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Breastfeeding Twins and Triplets UK supports parents of multiples to fulfil their breastfeeding goals.

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Here at Breastfeeding Twins and Triplets UK we will answer all of these questions and more. We will try to put your mind at rest whilst being honest about journey on which you are about to embark. Breastfeeding more than one baby is challenging, but it is definitely possible and a lot of mums go on to have a really enjoyable experience.

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Many mothers of twins or more breastfeed their babies successfully and Twins Trust are there to support you.

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

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

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

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

Personal stories

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

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

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The way a mother holds her baby affects how easy it is for her baby to feed effectively. This video shows basic points important for any position and then demonstrates several common positions that have worked well for many mothers and babies.

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Positions for Breastfeeding - Video - Global Health Media Project

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The way a mother holds her baby affects how easy it is for her baby to feed effectively. This video shows basic points important for any position and then

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Establishing and increasing your milk supply

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Establishing and increasing your milk supply

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Establishing and increasing your milk supply - The Breastfeeding Network

Your breastmilk is produced on a supply and demand basis. The more frequently your baby feeds and the more milk they drink, the more milk your body will produce. This is especially important in the first few weeks.

There is always some milk in your breasts, and they are always producing more, so you can breastfeed even if your breasts feel “empty”. Stimulating your breasts by feeding your baby tells your body to make more milk. By contrast, when your breasts become very full or engorged, a protein called feedback inhibitor of lactation (FIL) tells your body to stop making milk.

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After the first three months, many mothers start to settle into a bit of a rhythm with their baby and begin to feel like life has become a bit more predictable. Then around four months (or anywhere between three and six months), babies seem to change all over again, sometimes becoming more fussy, sleeping differently, and often being more distractible when nursing.

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https://www.breastfeedingnetwork.org.uk/breastfeeding-information/continuing-the-breastfeeding-journey/expressing-and-storing-breastmilk/

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Expressing and storing breastmilk - The Breastfeeding Network

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

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Busted: 14 myths about breastfeeding | UNICEF Parenting

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1. Myth? Breastfeeding is easy.

Babies are born with the reflex to look for their mother's breast. However, many mothers need practical support with positioning their baby for breastfeeding and making sure their baby is correctly attached to the breast. Breastfeeding takes time and practice for both mothers and babies. Breastfeeding is also time intensive, so mothers need space and support at home and work.

2. Myth? It's usual for breastfeeding to hurt - sore nipples are inevitable.

Many mothers experience discomfort in the first few days after birth when they are learning to breastfeed. But with the right support with positioning their baby for breastfeeding and making sure their baby is correctly attached to the breast, sore nipples can be avoided. If a mother faces breastfeeding challenges like sore nipples, support from a lactation consultant or other skilled professional can help them overcome the issue.

3. Myth? You should wash your nipples before breastfeeding.

Washing your nipples before breastfeeding isn't necessary. When babies are born, they are already very familiar with their own mother's smells and sounds. The nipples produce a substance that the baby smells and has 'good bacteria' that helps to build babies' own healthy immune system for life.

Did you know? Breastfeeding protects your baby from ear infections, diarrhoea, pneumonia and other childhood diseases.

4. Myth? You should separate a newborn and mother to let the mother rest.

Doctors, nurses and midwives often encourage the practice of 'skin-to-skin' - also known as kangaroo mother care - immediately after birth. Bringing your baby in direct contact, so their skin is against yours, is a very important practice that helps them to find and attach to the breast. If you can practice this within one hour after birth and then frequently after, it helps to establish breastfeeding. If the mother cannot do this, then the partner or another family member can step in.

5. Myth? You should only eat plain food while breastfeeding.

Like everybody else, breastfeeding mothers need to eat a balanced diet. In general, there is no need to change food habits. Babies are exposed to their mothers' food preferences from the time they are in the womb. If a mother perceives that her baby reacts to a specific food she eats, it is best to consult a specialist.

6. Myth? Exercise will affect the taste of your milk.

Exercise is healthy, also for breastfeeding mothers. There is no evidence that it affects the taste of your milk.

7. Myth? You won't be able to breastfeed unless you do it straight away.

It is easier to get breastfeeding started if you begin in the first hour after birth because a baby's reflexes are very strong at that time. They are ready to learn to feed at the breast. If you do not latch your baby on right after birth, do it as soon as possible in your situation. If you need help putting your baby to the breast, ask for support from a qualified lactation consultant or other skilled professional. Frequent skin-to-skin contact and putting your baby to the breast will help to get breastfeeding going.

Did you know? Breastfeeding protects the mother from diabetes, breast and ovarian cancers, heart disease and postpartum depression.

8. Myth? You can never use formula if you want to breastfeed.

Mothers may decide they need to use formula on some occasions, while continuing to breastfeed. It is important to seek unbiased information on formula and other products that replace breastmilk. To keep breastmilk production going, continue offering the breast to your baby as often as possible. It can be useful for mothers to consult a lactation specialist or skilled professional to help with a plan that works best for them to continue breastfeeding.

9. Myth? Many mothers can't produce enough milk.

Almost all mothers produce the right amount of milk for their babies. Breastmilk production is determined by how well the baby is latched on to the breast, the frequency of breastfeeding and how well the baby is removing milk with each feeding. Breastfeeding isn't a 'one woman' job and mothers need support. Support like ongoing breastfeeding guidance from health care providers, help at home, and staying healthy by eating and drinking well.

10. Myth? You shouldn't breastfeed if you're sick.

Depending on the kind of illness, mothers can usually continue breastfeeding when they're sick. You need to make sure you get the right treatment, and to rest, eat and drink well. In many cases, the antibodies your body makes to treat your disease or illness will pass on to your baby, building his or her own defences.

11. Myth? You can't take any medication if you're breastfeeding.

It's important to inform your doctor that you are breastfeeding and to read the instructions with any medications you buy over the counter. It might be necessary to take medications at a specific time or in a specific dosage, or to take an alternative formulation. You should also tell the baby's doctor about any medications that you're taking.

Did you know? The 'first milk' - or colostrum - is rich in antibodies and gives newborns an immunity boost while their own immune systems are still developing.

12. Myth? Babies who have been breastfed are clingy.

All babies are different. Some are clingy and some are not, no matter how they are fed. Breastfeeding provides not only the best nutrition for infants, but is also important for their developing brain. Breastfed babies are held a lot and because of this, breastfeeding has been shown to enhance bonding with their mother.

13. Myth? It's hard to wean a baby if you breastfeed for more than a year.

There's no evidence that it is more difficult to stop breastfeeding after one year, but there is evidence that breastfeeding up to two years is beneficial for both mothers and children. All mothers and babies are different and need to determine together how long they want to breastfeed.

14. Myth? If you go back to work, you'll have to wean your baby.

Many mothers continue breastfeeding after going back to work. First, check the policies in your country and your own workplace. If you have the right to time and a place to breastfeed during working hours, you may be able to go home and breastfeed, ask a family member or friend to bring your baby to you, or to express your milk and take it home. If you don't have the option to breastfeed during working hours, look for moments during the day to express your milk and then feed your baby directly when you are at home. If you decide to give your baby a breastmilk substitute for some feeds, it still very good to continue breastfeeding whenever you are with your baby.

This article was developed in collaboration with Dr. Michele Griswold PhD, MPH, RN, IBCLC. Dr Griswold is a lactation consultant, registered nurse, breastfeeding researcher and advocate. She represents the International Lactation Consultant Association to the WHO/UNICEF Global Breastfeeding Collective, which calls on governments and society as a whole to provide mothers the support they need to breastfeed.

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1. Myth? Breastfeeding is easy. Babies are born with the reflex to look for their mother's breast. However, many mothers need practical support with positioning their baby for breastfeeding and making sure their baby is correctly attached to the breast. Breastfeeding takes time and practice for both mothers and babies.

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Expressing and storing breastmilk - The Breastfeeding Network

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

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Guest Blog: 10 Things You Don’t Expect About Nursing Aversion: Zainab Yate explains the often complicated phenomenon of nursing aversion

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

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

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

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

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

3. One reason for aversion could be oxytocin!

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

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

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

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

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

6. Misdiagnosis can occur with aversion.

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

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

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

8. Mothers with aversion fear they are harming their nurslings

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

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

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

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

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

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

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How do you tell if your baby is getting enough milk? In a world where everything is measured, it can be nerve-wracking when you can’t see how much milk your breasts are making.

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

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

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Paced bottle feeding is a way of feeding a baby from a bottle that mimics the natural rhythm of breastfeeding. Instead of the milk flowing continuously, the caregiver controls the pace so the baby can drink, pause, and breathe- just like they would at the breast. Scroll across to see a wonderful graphic demonstrating this.

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Tongue-tie (ankyloglossia) is a condition in which the thin piece of skin under a baby’s tongue (the frenulum) is shorter than normal, meaning it may restrict the movement of their tongue. This can sometimes make it harder for a baby to breastfeed (and sometimes bottle feed).

If you suspect that your baby may have a tongue tie, this should be assessed by a trained healthcare professional such as a GP, midwife, health visitor or lactation consultant.

