally, at least eight times in 24 hours. Swapping sides every few minutes may be more effective than a longer session on one side.

Expressing once at night will provide extra stimulation as this is when levels of milk-making hormones are highest. This also means that you don't go for a long period without pumping.

Don't worry in the early stages about how much (or little!) milk you are able to express - the nipple stimulation itself will be stimulating your body to produce more milk for the future.

Some mums choose to hire a hospital-grade double electric breast pump.

You may get milk immediately, but if you don't... don't give up! It may take some women only a few days to develop their supply. Others pump for several weeks before they see a significant increase in their supply. Everyone responds differently to the process of relactation, so it's very difficult to give a definite timeframe.

If a baby will latch, you could also express directly after and / or between feedings. You may be able to find some time in the day when you 'cluster pump' (also called 'power pumping') and pump for ten minutes, break for 5, pump for another ten and repeat that a few times. Pumping should be pain-free. If your baby is happy to latch on and stay on the breast, it may not be necessary for you to pump at all.

Some mums choose to take herbs or medication (called 'galactagogues') to stimulate the hormones that govern their milk supply. These aren't right for everyone and are no substitute for regular and effective emptying of the breasts, but it's something you could ask your breastfeeding support team more about.
Continuing to feed other kinds of milk
It is likely that while you are building up your milk supply and getting the baby used to feeding at the breast, you will also be feeding the baby formula, or donor milk. If you are using a bottle, you may want to consider using a technique called 'baby-led bottle feeding (sometimes known as 'paced bottle feeding') which may help your baby transition to the breast. This slows the flow down and requires your baby to work a little harder. There are videos available on YouTube, you could ask a breastfeeding counsellor, or call our helpline for information.

Sometimes supplements can be given via cup or syringe so that a baby's desire to suck can be met by the breast entirely. Syringe-feeding or cup-feeding is something parents usually need to be taught.
Helping the baby to accept the breast
You want the baby to enjoy being at the breast, so anything you can do to avoid making breastfeeding a battle ground will be useful. It's better not to 'force' the baby into a breastfeeding position but to enjoy time skin-to-skin and present opportunities gently. You may need to use encouragement to bring them to an emptier breast. You could hand express some drips of milk, or trickle milk into baby's mouth, or you might pump for a moment to get the flow of milk started.

A baby may prefer to breastfeed when they are not desperately hungry or at certain times of day. Especially when your baby is younger, spending time with the baby tummy-down on your semi-reclined body will trigger instinctive feeding behaviour - and may encourage them to latch and suckle. They may prefer to feed when they are sleepier, or even in the bath!

You could consider the use of a nursing supplementer. This delivers milk from a bottle through a fine plastic tube which enters the baby's mouth along with your nipple. This may help to reduce frustration the baby might show at the breast and will stimulate your breasts to further produce milk.

A baby who is very accustomed to the bottle may accept the breast using a nipple shield, but this is best done with the support of a breastfeeding counsellor or lactation consultant. See our leaflet on using a nipple shield.
Things to consider:
Why did you stop breastfeeding in the first place? You might want to talk with a breastfeeding counsellor, lactation consultant or peer supporter before embarking on your journey to give it another go.

Be prepared to notice a difference to your own body. There may be a change in to your menstrual pattern as the baby nursing will affect your cycle. Your breasts may physically change too. You may also experience some emotional challenges and it can helpful to have someone to talk to as you go through the process.

Remember that if your baby will latch but you are not able to return to a full milk supply, it is still a valuable experience for both of you. And if you work hard to increase your supply but your baby is reluctant to latch, they can receive this expressed milk. Every drop counts!

Relactation may be difficult and time consuming at times, but it IS possible. With the right support, information and dedication, relactation works for women every day and produces happy and valuable results. Confidence and self-belief will help you on your journey.

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Relactation: restarting breastfeeding after a gap - ABM

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Relactation is when someone restarts breastfeeding after a gap. She may have not breastfed for several days, weeks, months or years. Why do it? You might have stopped breastfeeding earlier than you wanted, or you may have changed your mind. You might have been separated from your baby or your baby might have been ill.

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Bookmark this site for the most up to date information on formula milks

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Bookmark this site for the most up to date information on formula milks

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Infant milks for parents & carers — First Steps Nutrition Trust

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First Steps Nutrition Trust is a charity which provides clear, evidence-based and independent information and support for good nutrition from pre-conception to five years of age.

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DH sterilising and making up formula feeds

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DH sterilising and making up formula feeds

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Maximising breastmilk video from Unicef UK for health professionals

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Maximising breastmilk video from Unicef UK for health professionals

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In this video, we explore how best to support new mothers with feeding.

Exclusive breastfeeding for the first six months ensures the best outcomes for babies, and mothers need support to get this off to the best start. Ongoing help with positioning, attachment and skin-to-skin contact help mothers to maintain their milk supply and avoids disruption to breastfeeding.

If mothers wish to bottle feed, the impact on milk supply should be discussed so that they can make informed choices. A sensitive, non-judgmental approach is key.

For more information:

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Maximising breastmilk video - Baby Friendly Initiative

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In this video, we explore how best to support new mothers with feeding, including positioning, attachment and skin-to-skin contact.

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I've been taking calls from new parents on the National Breastfeeding Helpline since it opened in 2008. Calls often begin with a mum in tears and she's sounding desperate. Breastfeeding really matters to her and she wants it to work. She's overwhelmed and confused. The first voice we hear might sometimes be the partner's and a mum is too upset to even come to the phone.

Hundreds of these calls end with a contented calm voice saying, "Thank you. It's such a relief to know that's normal. I feel so much better now". As it happened, breastfeeding was actually going OK; what was interpreted as a breastfeeding 'problem' was actually a new baby's normal and natural response to their new environment. The family just didn't know how babies were 'supposed to behave'.

If I had a magic wand, I would download into all parents the knowledge of what is normal in a newborn. Think The Matrix film - but instead of the ability to pilot helicopters or practise high level martial arts, you'd know about cluster feeding and a newborn's desire for closeness, nappies and normal fussiness. The National Breastfeeding Helpline would be quieter overnight but we'd all feel a lot more relaxed and able to enjoy these teeny new people in our lives.

But actually ... you've already had that download. You just may not have realised it. It's deep in there after millions of years of evolution, facilitated by hormones and natural instincts. It may not mean you know the exact details of the colour of baby poo on day three, or how to correct a baby's latch without help, but there's so much you do know. You may not have grown up surrounded by breastfeeding, and for some aspects you will need support and information, but there's a ton you do know about your baby: things that just feel right and things that don't. And your baby had the download too. Sometimes it gets fuzzied with a birth that didn't go to plan but their instincts are in there too.

Two things that are normal:

Imagine a news story about a baby gorilla just born in London zoo: "ZSL London are delighted to announce the birth of new baby Fumbi. Mother and baby are in good health" but days later it's reported that staff are concerned. Fumbi's mother (despite being surrounded by other older female gorillas and having observed newborn care) keeps trying to put Fumbi down. She places her in the hay and walks off repeatedly and appears to be trying to avoid holding her for long periods. Fumbi is agitated. Her heart rate and respiratory rate shows signs of distress. She's losing heat (because teeny newborn gorillas have a large surface area and need to be held to regulate their temperature). Fumbi isn't feeding as often a newborn usually does because of the periods of separation. The mother appears to be missing out on some of the oxytocin- (the hormone that promotes feelings of love) induced bonding that helps the formation of their early relationship. Fumbi is at risk.

Oh dear. Something seems to have happened to Fumbi's mother. We'd be worried.

However, this is exactly what is happening in human homes across the UK today (though not in many other countries and cultures). We are primates just as gorillas are. We're designed to be close to our babies. We can see that by looking at the constituents of our breastmilk. Other mammals have much higher fat milk so babies can be left while mum fishes or grabs a rabbit for lunch. Our babies are born immature because of our pelvis shape from being upright and our large brains, and they are designed to have milk regularly for a relatively long time. We are supposed to hold our babies. Some people call us 'carry mammals'.

But instead we get the message that babies can be 'spoilt'. We are supposed to encourage them to be independent and sleep apart from us. If we can't put them down, if they want to sleep touching us, if we hold them when they sleep - we've apparently failed some test. Though it's not quite clear who the examiner is.

There are popular books that even use terms like 'accidental parenting' just to load on the value judgments. Parenting experts such as Truby King in the 1910s told parents to avoid cuddling and unnecessary attention and the spectrum of 'advice' has been flip-flopping backwards and forwards ever since. Today one book will tell you to wear your baby in a sling as much as possible and another will tell you to arrange a baby's sleep by the clock and leave a baby only a few weeks old to cry if necessary.
What does your baby want?
They don't want to be put down and eaten by a sabre toothed tiger (less of a problem these days). They don't want to waste energy keeping warm and crying when they don't need to. They want to keep those calories to lay down fat and develop their brain. They want to use your breathing rate to regulate their own respiratory rate. They want you to notice when they start to show early feeding cues. They want your familiar smell and taste. You are home to them.