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Tongue-tie (ankyloglossia) is a condition in which the thin piece of skin under a baby's tongue (the frenulum) is shorter than normal, meaning it may restrict the movement of the tongue. This can sometimes make it harder for a baby to breastfeed (and sometimes bottle feed). If you suspect that your baby may have a tongue tie, this should be assessed by a trained healthcare professional such as a GP, midwife, health visitor or lactation consultant.

Tongue tie can sometimes impact on a baby's ability to breastfeed effectively. It can mean that a baby may not be able to move their tongue fully up and down or side-to-side or they might not be able to stick their tongue out beyond their lower lip. If tongue tie does interfere with a baby's ability to latch and suckle at the breast it can cause:

nipple pain and trauma for mum

poor breast milk intake leading to poor weight gain

a possible decrease in milk supply over time.

Fussy, gassy baby due to poor latch and baby swallowing air when feeding

More chance of engorgement and possible mastitis due to the breasts not being emptied effectively at each feed

Sometimes, babies who have a tongue tie have no problems at all with feeding. They may still be able to go onto the breast and feed effectively - so not every case of tongue tie needs treatment and assessment by a trained health professional and someone trained in infant feeding is vital.

If the tongue tie is causing problems, it can be treated with tongue tie division, which involves cutting the short, tight piece of skin connecting the underside of the tongue to the bottom of the mouth. This must be done by a trained healthcare professional.

After having a tongue tie divided some mums find things get easier quite quickly and others find it can take a while to improve. Support from a breastfeeding practitioner to adapt positioning and attachment can be useful and your baby might need some time to practice and adapt to a slightly different way of feeding. Spending time in ski n-to-ski n and encouraging your baby to feed when calm and relaxed can also help. You can ask your health care professional about pain relief for your baby if needed.

You can find more information on tongue tie on these pages:

NHS Tongue tie page

NCT Tongue tie page

GP infant feeding network

La Leche League tongue tie page

UNICEF tongue tie page

The Association of Tongue Tie Practitioners lists tongue-tie practitioners in the UK

Links checked April 2023

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Tongue-tie (ankyloglossia) is a condition in which the thin piece of skin under a baby's tongue (the frenulum) is shorter than normal, meaning it may restrict the movement of the tongue. This can sometimes make it harder for a baby to breastfeed (and sometimes bottle feed).

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

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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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Infant milks: Information for parents & carers

First Steps Nutrition Trust is an independent public health nutrition charity.

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First Steps Nutrition Trust is an independent public health nutrition charity. We endeavour to fill practical and policy-relevant information gaps and provide resources for health workers supporting eating well from pre-conception to five years.

Our Mission

To influence policies which enable the safe, appropriate and optimal feeding of infants and young children in the UK, and to protect them from commercial interest.

To ensure that the importance of good nutrition from pre-conception to age five remains on everyone's agenda.

To provide conflict of interest-free information on infant milks marketed in the UK, and to promote better regulation and marketing of breastmilk substitutes.

To provide resources for health workers to support them in their work with pregnant women and young families.

Our Resources:

Are put together by nutrition experts and are regularly updated.

Can be used in Unicef UK Baby Friendly Initiative accredited settings.

Are available as free pdf downloads for use by anyone promoting better public health on a not-for profit basis.

Everyone who works at First Steps Nutrition Trust feels passionately about the need for better information and support for good nutrition - and good food - from pre-conception to five years.

First Steps Nutrition Trust is supported by generous individual donations and conflict of interest free grants. First Steps Nutrition Trust does not work with organisations or individuals that work with, or take funding from, the breastmilk substitute industry and we reserve the right not to sell them our subsidised resources.

First Steps works with and supports a number of organisations including Unicef UK Baby Friendly Initiative, the Baby Feeding Law Group, the Obesity Health Alliance, the Children's Food Campaign and the APPG on Infant Feeding and Inequalities.

First Steps Nutrition Trust host and regularly update their partner site infantmilkinfo.org which contains comprehensive information about infant milks (for 0-12 month olds) available on the UK market.

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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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Getting your baby positioned and attached comfortably at the breast is an art, people often say it takes a little while for breastfeeding to feel entirely comfortable and natural, even if they’ve breastfed before.

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Getting your baby positioned and attached comfortably at the breast is an art-mothers often say it takes a little while for breastfeeding to feel entirely comfortable and natural, even if they've breastfed before. In the past girls grew up learning about breastfeeding by watching mothers in their families and communities. These days many of us become mothers having never seen a baby breastfeed.
But breastfeeding has worked for mothers and babies for thousands of years and it can work for you too.
Many babies can find their way to the breast by themselves, especially if they haven't been too affected by birth interventions. Other mums and babies need a little longer to work it out with maybe some help from a skilled breastfeeding supporter such as an LLL Leader.

When all is going well, specific holds and positions don't really matter because you and your baby will work out what suits you best. However if you are finding it awkward, uncomfortable or downright painful then the following information is designed to help you think about where you can make adjustments and get breastfeeding working comfortably for you.

Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively. This is important for maintaining milk production. Well-drained breasts make milk quickly. If there is any concern about how much milk you are making, working on improving positioning and attachment is an important first step.

There's no 'right' or 'wrong'. If you are comfortable, your baby is producing plenty of dirty nappies and is gaining weight after the first few days, then breastfeeding is going well for you. There are no rules-but there are a few principles that can help you work out what to do if things aren't going well: see Latching on - getting a good attachment.

Positioning describes how you sit or lie and how you support your baby as he takes the breast. How you hold your baby can make a big difference to how well he can breastfeed. Even small adjustments can be significant. Attachment describes the way he latches onto the breast.

Tips for getting started
The laid-back approach
Latching on - getting a good attachment
Different breastfeeding positions
As time goes by

Tips for getting started

If it hurts then make changes

If it doesn't feel right to you, then it isn't fine, whatever anyone says. Pain is your body's way of letting you know something is wrong. Start by trying to improve positioning and attachment. A few quick adjustments to how you are sitting or lying or how your baby comes towards the breast may be all that are needed.

Sometimes it can take a little longer. You may need to work with one or more skilled breastfeeding supporters over a period of time to get to the point where everything falls into place and breastfeeding starts feeling natural.

Each mother and baby pair is different and what works well for one mother and baby may not work for you. This is one reason why you may hear different suggestions from different helpers. You are the best judge of what is helpful so don't be afraid to use what feels right for you and discard the rest.

Your baby needs to be calm

You can offer the breast at any time when you are both calm. You may even find it easier if your baby isn't obviously hungry. Feed your baby before he needs to cry. Early cues for wanting to eat include suckingtheir hand, smacking their lips, turning their head towards you, or fussing. They won't latch well if they are distressed. If your baby is upset take time to soothe them. Hold them upright against you, stroke them and talk to them. A little expressed colostrum or breastmilk given on a spoon can help to calm them if they are desperately hungry.

Your baby needs full body contact

When your baby is held in full body contact against you, they will feel stable and be better able to coordinate their movements. Laid back positions ensure full body contact. If you're sitting up, you'll need to hug your baby in as tightly as if you were standing up holding them against you. Babies who don't feel stable tend to wave their arms around, which can make latching more difficult. Pillows can get in the way and aren't always necessary. So wait until after your baby's latched on, and then tuck them in only if you need them for support.

Some babies need time

Some babies find it difficult to latch on, or simply nurse ineffectively at the breast. Often a difficult birth or interventions during labour or birth are the cause. Giving a baby time to recover, and using laid-back breastfeeding positions with skin-to-skin contact can maximise your baby's natural instinct to breastfeed. If your baby isn't latching or feeding well seek help from an LLL Leader and read our page My Baby Won't Breastfeed. With time and patience, most babies will breastfeed. In the meantime express your milk for your baby to maintain milk production and give you both the time to work it out.

Laid-back breastfeeding

Many people assume you have to sit up to breastfeed. Not so. In fact evidence suggests humans evolved to breastfeed in laid-back positions with our babies upright against our chests. You may have experienced this type of position when you had your first feed, soon after your baby's birth. There is more and more evidence that laid-back breastfeeding positions (also called Biological Nurturing) help babies breastfeed more effectively and are more comfortable for mothers, especially in the early days and weeks.

Laid back breastfeeding is really useful for those first few days and weeks when you want to rest and recover and your baby needs to be in close contact with you to get breastfeeding established. It can be done skin-to-skin or with you both lightly dressed. You don't have to be in bed; the sofa or a reclining chair is a comfortable alternative.

You can also use laid-back breastfeeding principles when sitting in an upright chair by shifting your weight back onto your tail bone and reclining your body back a little, to open up a space for your baby. This allows more of their weight to be supported by your body and less by your arms. It isn't safe to sleep with your baby on a chair or sofa.

Sleepy babies

If your baby is sleepy, perhaps because of birth interventions, then using laid-back positions with skin-to-skin contact can encourage your baby's interest in feeding. In laid-back positions babies often attach and feed when in light sleep so it helps to spend substantial periods of time with your sleepy baby against you. When you notice the little movements that indicate your baby is moving into a light period of sleep you can encourage them to latch.

How laid back breastfeeding works

You lay back in a comfortable, supported semi-reclining position (not flat) that opens up your body, creating space for your baby.

Your baby lies against you, their whole front against your body, vertically or at any comfortable angle.

Your baby feels stable and secure and their instinctive feeding reflexes are triggered, prompting them to bob their head and seek out the breast.