"My baby won't go down in its Moses basket". Yes, it's frustrating when you thought that was what they were 'supposed to do'. But would it feel easier if you knew that wasn't likely to be their first choice and there are good biological and evolutionary reasons for that?

"But I'm not going to get any sleep". According to the Infant Sleep Information Source, "70-80% of breastfed babies sleep with their mother or parents some of the time in the early months, and many studies have found that mothers and babies who bed-share breastfeed for much longer than those who sleep apart." Research shows that these mums breastfeeding through the night (and mostly bed sharing) will also be getting better quality sleep and be more rested than other parents. Good sleep is possible if we stop battling nature.

The book "Sweet Sleep: night time and naptime strategies for the breastfeeding family" is a great place to start. It talks to you about creating a safe space where everyone gets a better night's sleep.

A lot of your baby's urges are eminently sensible. If they don't want to sleep in a separate pile of hay, trust them. They are here today because those urges have kept them safe over the generations.

Don't expect to be up and making a moussaka on day five. The feeling that you 'shouldn't' be holding your baby is exacerbated when we live in a society which tries not to let new parenthood change our lives. Our bodies aren't supposed to change. Our commitment to work isn't supposed to change. Our ability to engage with political life and housework and social media isn't supposed to change. Actually, throughout much of human history, mum isn't going to do much of anything for a good 40 days. Someone else is making the moussaka, just as you would have once made the moussaka for them. We are supposed to be doing nothing else other than eating the food made by others (really doesn't have to be moussaka), sleeping and being with our new baby.

They come to the breast for lots of different reasons and they usually have a good reason for doing so.

Just as parents feel they've failed if their baby doesn't sleep in the separate pile of hay (aka fancy Moses basket that cost £75 and granny knitted a blanket for), they feel a failure if baby is at the breast 'too much'. I have written elsewhere on the dangerous obsession of the infant feeding interval. It's dangerous for both babies and mothers. But we need to remember breastfeeding isn't just about feeding and it never has been.

Babies have jobs to do. They are helping you to form new breast tissue in the first few weeks. They are elevating your prolactin levels (the hormone that governs milk supply). They are stimulating oxytocin (which is the key hormone in relationship-building and creating a sense of calm and well-being). They are increasing milk volume and altering fat content. They are reducing levels of the stress hormone, cortisol. They are facilitating digestion and the passing of stools. They are hydrating, regulating their temperature, feeling emotionally secure, growing brain connections and trying to get to sleep (which is one of the purposes of breastfeeding.)

To think breastfeeding is just about food and calories (and "quick, measure the gap between breastfeeds!") is to do nature a huge disservice. Measuring all the different reasons a baby comes to the breast is like trying to measure fairy dust. Do you count all the times your partner cuddles you, strokes your arm, kisses you, smiles at you affectionately, communicates with you, has a drink of water, eats a snack or has a meal? You wouldn't find an app for that.

Stop thinking about minutes. No one can tell you a baby should feed for X number of minutes because we all have different physiology and our babies do too. Create your world around you so you can meet your baby's needs in the way they are asking you to. Don't try and mould your baby to fit into a world that has become obsessed with counting and measuring. If you know you are a routine person and you are struggling with a feeling of 'losing control', give yourself a few weeks and see how it feels to trust your baby. Once your milk supply has maximised, you'll have some options. Try and 'control' too early and you'll find things go out of your influence in ways you can't come back from easily.

Get help if things feel wrong - if breastfeeding hurts, if you're not sure about weight gain or nappies, if you can't work out how to meet your own needs for food and sleep. There are lots of people who will help out and we're at the end of a phone or a Twitter account or Facebook page. But don't confuse your baby behaving unexpectedly for something going 'wrong'. Maybe no one told you what normal would be.

If we let normal happen it will make all of our lives easier in the long term. You're creating a little person who enters this world with their needs being met.

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"Is this normal?" - The first week with a breastfeeding newborn - ABM

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I've been taking calls from new parents on the National Breastfeeding Helpline since it opened in 2008. Calls often begin with a mum in tears and she's sounding desperate. Breastfeeding really matters to her and she wants it to work. She's overwhelmed and confused.