Gravity helps them latch deeply and stay latched, rather than hindering the process.

Your hands are free to support and caress your baby and help them attach.

Your body releases the hormones that stimulate milk production and make you experience loving feelings towards your baby.

There are no rules-you and your baby are free to work it out between yourselves.

Latching on - getting a good attachment

Your baby needs to tip their head back and reach forward with their lower jaw. As your baby tips their head back their jaw drops and their mouth opens wide, so they can anchor their chin and lower lip firmly against your breast. If they have to tuck their chin in to reach the nipple they won't be able to open their mouth so wide. Tipping their head back also makes a deep latch possible, swallowing easier, and frees up their nose for comfortable breathing. In laid-back positions lay your baby with their head between your breasts. If you are sitting up, keep your supporting hand away from the back of their head. Babies tend to creep forward, so try shifting them so that their eyes and nose are opposite the nipple to encourage them to reach forward and anchor their chin first. In sitting or side lying positions a little push between the shoulder blades with your supporting hand or arm as they latch brings their chest in closer and helps their head tip back.

Their lower jaw needs a clear space to anchor. Think about how you might take a mouthful from a big sandwich by placing your lower jaw first then opening your mouth to accommodate the top of the sandwich-the principle is the same. Your baby's lower jaw needs to be deeply placed on your breast well away from the nipple. Keep the fingers of your supporting hand away from the place where their chin and lower jaw need to be so their lower lip and chin can sink into your breast. Your baby's chin needs to stay firmly in contact with your breast.

Your baby needs a big mouthful. When a baby chews on a nipple, this compresses the milk ducts, prevents milk flowing and hurts. When a baby has a good big mouthful of breast beyond the nipple, breastfeeding is comfortable and milk can flow. Some women like (or need) to hold their breast when nursing. They flatten their breast as they would a big sandwich they were offering to the baby, matching it to the oval of his mouth. This can help their baby grasp more breast tissue. It doesn't matter if fingers are closer to the upper jaw but try to keep the "lower jaw fingers" out of your baby's way. Biological Nurturing™ positions make use of gravity to help a baby get a bigger mouthful.

The exaggerated latch. To get an even deeper latch you could try this optional extra. Place your thumb or finger near the base of the nipple where the middle of your baby's upper lip will be, lined up with their nose. If you press, your nipple will tilt away from your baby, presenting them with your breast rather than your nipple. Avoid pressing your nipple into their mouth. As they open wide, snuggle them in close and use your thumb or finger to tuck the breast into their mouth. Your nipple will be taken in last and unroll in their mouth. You can then slip your finger out.

Our own video below demonstrates flipple technique (aka exaggerated latch), it can be very helpful for getting an effective pain free latch:

Let your breast rest at its natural level. It can be tempting to lift your breast and move it towards your baby's mouth. If you do this, your baby probably won't get a full mouthful, and after a while your hand will get tired and the breast will drop and slip out of their mouth. Breastfeeding pillows can get in the way too because they lift a baby up too high and prevent you tucking them in against your tummy. See where your breasts naturally rest and hold your baby accordingly. If you need them, tuck pillows in after they are well attached.

Bring baby to breast, not breast to baby. Since breasts are attached to you and you baby is moveable it makes much more sense to bring your baby to the breast, not the other way round! And it works better too. With their body tucked firmly against you (or laid on top of your body), your baby will feel more stable and have better head control, and you'll feel a lot more comfortable too.

It's easier to latch onto a softer breast. It's much easier to get a deep mouthful if the breast is soft so breastfeed frequently to avoid engorgement. When your baby bobs their head and licks the nipple, it naturally makes it easier to latch on. If your breast is full and hard, you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Apply gentle steady pressure with your fingertips on the areola around your nipple for about a minute. You can also press with the sides of your thumbs or fingers. Denting the breast at the edge of the areola with a finger and placing your baby's chin in the dent may also help. Gently hand express a little milk too if needed.

Your baby needs to choose his own timing. Your baby will probably do best if they pick the moment to latch on. You can help by supporting them in a position that lets them do this when they are ready. To encourage your baby to gape hold them close against you, close enough to the breast so they know the nipple is there, but where they can't quite reach it. Be prepared for your baby to lick and nuzzle for several minutes before they are ready to open wide.

The natural or laid-back breastfeeding positions shown in the following videos can be a great help in encouraging your baby to latch on well, as well as being comfortable for you. You can recline comfortably with your baby on top of you with their whole front against you and their body completely supported by yours.

Best Beginnings' video demonstrates clearly how to make sure your baby is attaching well to the breast, you can view it here.

This video from Global Health Media demonstrates how to enable your baby to latch deeply on to your breast so that breastfeeding is comfortable for you and means your baby get enough milk:

This video from Raising Children.net.au shows how to attach your baby well, and shows a variety of comfortable breastfeeding positions:

Using different breastfeeding positions

The cradle hold

Although the cradle hold is one of the most common nursing positions it can be a challenge for new mothers to learn. You need to hold your baby's body firmly against you to give them stability because their weight is supported mainly by your arms. Shifting so you are sitting on your tailbone, rather than upright can help stability and reduce the strain on your arms (see picture right). It can be difficult to control a baby's head and to keep them high enough and close enough to your breast. A small baby may tend to curl up in a ball in this position if not pulled in closely enough against your body. It may not be the best choice at first if you're experiencing any problems with latch-on, milk transfer or if you have sore nipples. Once you're more confident with breastfeeding, you may find you use a version of the cradle hold much of the time, especially when out and about.

Your baby's whole front is against your tummy, their hip resting on or near your thigh, tucked around you like a comma. Their chest will be snuggled into the breast and your nipple near their nose.

Their head is resting on your forearm and/ or wrist (not the crook of the elbow).

As your baby opens their mouth to take the breast, pull their body in firmly against you.

Once your baby is attached, settle back a little for your own comfort and so that more of their weight is taken by your body.

Laid back breastfeeding

Remember that Biological Nurturing™ positions aren't just for the first week or two. They can be really useful later on when you want to relax, and especially if you are breastfeeding more than one baby or if your baby is fussy or unwell.

The cross-cradle hold

The cross-cradle position can be useful in the early days because it gives you more control in guiding your baby to the breast. It can be uncomfortable to maintain without good support under your arms, especially with larger babies, so once your baby is attached, switch arms as shown in the picture below. After the first few weeks and as your baby grows longer and heavier, you may prefer to use other comfortable holds. Avoid touching the top or back of your baby's head because it often causes a baby to pull back from the breast. Forcing a baby onto the breast by firmly holding the back of the head usually has the opposite effect and can put a baby off breastfeeding.

Cross cradle

Tuck their whole front against your tummy, their hip near or resting on your thigh.

Your hand supports their neck (not the back of the head) with your palm between their shoulder blades.

Your other hand is free to shape or stabilise your breast if needed.

Make sure your baby isn't too far round the front-line them up so their eyes and nose are near the nipple.

As your baby opens their mouth, give a little push with the palm of your hand to bring their chest in close against you.

This will help their head tip back and let them plant their chin deeply against your breast.

Once your baby is attached you can bring your other arm round to support your baby's body and settle back a little for your own comfort and so that more of his weight is taken by your body. Hold your baby with the arm opposite to the breast he's going to latch onto.

The underarm (clutch or rugby) hold

The underarm hold is useful if you have had a caesarean birth. It helps keep the weight of your baby off your incision. It is also a good position for mothers with flat or inverted nipples and for babies with latch-on or sucking problems because it offers you a good view of baby and breast and control of your baby's head. You can also feed two babies at once in this position. For larger, longer babies you may need extra cushions behind your back to bring you further forward and allow space for your baby's length.

Your baby's front is close against your side, with your hand under their shoulders and neck.

Your elbow keeps them tucked closely against your body.

Your baby approaches your breast from below. This can work well if you have large breasts. If you have smaller breasts you may need to bring your baby into a semi-sitting position.

Make sure your baby isn't too far round the front. You may need a cushion between your back and the chair back to allow room for your baby's length and prevent them pushing themselves forward with his feet.

Side lying

This side-lying position is helpful if you are recovering from a caesarean birth or an episiotomy and invaluable for nursing in bed during the night.
It can take a while to get the knack but it's well worth persisting because it can make night feeds so much easier.
Some mothers decide to sleep with their baby alongside them. Others choose to move their baby back onto a separate sleep surface.
Safe Sleep and the Breastfed Baby will help you decide on the safest sleep arrangements for your family, based on your own individual circumstances.

* Lie on your side, with your knees bent up and a pillow under your head.
* Place your baby on their side facing you so that their body and your body form a V-shape, meeting at your hips, with your nipple level with their nose or eyes.
* You can put your arm under your baby's head as shown, or up by the pillow with your baby lying on the bed.
* As your baby latches, give a little push between their shoulder blades to bring their chest in closer and help their head to tip back and their mouth to
open wide.
* You may find it helpful to tuck a small pillow or rolled blanket behind the small of your back and/or between your knees.

Standing up

At some feeds babies just do better if you stand up. You can sway or bounce gently to help calm your baby, and the lack of a lap can be helpful. As always keep your baby nice and stable and let them lead the way. Try angling their legs down instead of holding them horizontal, and see what happens. Or try starting with them against your shoulder, supporting them as he moves down to the breast. Even when using other positions, sometimes just standing up and sitting down again straight away helps everything settle into a comfortable position.

As time goes by

Whether you choose to breastfeed sitting up, reclining or lying on your side, you will need to adjust how you support your baby as he grows in length and weight. Use the principles shown here as you experiment with different positions. Sometimes there are physical or medical causes for pain or discomfort such as tongue tie or a thrush infection. If you are still finding it difficult to get comfortable, do persist with seeking further and continued support. There is almost always a breastfeeding solution to breastfeeding problems. You can contact an LLL Leader by calling our Helpline. You can also find support and encouragement from breastfeeding mothers in your local LLL group.

Written by Sue Upstone, Karen Butler and mothers of LLLGB

Further Reading

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

Mastitis
Beginning Breastfeeding
Breastfeeding Your Baby - easy read
Caesarean Birth & Breastfeeding
Comfortable Breastfeeding - easy read
Skin-to-Skin
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
Inverted Nipples
My Baby Needs More Milk
My Baby Won't Breastfeed
Nipple Confusion?
Nipple Pain
Nipple Shields
Nursing Supplementers
Safe Sleep & the Breastfed Baby
Sleepy Baby - Why & What To Do
Tongue Tie
Too Much Milk & Oversupply

LLLI Resources
Position to breastfeed

Other resources
How to do Biological Nurturing: www.biologicalnurturing.com/video/bn3clip.html
Best Beginnings videos to watch online: www.bestbeginnings.org.uk/watch-fbtb

References
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.
Biological Nurturing: Laid-back breastfeeding for mothers (DVD). Colson, S. et al. 2012.
An Introduction to Biological Nurturing; New angles on breastfeeding, Colson S. Amarillo, TX: Hale Publishing, 2010.
Supporting Sucking Skills, Watson Genna, C. Burlington, MA: Jones & Bartlett, 2012.

This information is available to buy in printed form form the LLLGB Shop.
It is also available in kindle edition.

Information, references and links on this page are taken from La Leche League resources, unless stated otherwise. Please note that LLLGB does not endorse information from outside sources, extra information is provided for you to consider. Information supplied is not intended as advice, and you are in the best position to make a decision as to how the information offered will affect you and your baby.

Copyright LLLGB 2016

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Positioning & Attachment - La Leche League GB

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Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively.

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

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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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This video by Kathryn Stagg IBCLC demonstrates how to get an exaggerated latch, where we move the nipple away from the babies mouth to get a bigger mouthful of breast.

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This video from Lucy Webber IBCLC is a visual demonstration of how to get your baby to tilt their head back to get a deep and comfortable latch.

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Positioning and Attachment

By Dr Louise Santhanam, General Practitioner. This video is a demonstration of good attachment at the breast (‘the latch’), including a visualisation of the anatomy inside the infant’s mouth.

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Good positioning and attachment of the baby at the breast is critical to effective breastfeeding. This enables:

Maternal comfort while feeding

Development and maintenance of breastmilk supply

Effective milk transfer and optimal infant growth

If breast problems, feeding difficulties or growth faltering occur, the breastfeeding 'first principle' is to review positioning and attachment as part of the diagnostic process. Refer the mother and baby for a breastfeeding assessment by an appropriately skilled practitioner, with observation of a full feed. See our page on ' Breastfeeding Support' for more information. Familiarisation with the contact details for local infant feeding support colleagues is recommended.

Situations in which anatomical or functional problems are present (eg. tongue-tie, neuromuscular problems) may impair the ability to achieve effective attachment and milk transfer.

As breastfeeding is a learned behaviour for each individual mother-baby dyad, attention to correct positioning and attachment is essential in the early days and weeks. This can help to quickly achieve maternal comfort while feeding, facilitate the development of optimal milk supply and thus increase the potential for longer-term breastfeeding. The assistance of an experienced breastfeeding supporter who assesses positioning and attachment and can advise on alterations for improvement is often critical to breastfeeding continuation. The same principle applies if breastfeeding problems or difficulties with feeding or weight develop later down the line- a feeding assessment is an important part of investigating possible causes and any necessary adjustments can be made.

The following principles assist good positioning and attachment of the baby:

Find a comfortable position in which to feed

Hold the baby close, facing the breast with its shoulders and body in a straight line and its neck supported but the head free to extend

Hold the baby with its nose opposite the nipple. The nipple can be brushed on the baby's lips to encourage mouth-opening

Wait for the baby to extend its neck and open its mouth wide

When the mouth opens wide bring the baby to the breast with the chin touching the breast first, followed by the bottom lip and tongue near the outer edge of the areola

The top lip should latch over the nipple as far as possible

Less of the areola should be visible underneath the chin than above the nipple

It is important to note that babies breastfeed not nipple-feed. If the baby sucks on the nipple only this will cause pain, cracking and bleeding. If attachment at the breast is good the nipple comes into contact with the baby's soft palate inside the mouth, and feeding should be comfortable for the mother.
How to Breastfeed- Getting a Good Attachment
The video below is a demonstration of good attachment at the breast ('the latch'), including a visualisation of the anatomy inside the infant's mouth:

Sourced from the Raising Children website, Australia's trusted parenting website. For more parenting information, visit raisingchildren.net.au.
Indicators of Good Attachment at the Breast
NICE Guideline CG37: Postnatal Care up to 8 Weeks after Birth defines the indicators of good breastfeeding attachment, positioning and successful feeding as follows:
Indicators of good attachment and positioning:

Mouth wide open

Less areola visible underneath the chin than above the nipple

Chin touching the breast, lower lip rolled down, and nose free

No pain

Indicators of successful feeding in babies:

Audible and visible swallowing

Sustained rhythmic suck

Relaxed arms and hands

Moist mouth

Regular soaked/heavy nappies

Indicators of successful breastfeeding in women:

Breast softening

No compression of the nipple at the end of the feed

Woman feels relaxed and sleepy

Additionally newborn stool pattern and changes can help to indicate if milk transfer is effective. NCT: What's in a nappy?- How to know if your baby is feeding well Explains how the contents of the nappy can indicate if a baby is feeding effectively.
Further Information Unicef UK Baby Friendly Initiative: Breastfeeding Assessment Tool for Health Visitors - How you and your health visitor can recognise that your baby is feeding well The Breastfeeding Network: Positioning and Attachment
La Leche League GB: Positioning and Attachment Includes information on breastfeeding positions, including Biological Nurturing™ positions ('laid-back' breastfeeding).
The NHS Website: Breastfeeding Positioning and Attachment The Breastfeeding Network: Signs of Effective Attachment Best Beginnings: Video of good attachment at the breast The Breastfeeding Network: How do I Know my Baby is Getting Enough Milk?
Published April 2017

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By Dr Louise Santhanam, General Practitioner Good positioning and attachment of the baby at the breast is critical to effective breastfeeding. This enables: Maternal comfort while feeding Development and maintenance of breastmilk supply Effective milk transfer and optimal infant growth If breast problems, feeding difficulties or growth faltering occur, the breastfeeding 'first principle' is to review...

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

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

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

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A guide to help you start breastfeeding- Off to the best start

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A guide to help you start breastfeeding- Off to the best start

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A guide to help you start breastfeeding

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This link has information on Getting Started & Signs of Effective Attachment.

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How to breastfeed - The Breastfeeding Network

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Getting Started Breastfeeding should be COMFORTABLE How you sit (or lie down) and how close you hold your baby as you feed can make a difference to how well things go. Sometimes a little difference in how your baby is feeding can make a big difference to how comfortable it is for you and how [...]

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The Breastfeeding Network | Independent Breastfeeding Support

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The Breastfeeding Network (BfN) is an independent source of support and information for breastfeeding women and others.

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Baby feeding cues or signs that they are hungry

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Responsive breastfeeding - The Breastfeeding Network

Breastfeeding works best when you feed your baby responsively. There are no limits to how often you can offer your baby your breast. In the early weeks especially, you can breastfeed your baby every time they want it. A new baby is not used to feelings of hunger and will feel upset and alone if their needs are not met. They have a small tummy and can digest breastmilk quickly, so they need to feed frequently. You can breastfeed your baby to comfort them as well or help them drop off to sleep.

You can also feed your baby whenever you feel you want to, for example if you feel your breasts are becoming over full, or if you are about to do something like attend an appointment, eat a meal or have a bath and want to be sure they won’t be hungry whilst you are occupied.

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cracked nipples and moist wound healing factsheet

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cracked nipples and moist wound healing factsheet

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This information is also available in a printer-friendly PDF format by clicking here.
Updated (2019) by Agnès Léger, BfN Supporter Reviewed by Phyll Buchanan, Anthea Tennant-Eyles, Sarah Turner, Wendy Jones. Registered BfN Supporters
The original version of this leaflet was produced in 2002 and can be found below. Although some further research has been conducted since, the conclusions mostly haven't changed. This is still an area in urgent need of further systematic reviews and independent research, especially distinguishing sore and damaged nipples. Nipple pain is usually poorly defined in the studies, without distinction between broken and unbroken skin (see Section "Sore or cracked?"). It could be the case that those different types of issues benefit from different treatments.