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New mum's diary - Baby Tom (BfN)

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How often should I feed my baby? feeding cues are in here too (NCT)

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How often should I feed my baby? feeding cues are in here too (NCT)

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When should I feed my baby?

As a rough guide, babies need to feed at least eight to 12 times (sometimes more) over 24 hours during the first few weeks (NHS, 2019a; UNICEF, 2010). That means they'll probably need to feed every two to three hours.

Watch our video for tips on how often and how long to breastfeed your baby for.

It's best to feed babies responsively or in a baby-led way rather than sticking to a feeding schedule (WHO, 2009; Entwistle, 2013; Fallon et al, 2016). Letting your baby feed when they want will help them get the milk they need. It will also stimulate your milk supply (Infant and Young Child Feeding, 2009).

What if I'm struggling or worried about the number of feeds?

We know from the experiences of new mums that breastfeeding responsively can feel emotionally and physically challenging (Fallon et al, 2016).

A baby that breastfeeds frequently can give parents a sense of reassurance but it can also cause worry. Some people may think frequent feeding is a sign of insufficient milk, or that baby isn't getting enough breastmilk during feeds. This sometimes leads to women supplementing feeds with formula milk or deciding to stop breastfeeding (Leurer, 2015).

Try and keep in mind that a newborn baby's stomach is really small. They need to feed little and often (NHS, 2020). It's really common for babies to have a good feed and then appear to be hungry again quite quickly. This doesn't mean something is wrong or that they're not getting enough milk. It's just the way newborn babies feed (Kent et al, 2012).

All of this also means that newborn feeding is frequent. In fact, much of the time, it's not really a question of clearly-defined 'feeds' with clear beginnings and endings (WHO 1998).

Your baby knows your voice, your smell and your taste but they are much less familiar with the 'world' outside your womb. Staying close to you gives them a vital sense of safety and reassurance. This builds their confidence that they are loved and cared for (Crenshaw, 2007).

If you're worried, it can really help to talk through your concerns with a breastfeeding counsellor. So call our Infant Feeding Support line on 0300 330 0700.

Will I produce enough milk?

The more you breastfeed your baby, the more milk you will produce (Daly & Hartmann, 1995). If your baby is attached properly, and you're both comfortable and feeding them when they ask for it, you will make enough milk for them (Kent et al, 2012; WHO 2019).

How do I know when to feed my baby?

When your baby is hungry they may give you little signals, known as early feeding cues (NHS, 2019a,b). They might:

* get restless

* suck their fist or fingers

* make murmuring sounds

* turn their head and open their mouth (rooting).

Looking out for and responding to these cues is important. It can help prevent your baby from becoming upset and frustrated, which will make it more difficult to feed them (WHO, 2009). Here's what you might see...

How long should each feed last?

Every baby is different and they will go through different patterns of feeding as they grow (Kent et al, 2012). How much milk a baby needs per breastfeeding session will vary. It's best to be guided by your child (Kent et al, 2012).

Some feeds will seem to last a long time, with your baby dozing for short periods before wanting more. And more. And still more! It's normal for a young baby to be on the breast many times a day and night. 12-15 'visits' to the breast is well within a normal range (Entwistle, 2013).

As a general rule, babies who are feeding well will feed for between five and 40 minutes at each feed (UNICEF, 2010). Your baby will let you know when they've had enough milk. They will usually come off the breast themselves, look sleepy or calm, and look around (UNICEF, 2010).

During each breastfeed, your milk changes slightly. So the milk at the end of the feed is more creamy and filling than the milk at the beginning of the feed (Ballard and Morrow, 2013). Offer one breast and let your baby feed until they stop drinking. If they still appear hungry, offer the second breast - allowing them to drink as much as they want (NICE, 2015).

Should I wake my baby up to feed?

In most cases, healthy, thriving newborns will wake up for feeds and, provided they are well latched on, get all the milk they need (Australian Breastfeeding Association, 2017). But there might be reasons why a newborn might be more sleepy and therefore need to be woken up for feeds.

This includes medical reasons, such as jaundice, infection or a heart problem, or perhaps because the pain relief used during birth is still affecting them (Australian Breastfeeding Association, 2017). If you're worried your baby might be sleeping too much and this is affecting their feeding, talk to your health visitor or call our Infant Feeding Support line on 0300 330 0700.
This page was last reviewed in March 2021
Further information

We support all parents, however they feed their child. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

National Breastfeeding Line (government funded): 0300 100 0212.