A review of most of the recent studies that assessed the efficacy of treatments for painful nipples was produced in 2014, and we recommend readers to refer to this document to help them understand the evidence supporting the use of various treatments. Note that it does not separate treatment of recent and established wounds. This Cochrane review is entitled " Interventions for treating painful nipples among breastfeeding women" and was conducted by C‐L Dennis, K Jackson and J Watson. It can be accessed at the following link:
https://doi.org/10.1002/14651858.CD007366.pub2

Most of the content of this leaflet is still as relevant today. The amendment highlights some of the main updates of the last 17 years throughout the text (in boxes). The BfN is investigating paths to either produce an updated leaflet or support further systematic reviews.

Summary of the key points

· Cause of soreness

Addressing the cause of the nipple soreness is the most effective way of solving it! Correcting positioning and attachment is paramount in allowing a damaged nipple to heal and enable pain free, effective breastfeeding. Positioning and attachment should always be investigated, including for older babies, because even a good latch can be improved. There are resources on the subject here:
bfn.local/positioning-attachment

· How to treat sore nipples

Nipples can be air dried or kept moist using a few drops of expressed milk. To this date, there isn't satisfactory evidence than any other treatment is as effective in helping nipples heal, including purified lanolin and vaseline ( Dennis et al., 2014). If using creams, apply after feeds. Most do not need to be washed off before the next feed, though if using creams/gauze containing antibiotics its worth wiping off any excess before a feed. You can also check our section "A few things to try".

· How long does healing take

The duration of the healing will vary. Superficial and recent soreness may clear in a matter of hours or days. However, long-established and profound wounds may require a up to 2 or 3 weeks to be entirely resolved even after the cause of the soreness has been eliminated. Long-established wounds usually close from the bottom to the top, so creams applied to the wound in order to prevent a scab forming is likely to aid healing, see section on "Two ways of wound healing".

· Continuing breastfeeding

If positioning and attachment is adjusted so that pain is minimised with no new damage visible after a feed, you can continue breastfeeding. The wound will continue to heal. See our section "Expressing versus continued breastfeeding".

· When to contact a medical professional

You should speak to your health visitor or GP if you have signs of infection (like abnormal swelling, inflammation, [pus - check description] discharge, fever and/or chills, or feeling ill), or if your wound doesn't heal after a few weeks, even after adjusting attachment to a pain free latch. You can also check our section on "Other medical considerations".

Supporting women with cracked nipples is such a large part of our work, it is surprising how little certainty there is on the best method of healing them. We know that adjusting positioning is crucial to avoid any further damage. An established wound that is slow to heal may be a sign of continued friction. So, start with watching a whole feed to see whether fresh injury is happening and if so, at what stage. Sometimes it's when latching on, other times during a feed, or maybe it's towards the end when the baby is getting sleepy and the mother's arm relaxes downwards. Watching for any changes in suckling and swallowing will give further clues. Usually a more comfortable position can be found, but the wound may have been established for some weeks before we become involved. In these circumstances we can offer support while working towards comfortable feeding. Part of the feeding assessment should include looking into the baby's mouth to check for a high palate or tongue-tie.

Many women with cracked nipples want to know if there is anything they can put on the wound to speed up healing. A typical response might have been to suggest air drying or expressed breastmilk (EBM). However, when looking at the research we have a dilemma. A few years ago the available information on treatments was clear: In the Royal College of Midwives handbook, Successful Breastfeeding (2nd edition,1991, page 58), the section on treatment of sore nipples states "No randomised trial has yet been done to assess the usefulness of any of the creams, sprays, lotions or ointments [in current use] .... there is no scientific basis for their use. Nor is there any scientific evidence to support the use of expressed breastmilk or colostrum on the nipples after feeding." The 3rd edition (2002) now agrees that there is a strong theoretical basis for moist wound healing techniques though they have yet to be evaluated in the context of RCT's. Murray Enkin's A Guide to Effective Care in Pregnancy and Childbirth ' (3rd edition 2000, p507), still relegates nipple creams and ointments to forms of care likely to be ineffective or harmful. However Renfrew, Woolridge, and Ross McGill (2000) consider new evidence that the presence of 'epidermal growth factor' in breastmilk has potential therapeutic benefit in promoting the growth and repair of skin cells. This growth factor appears to be passively transported from the circulation into breastmilk as levels measured are constant over weeks and throughout a day's feeds.

Mohrbacher and Stock (1997) retract information in the previous edition on keeping the skin dry when sore, cracked or bleeding and add that research into moist wound healing results in wounds healing 50% faster when the internal moisture of the skin is maintained.

All books agree that no product is a substitute for finding and correcting the cause of soreness. The aim of this article is to help women achieve pain free effective breastfeeding.

Sore or cracked?

There is a move towards using moist wound healing for cracked nipples. At this point it is worth distinguishing between sore (unbroken skin) or cracked (wounded, broken skin) nipples. Many of the text books discuss sore, rather than cracked nipples or include sore and cracked nipples together (see above). This is reflected in the design of many research studies into moist wound healing, so it is perhaps not surprising that results are often inconclusive.

Mohrbacher and Stock (1997) now say, 'keeping the skin dry is no longer recommended for nipple soreness' while reminding us that many creams and ointments sold for the treatment of sore nipples may actually contribute to the problem (page 394). Yet sore nipples should be able to heal without creams, providing help is given with positioning to prevent a crack developing. Renfrew, Woolridge, Ross McGill (2000) find it plausible that this process (of moist wound healing) may have contributed to the previously reported claims by women that oil-based formulations (eg lanolin, 'Calendula', 'Kamillosan') are beneficial with nipple soreness.

Any study which suggests that using a moisturiser would help women with sore nipples should compare subsequent rates of cracked nipples in each group, as well as levels of pain. There appears to be no such study. It seems probable that the main use of moisturisers (or other forms of skin care) should be when the skin is broken as a result of nipple trauma, especially when prevented from healing by repeated damage. Renfrew, Woolridge, Ross McGill (2000) agree that no controlled studies of adequate size have been published to date.

Compare this with general health care, where the principles of moist wound healing are well established. The importance of a moist environment for wound healing was identified by the work of George Winter ( Nature, 1962, 193, 293-294.). He compared the effect of leaving superficial wounds exposed to form a scab, with the effect of applying a vapour-permeable film dressing (on a pig). The wounds healed twice as quickly when kept humid. The dressing maintained humidity on the wound surface, allowing skin cells to slide across the surface of the wound. With a scab, the cells had to go deeper under all the dry crust and dead skin to find a moist layer (ref 6, p79).

Ideal skin care would allow moisture to be retained, without making the skin 'soggy' (or macerated) - like when a plaster has been on the skin too long, or feet go wrinkly in the bath. This moisture prevents a hard scab forming. When applying this to cracked nipples, a softer wound has an extra advantage. There is less risk of further damage happening during breastfeeding as there is no hard scab to pull off during a feed, taking the new skin cells lying underneath with it.

Keeping the wound moist also reduces pain by keeping air from drying out the exposed nerve endings (then more pain as it rehydrates) (ref 6, p80). Just as grazed knees are really nippy when going into the bath, but don't hurt so much once underwater, keeping a cracked nipple moist avoids it being re-wetted every time the baby latches on. We are, however, unaware of any study that has looked at this specifically.

Two ways of wound healing

Normally a new wound heals when the edges close together. An established wound heals from the base upwards, with the new skin growing over the edges, so they look smooth - often described as a rolled edge. As these wounds look like they are healing relatively slowly, women can feel disheartened. It helps to explain this and to look for the wound getting shallower. These wounds are most likely to benefit from moist wound healing, reducing any scab formation and allowing the skin cells to glide over each other.

Amendment - Sept 2019

This is sometimes referred to as secondary wound healing, as opposed to the primary wound healing that occurs for more recent and superficial wounds. Chronic wounds are more likely to heal "by secondary intention", which means that they heal bottom to top. This process takes longer, and the wound is more susceptible to infection and scab formation in the meantime.

Newly healed wounds are not as strong as normal skin, so can re-open if the baby slips when feeding. This is more likely to happen when the mother or baby is sleepy. Feeding lying side-on may help reduce the chance of this happening during night-time feeds.

While the wound is healing, it sometimes helps to talk about a pain scale - imagine a ruler numbered 0 to 10, with 10 being unbearable pain. Suggest trying to drop down the scale at each feed so the mother can see a progression towards no pain at all. Correcting the position should give her an instant drop someway down the scale but not necessarily to 0. Depending on the extent of the wound, it may take some time before she reaches 0. If pain stays the same, or increases, ask her to contact you again.

Expressing versus continued breastfeeding

Expressing is sometimes suggested as an option to 'rest' the nipple. Finding a comfortable feeding position however, is usually less trouble than expressing milk, which puts suction on the wound. Breastfeeding only involves suction at the very beginning of the feed, as the nipple and areola are drawn into the baby's mouth to form a teat. Once the milk begins to flow the negative pressure is relieved and the nipple should be well into the baby's mouth, safe from any further damage (ref 12, Chap 80, p1362).

Possible treatments

The table below reviews the different moist wound healing treatments available. Choosing a moisturiser is not easy. Perhaps the first suggestion for mothers would be either white soft paraffin (Vaseline) or purified lanolin (such as Lansinoh ®). Vaseline is widely used in wound care, either directly, or as a base for other creams. Lanolin is also used as a base but concerns over allergic responses and high levels of contaminants (ref 2 and 7) limit its use. Purified lanolin is a purified anhydrous version. The revised edition of the Breastfeeding Answer Book warns that Vaseline is unsuitable because it "keeps out air" (ref 2, page 163) and is "not safe for ingestion" (page 395). Unfortunately, these comments are not referenced and the standard reference book for drugs, Martindales Pharmacopoeia, makes no reference to this. Softened paraffin is likely to stay on the surface of the skin longer than purified lanolin but this is what makes it so useful in preventing hard scab formation. It is worth noting that white soft paraffin, or its unbleached version yellow soft paraffin, has been widely used over many years for lip care in special care baby units - if it was unsafe for ingestion why is it used directly on babies lips? White soft paraffin is widely available and cheap (a small tin currently costs 99p) while purified lanolin cost between £5-£10.

Sue Huml, Lactation Consultant for Lansinoh ®, believes "Petrolatum [Vaseline] is occlusive (prevents any air reaching the wound/skin). Lansinoh ® is semi-occlusive, allowing oxygen and water transpiration. Petrolatum remains on the surface of the skin. Lansinoh ® penetrates the stratum corneum and in a study was found to penetrate into the stratum granulosum, where in can hold moisture already in the skin ...... In lanolin sensitive patients researchers were unable to elicit a single allergic response."

Amendment - Sept 2019

A 2014 feasibility study ( https://doi.org/10.1891/2158-0782.5.1.28) investigated if breastfeeding women using purified lanolin may have a higher rate of infections than others - however the results weren't conclusive. Further research is required to answer this question.

A few things to try

Get a breastfeeding supporter to watch a whole feed, even good positioning may be made better.

Use only water when washing, because soap will dry the skin further.

Massage the breast gently and/or hand express a little milk to shorten the time between the baby latching on and the milk beginning to flow.

Feed when the baby at the first stirs rather than when really wide awake - so the baby feeds in a more relaxed way.

Feed from the least painful side first.

After a feed, try expressing some milk, and let it dry on the nipple.

You can try anaesthetising the nipple with ice wrapped in a cloth before a feed.

Consider pain relief, e.g. Paracetamol or Ibuprofen at least 30mins before a feed is expected, and at regular intervals.

Change breast pads at each feed.

Conclusion

Correcting positioning is paramount in allowing a damaged nipple to heal and enable pain free, effective breastfeeding. Sore nipples alone are unlikely to need further treatment, no evidence exists to support the use of creams, sprays or ointments to prevent or treat nipple soreness (11). Cracked nipples may benefit from applying a moisturiser such as white soft paraffin (Vaseline®) or purified lanolin. Some women may not like a particular choice of treatment. It may be useful to check whether they have any allergies to creams or cosmetics. Creams can be tested on their inner arm, but bear in mind that healthy skin is often less likely to react than damaged skin.

This is certainly an area in urgent need of systematic review and further, independent, research. We would like to hear from anyone with any experience of moist wound healing, with examples of what worked or not. We would like to collect this information. It's your experiences that will help us learn.

Moist Wound Healing Treatments: a review (November 1999, revised May 2001)

Amendment - Sept 2019

For an update on this table, please refer to the Cochrane review "Interventions for treating painful nipples among breastfeeding women", published in 2014 by C‐L Dennis, K Jackson and J Watson ( https://doi.org/10.1002/14651858.CD007366.pub2).

The authors of this review conclude that

"The results [...] suggested that applying nothing or just expressed breast milk may be equally or more beneficial in the short‐term experience of nipple pain than the application of an ointment such as lanolin."

"There was insufficient evidence that glycerine gel dressings, breast shells with lanolin, lanolin alone, or the all‐purpose nipple ointment significantly improved maternal perceptions of nipple pain."

Expressed breast milk has no risk of allergy, contains antibodies and 'epidermal growth factor' which potentially may promote the growth and repair of skin cells (1).

Using expressed breastmilk encourages hand expressing - may have benefits not considered in studies of nipple healing. Is used in many cultures on skin irritations (2).

USP-modified lanolin, warm compresses, and expressed breast milk with air drying were compared to a control group (177 women with sore nipples) (3).

Results No differences in pain or duration of breastfeeding. Exclusive breastfeeding rather than partial was a better predictor of breastfeeding beyond 6 weeks.

Conclusion Clinicians should discontinue recommending creams and ointments, since these have not been proved to be effective... and may only present an unnecessary nuisance and expense for the mother.

White soft paraffin (Vaseline®)
Use in tube form where possible.

Widely available.

Might try next after breast milk.

Good at preventing scab formation which may be pulled off during a feed causing further damage.

Compared white soft paraffin to antibiotic creams in general wound healing (884 women) (4).

Results No skin reaction to Vaseline® was found when confirmed by patch tests. Only 0.9% reacted in the antibiotic group.

Yellow soft paraffin
This is the unbleached form of Vaseline®.

Available in hospitals and pharmacies.

This is used in special care baby units as a moisturiser on babies' lips.

See above re scab formation

Not tested on nipple wounds although in common usage. Compared reactions to yellow and white soft paraffin on 3 people with known sensitivity to yellow soft paraffin (5).

Results Within each brand purification meant less sensitivity, may mean white soft paraffin is preferable to yellow.

Jelonet® Gauze square soaked in yellow soft paraffin. Comes in foil pack or tin

Available on prescription, or from pharmacies.

Useful on open, established cracks; should help stop the wound sticking to a breast pad. Use folded in double layer to stop drying out, if it still sticks try something else.

Change at each feed.

See illustration in (6)

Has been used as a wound dressing for many years.
One book claims it does not maintain a moist wound environment, not as popular in general wound care because it can stick to the surface of larger wounds
(7, p 85).

Purified lanolin (e.g. Lansinoh ®)
Claims to be a highly purified form of lanolin, although allergies may still be possible.

Substitutes are widely available in high street chemists and supermarkets and unlikely to be effective.

Claims to be absorbed more effectively than Vaseline® and that Vaseline® needs to be washed off - no evidence of this.
See text

Advertised in baby magazines.

Look out for various substitutes purporting to be pure lanolin - some are diluted by other compounds i.e. liquid paraffin

Several studies published but have design shortcomings. No study found which compared purified lanolin to the soft paraffin group. One unpublished thesis compared purified lanolin to expressed breast milk (8) and (9).

Results Cracked nipples took on average 1-2 days quicker to heal with purified lanolin. Delay in publication has been prolonged which must cast doubts on its methodology.

Creams
Kamillosan®, Calendula, and other similar brands.

Widely available

No scientific evidence exists for their use.

Look for ingredients that should not be ingested by babies - vitamins, peanut oil. Many stores have own brand versions. Kamillosan® no longer contains peanut oil.

Referred to in (1) (11) (12) and (13).

Hydrogel
A dressing of gel granules which can be applied to the cracked nipple. Large water content. May feel cold to touch.

Expensive. Available from pharmacies e.g. as NuGel®, market is still developing

Various papers warn of the risk of the baby choking if the mother is sleepy enough to forget to take it off. Seems remote given that it would be held in place by a bra and breast pad which would have to be removed. Will absorb some wound fluid/ milk. Good at moistening a dry wound. Used for open and established wounds (granulating wounds). New dressings designed and marketed specifically for breastfeeding are being marketed in some countries. Some advantages are claimed for dressings containing glycerine, as these residues are considered safer.

Compared hydrogel dressings with standard hospital care of lanolin plus breast shells. (10)

Results Stopped early because of increased infections in the hydrogel dressing group. Two groups each with
21 mothers. Worth checking whether there is an explanation for this, eg how often the pads were changed.

Sprays
Rotorsept® and other sprays

Sprays have an alcohol base which is drying to the skin, may be more likely to cause cracking. May alter the normal skin bacteria

Antibiotic creams
Such as fucidic acud (Fucidin® cream)

Only available from GP's.

Antibiotic dressings
Yellow soft paraffin squares impregnated with fucidic acid

Not in general use in the UK but is more common in America and through information found on internet sites.

Expensive, can cause skin reactions, increase the risk of bacterial resistance.

Wipe off excess cream before the next feed but don't wash off or it may further damage skin.

Tulle gauze used like Jelonet® - doubled over and kept under breast pad.

May be used instead of a Jelonet® type dressing if the wound is superficially infected (11).

Study A randomised trial with 922 patients divided into 440 having white petrolatum (wsp) and 444 Bacitracin® - an antibiotic cream(ac)

Results The rate of infection was similar in both groups (2%wsp v 0.9%ac, not sig). Antibiotic creams were associated with infections that were more serious and expensive to treat. No patient in the wsp group developed an allergic reaction but 4 did in the antibiotic group (4). In a study of treatments for infected sore nipples (confirmed by lab culture) better healing was achieved in the group taking antibiotic tablets rather than creams (14). Letter states study was too small to be conclusive (15).

If using any of the above creams, apply after feeds. They do not need to be washed off before the next feed, though if using creams/gauze containing antibiotics its worth wiping off any excess before a feed (see above). Phyll Buchanan, Anabel Hands and Wendy Jones, Breastfeeding Network Supporters (2019 amendment also by Agnès Léger, Anthea Tennant-Eyles and Sarah Turner.)