Australian Breastfeeding Association. (2017) Do I need to wake my baby for feeds? Available at: https://www.breastfeeding.asn.au/bfinfo/do-i-need-wake-my-baby-feeds [Accessed 20 March 2021].

Ballard O, Morrow AL. (2013) Human milk composition: nutrients and bioactive factors. Pediatric Clinics of North America. 60(1):49-74. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/ [Accessed 20 March 2021].

Crenshaw J. Care practice #6: No separation of mother and baby, with unlimited opportunities for breastfeeding. Journal of Perinatal Education2007;16(3):39-43. Available at: doi:  10.1624/105812407X217147 (Accessed 26 Apr 21)

Daly SEJ, Hartmann PE (1995). Infant Demand and Milk Supply. Part 1: Infant Demand and Milk Production in Lactating Women. Journal of Human Lactation. 11(1):21-26. doi:10.1177/089033449501100119 Available at https://journals.sagepub.com/doi/10.1177/089033449501100119 [Accessed 13 April 2021]

Entwistle FM. (2013) The evidence and rationale for the UNICEF UK Baby Friendly Initiative standards. UNICEF UK. Available at: https://www.unicef.org.uk/babyfriendly/about/evidence-and-rationale-for-the-baby-friendly-standards/ [Accessed 20 March 2021].

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D. (2016) Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database of Systematic Reviews. (9):CD009067. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009067.pub3/full [Accessed 20 March 2021].

Kent JC, Prime DK, Garbin CP. (2012) Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 41(1):114-121. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1552-6909.2011.01313.x [Accessed 20 March 2021].

Leurer MD, Misskey E. (2015) "Be positive as well as realistic": a qualitative description analysis of information gaps experienced by breastfeeding mothers. International Breastfeeding Journal. 10(10):2-11. Available at: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0036-7 [Accessed 20th March 2021].

NHS. (2019a) Breastfeeding: the first few days. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-first-days.aspx#building [Accessed 20 March 2021].

NHS. (2019b) Breastfeeding: is my baby getting enough milk? Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 20 March 2021].

NHS. (2020) Your breastfeeding questions answered. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 20 March 2021].

NICE (2015) Postnatal care up to 8 weeks after birth. CG37. Available at: https://www.nice.org.uk/guidance/cg37 [Accessed 20 March 2021].

UNICEF. (2010) Baby Friendly Initiative. Breastfeeding checklist for mothers - How can I tell that breastfeeding is going well? Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf [Accessed 20 March 2021].

World Health Organization. (1998) Evidence for the Ten Steps to Successful Breastfeeding. Geneva: World Health Organization.

World Health Organization. (2009) Session 2 The physiological basis of breastfeeding. In: Infant and Young Child Feeding. Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Available at: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 20th March 2021].
Further reading
Hoddinott P, Craig, LCA, Britten J, McInnes RJ. (2012) A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open 2:1-14. Available at: https://bmjopen.bmj.com/content/2/2/e000504 [Accessed 20 March 2021].

Martin CR, Ling PR, Blackburn GL. (2016) Review of infant feeding: key features of breast milk and infant formula. Nutrients, 8(5):279. Available at:   https://www.mdpi.com/2072-6643/8/5/279 [Accessed 20th March 2021].

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

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

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NCT how can I tell if my baby is thriving?

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NCT how can I tell if my baby is thriving?

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In this video, we look at the importance of developing close and loving relationships with babies in their early days and weeks.

Responding to babies' needs for comfort and food is hugely beneficial for brain development and makes for more confident toddlers. Parents should be supported in breastfeeding responsively and keeping their babies close to help them become happy, healthy and secure children and adults.

For more information:

Find more relationship building resources

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The Importance of relationship building video - Baby Friendly Initiative

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This video looks at the importance of developing close, loving relationships with babies in their early days and weeks.

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

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

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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

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For comparision, this is what it looks like if your baby doesn't have a big enough mouthful of breast

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This clip from Best Beginnings shows how ineffective attachment happens and how it can cause sore nipples.

You can see more of the 'From Bump to Breastfeeding' DVD on the Best Beginnings website.

Video not working? Contact us.

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Ineffective attachment video - Baby Friendly Initiative

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This clip from Best Beginnings shows how ineffective attachment happens and how it can cause sore nipples. Watch to learn more.