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Cracked Nipples and Moist Wound Healing - The Breastfeeding Network

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This information is also available in a printer-friendly PDF format by clicking here . Updated (2019) by Agnès Léger, BfN Supporter Reviewed by Phyll Buchanan, Anthea Tennant-Eyles, Sarah Turner, Wendy Jones. Registered BfN Supporters The original version of this leaflet was produced in 2002 and can be found below.

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Building a close relationship with your baby

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Building a close relationship with your baby

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A child’s experiences in their early years shapes their rapidly developing brain. This is an important opportunity for you to give your baby the best start in life.

It is your baby’s experiences with you and with the world around them, that make connections in their brain.

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Building a close relationship with your baby - Best Start in Life - NHS

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Your baby’s early experiences shape their development. Find out how to build a strong relationship with your baby to help give them the best start in life.

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Our telephone helpline is open 24 hours a day, 365 days a year, and via social media direct messaging. Support is also available in Welsh, Polish, Bengali & Sylheti and for people who have hearing or speech impairments.

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National Breastfeeding Helpline - Helpline

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

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Your breastmilk in the first week - The Breastfeeding Network

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Before your baby is born, and for the first few days afterwards, your breasts will produce colostrum. Colostrum is a highly valuable fluid. It is rich in protein, immunoglobulins, vitamins, anti-infective agents, living cells and minerals. It can be described as being low volume and high yield; there is plenty for your baby in the […]

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The baby sleep
info source

For parents who wish to make informed
choices about infant sleep and night-time care.

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Research-based information on baby sleep for parents and practitioners, covering normal infant sleep, sleep safety, where and how babies sleep, SIDS and SUDI, parental sleep and free resources.

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Mastitis, blocked ducts, and engorgement: what to do when your breasts are inflamed

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Mastitis, blocked ducts, and engorgement: what to do when your breasts are inflamed

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Have you got discomfort or pain from swelling in one or both breasts?

Mastitis (breast inflammation) covers a range of symptoms — from a small, tender area (often called a blocked duct) through to severe infection. This article explains what causes breast inflammation, how to treat it, and when to get help.

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

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

LLL Leaders are here to help.

What do all these words mean? A quick guide

What are the signs of mastitis?

How can I prevent mastitis in the future?

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

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

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

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

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

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

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

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

Could it be a breast abscess?

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

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

Common causes of mastitis

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

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

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

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

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

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

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

Less common causes of mastitis

Previous breast surgery, such as implants

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

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

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

Factors that may make mastitis more likely:

Causes of engorgement

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

your baby starts sleeping for a longer stretch at night

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

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

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

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

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

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

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

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

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

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

Things to avoid

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You have a fever

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

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

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

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

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

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

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

Contact NHS 111 or your GP straight away if:

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

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

Written by Jayne Joyce and Justice Reilly

Last updated June 2024

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

References

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

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

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

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

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

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

NHS Specialist Pharmacy Service - UK Drugs In Lactation Advisory Service

Using paracetamol during breastfeeding , published November 2023

Using NSAIDS during breastfeeding , published February 2024

Other websites

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

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

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

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

Copyright LLLGB 2024

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

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Avoiding and treating mastitis and breast infections

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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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Facebook pages, and Linktrees across the South Coast

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Facebook pages, and Linktrees across the South Coast

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Stay Connected with The Breastfeeding Network Across the South Coast

We have a private Facebook group, a supportive space to share experiences, ask questions, and connect with others on your breastfeeding journey: https://www.facebook.com/groups/southcoastbreastfeeding/ (please answer the joining questions)

To help you keep up to date with all the latest information, local events, drop-ins, and breastfeeding support available in your area, we’d love for you to also follow our public Facebook pages!

Each local Breastfeeding Network project across the South Coast regularly shares:

Up-to-date session times and venues
Evidence based information
Community news and local events
Training opportunities.

Follow your local page below to make sure you don’t miss anything that’s happening near you!

Dorset: https://www.facebook.com/bfndorset

https://linktr.ee/bfndorset

Isle of Wight:

https://www.facebook.com/IOWbreastfeedinginfo

https://linktr.ee/bfn_iow

Portsmouth:

https://www.facebook.com/PompeyBreastfeeding

https://linktr.ee/pompeybreastfeedingnetwork

Southampton:

https://www.facebook.com/southamptonwelcomesbreastfeeding

https://linktr.ee/sotonwelcomesbreastfeeding

South and East Hampshire:

https://www.facebook.com/southandeasthampshirebreastfeedinginformation

https://linktr.ee/bfnhants

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When expressing it is important your flange fits properly, for optimal comfort, efficiency and milk yield.

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Ending your breastfeeding journey: some approaches to parent-led weaning, Emma Pickett IBCLC

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Ending your breastfeeding journey: some approaches to parent-led weaning, Emma Pickett IBCLC

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This is a great blog by Emma Pickett IBCLC with lots of information about parent-led weaning and ending the breastfeeding journey.

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Making the decision to end breastfeeding
Breastfeeding support is all about helping you to breastfeed for as long as you want to. We want families to reach their breastfeeding goals, and that means Breastfeeding Supporters are here for parents at the end of their breastfeeding experience, as well as at the start. Some families want to breastfeed for years. Some want to for months or weeks. If you are able to make the decision with the right information and feeling supported, we have done our job.

We want to make sure that you make the decision to end breastfeeding in a way that you will have peace with in the future. If you are struggling with breastfeeding, it may be that the right support can resolve issues and you can continue breastfeeding happily. We would want all avenues to be explored if the idea of ending breastfeeding is an unhappy one.

Are you hoping that ending breastfeeding might improve your child's sleep? It's important that parents understand what's normal when it comes to how babies sleep: "No difference in night wakings or night feeds was found between mothers who were currently breastfeeding or formula feeding ... Breastfeeding has no impact on infant sleep in the second 6 months postpartum." (Brown and Harries 2015)

You might have been told you have to end breastfeeding to take a medication and the Drugs in Breastmilk Information Service can provide evidence-based information on the compatibility of breastfeeding and medications. Sadly, parents are often misinformed.

It can be valuable for you to talk through your decision to end breastfeeding before starting the process. A breastfeeding supporter can help you reflect on your decision, as well as help you take some practical steps to get the process started. Every family's journey will be different because every child and parent's relationship to the breast is different. There is no 'one size fits all' approach to ending breastfeeding. In some families, the breast is at the heart of parenting. A mother might breastfeed throughout the night and day to meet her child's emotional needs in a host of different ways. In other families, a child might be feeding a couple of times a day, and even then, only when offered. You can see those families will have very different experiences around the weaning process. However, there are some general guidelines about starting the transition to ending breastfeeding.
Weaning under 12 months
If your baby under 12 months is ending breastfeeding, their nutritional requirements will obviously need to be the highest priority. A baby of around 7-9 months who is taking solid food reliably will still need around 600 ml (20 oz) of formula in 24 hours (NHS Better Health Start for Life 2023). From around 10-12 months, if we can assume that solids have become more established, we're expecting still around 400 ml (13 oz) of formula in 24 hours. If a young baby is feeding roughly eight times in 24 hours (it could easily be more), then we would start by looking at the formula total needed over 24 hours and dividing by eight. If day one means one bottle of 30 ml of formula at some point in the day (perhaps before a breastfeed), when everyone is in a good mood, that is a good place to start. If that volume increases gradually until one feed is entirely with the bottle, we might then pause for a couple of days to let breasts adjust and to consider next steps. Dropping one breastfeed no faster than every three days feels sensible to reduce the risk of breast health problems.

What kind of bottle is best? Parents often get pulled down a rabbit hole when it comes to this question. If a family is ending breastfeeding, we have less need to consider which bottle is protective of breastfeeding. There is not one 'best' bottle. We are looking for the bottle which is affordable, easy to buy where a family lives and with replaceable teats that are also easy to find.

What about choosing the type of formula? Any 'First' formula is appropriate and babies do not need 'follow-on' formula.

"All infant formula have to be of a similar composition to comply with UK compositional requirements and all brands are nutritionally adequate for infants. If a substance was found that was definitely beneficial for infant health that could be added to infant formula, it would be in all infant formula by law." (First Steps Nutrition Trust 2021)

After 12 months, full fat cow's milk can be given as a main drink. With a younger baby, giving milk in a bottle is likely to be a first choice. We want all bottle feeding parents to be confident with a technique known as responsive bottle feeding (sometimes referred to as paced bottle feeding) which can help the feed to be a time for connection and communication and reduce the risk of over-eating. However, the NHS recommend that families move away from bottles from around 12 months, and that means some older babies will be moving from a breast directly to a cup. We want families who use powdered formula to understand that the powder may contain bacteria and other pathogens and there are careful recommendations about how to make up a bottle safely. ( https://www.nhs.uk/start4life/baby/feeding-your-baby/bottle-feeding/how-to-make-up-a-feed/making-up-a-feed/)

When we talk about a baby under twelve months transitioning from breastfeeding, it is easy to get wrapped up on dropping breastfeeds and discussions of milk volume, but we must never lose sight of the fact that breastfeeding was about connection and an exchange of love and physical affection too. It was about oxytocin. We still want that oxytocin creation to happen. We are not just changing how a baby is fed but adding in a new method of feeding AND lots of opportunities for physical affection. Bottle feeding can happen skin-to-skin and there's lots of time for snuggles and connection.