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video of effective attachment from 48 seconds in

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video of effective attachment from 48 seconds in

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding.

Key to achieving the Baby Friendly standards is a workforce able to support mothers to breastfeed effectively. This video provides some guidance on this.

You can see more of the 'From Bump to Breastfeeding' DVD on the Best Beginnings website.

Video not working? Contact us

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Positioning and attachment video - Baby Friendly Initiativ

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding. Watch to learn more.

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A good checklist for you to work through

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A good checklist for you to work through

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The importance of twice a day pooing in the first 4-6 weeks and how to tell if breastfeeding is going well p11 and p17

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The importance of twice a day pooing in the first 4-6 weeks and how to tell if breastfeeding is going well p11 and p17

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Newborn baby poo in nappies: what to expect | Baby & toddler articles & support | NCT

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

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NCT Breastfeeding step by step - individual pics of attachment

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NCT Breastfeeding step by step - individual pics of attachment

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations. BfN endeavours to provide information to enable mothers to breastfeed their babies for as long as they wish and to provide information on the safety of medicines for each mother and baby pair.

Please use the below links for more information

We are constantly reviewing the information available on drugs and breastfeeding as new research is conducted. Therefore, from time-to-time the information on this website may be updated - please be sure to check regularly for any new information and changes to the drug information fact sheets and leaflets.

What is the Drugs in Breastmilk Information Service?

The original Drugs in Breastmilk Helpline was set up by BfN in response to the number of calls we were receiving that concerned medication.

In 2017 we noticed that majority of enquiries from parents and professionals to the Drugs in Breastmilk Helpline were coming via email or social media. As a charity operating on reducing funds we need to run the service in the most efficient and effective way possible without compromising the needs of parents. As a result we decided to run the Drugs in Breastmilk service via email and social media enquiry only.

You can still access information on taking prescription drugs while breastfeeding by sending a private message via our Facebook page or via . Please provide as much information as possible (age of baby, dose, frequency and name of medication or drug). All enquiries are answered as soon as possible by one of our small, volunteer team of qualified pharmacists or breastfeeding supporters. As we can't guarantee a response time, in an emergency situation, please do not wait for our reply, but access help from a trained healthcare professional.

If you call the old Drugs in Breastmilk helpline 0844 number, you will hear a recorded message with information about where to access alternative support. Calls won't be answered live and there is no voicemail service available.

If you still have the Drugs in Breastmilk helpline number on any materials or web pages please could you remove it and replace it with the following information:
'If you have specific questions about medications or treatments, please message the Drugs in Breastmilk information service Facebook page or email druginformation@breastfeedingnetwork.org.uk. If you require breastfeeding support, please call the National Breastfeeding Helpline on 0300 100 0212."

The service is open to mothers and professionals. As the time available to deal with breastfeeding support of mothers is limited, professionals are encouraged to find out the information to enable them to support the mothers themselves.

Evaluation of the Drugs in Breastmilk Information Service

In 2019, BfN commissioned Swansea University to undertake an evaluation of the DIBM service we offer. The executive summary of this report can be found and the full report can be found .

Become a Friend of Drugs in Breastmilk

Please click here for more information on how you can help support this vital service.

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Drugs In Breastmilk - Is It Safe? - The Breastfeeding Network

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations.

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BfN the best source of information - lots of info sheets

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BfN the best source of information - lots of info sheets

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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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Unicef UK information on infant feeding in neonatal units

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Unicef UK information on infant feeding in neonatal units

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Unicef UK information on infant feeding - breastfeeding and bottle feeding

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Unicef UK information on infant feeding - breastfeeding and bottle feeding

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Supporting Baby Friendly assessments during Covid-19

The UNICEF UK Baby Friendly Initiative has produced a series of statements on supporting Baby Friendly assessments during the Covid-19 outbreak. We recommend that all practitioners follow latest updates from the UK governments and the World Health Organization (WHO) as these could change as more information becomes available.

INFANT FEEDING AND COVID-19

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Statements on supporting Baby Friendly assessments during Covid-19 - Baby Friendly Initiative

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The UNICEF UK Baby Friendly Initiative has produced a series of statements on supporting Baby Friendly assessments during the Covid-19 outbreak. We recommend that all practitioners follow latest updates from the UK governments and the World Health Organization (WHO) as these could change as more information becomes available.