Whatever age a baby is when breastfeeding ends, we need parents to be prepared for some possible impacts on them. Ideally, the transition from breastfeeding to exclusive bottle feeding happens gradually. If you have been producing a full milk supply, it is going to take time for your body to get the message that the order has changed. If that isn't handled carefully, at the very least we could be looking at engorgement and blocked ducts. In more serious cases, we could be increasing the risk of mastitis and abscesses. A gradual weaning process means it's more likely that the body will adapt. The grape-like lobules in the milk storage areas can feel lumpy under the skin and this can be frightening if you have spent months, or even years, associating lumpiness with blocked ducts. Milk storage areas that remain full are doing some important jobs. Fullness is part of the natural process which slows milk production. However, this is a balance, and we want the reduction to be as comfortable as possible. Breasts need to be well supported (but not squashed). Pain relief may be helpful. Cool compresses, and even cabbage leaves, may also provide relief. There are physical adaptations that are needed, but also emotional ones. You might experience 'weaning blues' even if you very much wanted to end breastfeeding. Your body is adapting to a change in hormones. Previously, with every breastfeed, there was a release of oxytocin. Your body may miss that, and you may have some other complicated feelings alongside the end of breastfeeding. It's important for you to be gentle with yourself and reach out for support if you need to.
Weaning an older toddler
Let's imagine we are talking about ending breastfeeding an older child. We start with doing some thinking about this child's relationship to the breast. Are they more likely to ask at a particular time of day? Or when you are engaged in a certain activity? Are they hungry for food or hungry for connection? Once we understand when requests for a breastfeed are more likely, we can reflect on what a child will need to replace breastfeeding. The act of weaning is not simply the act of removing breastfeeding. Many new things often need to be added in. We can think of breastfeeding as being like the 'Swiss army pen knife' of parenting. It contained so many different tools and met so many different needs. Now you are taking it out of your tool belt, and you're going to need to replace it with some new things. Some parents will learn to parent in different ways. Your child may need new ways to ask for help in emotional co-regulation. They may need a new language that helps them feel empowered and in control of their world. They may need a new language of sleep and getting to sleep. They may need help to find ways to say, "I'm feeling a bit vulnerable, and I need to check in with you."

It may be that breastfeeding is the tool a child uses to physically calm themselves. It is how they wind down when they are buzzing. It is also often used as a tool for sleep. It makes biological sense when you think that breastmilk contains hormones that aid sleep for any age - for both the nursling and the parent. Nurslings of any age can enjoy breastfeeding as a way to transition to sleep, whether it is for a nap, at bedtime or after waking in the middle of the night. Breastfeeding might also be their decompressing tool when they feel overwhelmed at other times. They may be experiencing physical pain or feeling unwell. They may feel afraid.

Weaning is not a battle of parent versus nursling. It is trying to find a new world together, with compassion, that meets the needs of everyone. A lot is going to depend on the age of the child, but if your child is verbal and is able to understand what you are saying, they can be a partner in your process. You might start with conversations in daily life that explain milkies don't last forever for everyone. These conversations can happen long before they are personalised to say, 'One day, YOU will not have mummy milk.' We want your child to understand that one day breastfeeding ends and that can be hard, but it ends for everyone eventually. In the park, you might point out an older child on a skateboard, 'I wonder how old he is. I think he's about ten. I wonder how old he was when he stopped having mummy milk and how he felt about that?' A parent might talk about people in the supermarket, characters in the background of picture books or television friends. Does Peppa Pig still have mummy milk? It is never discussed so we assume not. I wonder how old she was when she stopped? How does she get to sleep now? What does she do when she wants to feel close to mummy pig?

Reading picture books about weaning can also be an extension of this conversation. For many young children, reading a book is a time where they are most likely to focus, and the repetition is ideal to embed new concepts. You may like to go one step further and make your own weaning book. Using online photo companies, it's possible to create individualised books using family photos with familiar phrases, that give everyone a sense of ownership of the process. Young children often like to see photos of themselves, and you can include photos of their sleeping space, special toys and their favourite foods and activities.

Alongside reading picture books, eventually the time comes to put the theory into practice. You will need to explain to your child that one day milk will go away FOR THEM. You might share pictures of early breastfeeding and share memories. You might talk about how you have loved breastfeeding and how special it is and how you will find it hard to say goodbye too. This conversation doesn't just happen once but is sprinkled throughout some days at different times. It might happen at the park or during dinner. Ideally it happens at times when emotions are steady to start with, and there is time to explore feelings that arise. A child as young as 18 months or two years old may not be able to articulate, or even fully comprehend what is being said, but repetition may help and it makes sense to try and offer some explanation, rather than underestimate their level of understanding. It is important that you reflect on how you will explain to their child WHY breastfeeding is going away. Some parents struggle with doing this authentically. You will see stories online of parents rubbing their nipples in unpleasant tasting foods or even chilli oil (ouch). Breastfeeding has been such an honest and beautiful connection. If a parent has breastfed their child for several years, it seems a shame to end it with something inauthentic, and something they may later look back on with suspicion. Are we really protecting them?

Many parents fear speaking honestly. They want to say things like, 'milk is going away because you are getting older' or 'I think we will both sleep better if we don't have milk at night.' Neither of those concepts really make sense to a child. Why is milk going away? Being 'older' or 'a big boy' doesn't mean they don't need you! They may feel they sleep better at night because they have milk. They don't want a parent to do this for them! If a parent can find a starting place that is truthful, they will be able to continue with that honest communication. You might say something like, 'My body is going to stop making milkies' or 'my boobies are tired, and my body is tired and I'm going to help you say goodbye to milkies. I know it will be hard and sometimes you might feel angry and sad that boobies are going away, but mummy cuddles will always be here.'

A nursling who is weaning reluctantly has every right to be angry. Just as you have a right to wean, your nursling has the right to be angry and disappointed. It is important that they understand the feelings they express are to be validated. There is a misunderstanding by some that validation is a tool we use to calm children down. When we say, 'I understand', that we are actually hoping it is enough to stop them being upset, but in fact things might be more painful initially. A child who knows that their feelings are being listened to and recognised, is eventually going to be in a better place.

It is sometimes said that distraction is a valuable weaning tool. I have said it myself in the past. For much younger children, it can be useful as you seek to meet their needs in other ways as quickly and as effectively as possible. It is natural to not want to imagine that a child is experiencing pain. If there is a way to avoid seeing distress or anger, that sounds like an ideal scenario. However, distraction shouldn't be about pretending weaning isn't happening. We are not aiming to wean and hope they don't notice.

The psychotherapist Philippa Perry describes how distraction 'can be an insult to a child's intelligence': "What message does distraction convey? Imagine you fall over and badly graze your knee how would you feel if your partner, instead of being concerned or interested in the pain or the blood or the embarrassment, pointed out a squirrel or promised that you could play your favourite video game?" (Perry 2019)

Distraction is attractive in the short term. It might feel like a handy short cut, but this may not be the best time for short cuts. Of course, it does depend on what a child's motivations for wanting the breast are. Ideally, if distraction does happen, it should be on-topic and meeting the underlying need. If your child is requesting connection and time with you, then offering a different loving focused activity isn't distraction so much as offering a new way to meet the same need. However, a child who is asking for connection, and is instead offered a screen and a snack, is not having that need met respectfully.

If we see weaning from breastfeeding as a time to add in new parenting tools and new languages, what can that look like in practice? A new language around thirst and nutrition is about providing opportunities. Does the child have a cup they can use independently that is within easy reach? Do they have a way to request snacks or to explain when they feel hungry? All they may be skilled to do in that situation is to ask for a breastfeed.

Giving a child a new language to ask for connection and affection is often at the heart of weaning from breastfeeding. When a child continues breastfeeding beyond infancy, the dialogue of requesting a breastfeed and having that need met can feel powerful and wonderful. The most important person in their lives is pausing and meeting their request. When they have that urge for parental love and a sign of affection, they have the tools to do that. If that tool is taken away and no alternative is given, the risk is that the child feels not only rejected but also disempowered and destabilised. That was the only way that they knew how to ask for a physical sign of love. It was the only way they knew how to say, 'Hey I need you for a moment!' Can your child ask for a cuddle? Do you ask them for a cuddle? What other kinds of physical affection do you model in your home and have words for? You may want to add in more times for attachment play and power reversal play, where your child feels in control and taking the lead. Attachment play may only last for 10-15 minutes but it's a time when you give your child your focus and your energy.

A feed that is sometimes difficult to drop is the reconnection feed that happens when a child is reunited with their parent after a day of nursery and work. That feed is a powerful moment of a child decompressing at the end of a long day and celebrating seeing the parent again. Some children will arrive home full of energy, and high energy connective play and physical games may meet a need. Some are tired and are looking for a moment of peace. Activities like a hand massage or head and shoulder massage can be special, and the nursling might take the role of the facilitator and the expert. Dens are a great tool to give little people a sense of fun and excitement. You can create a cuddle nook which may be a tent or a home-made den, with cushions, bean bags and fairy lights. This isn't a place where breastfeeding happens but where reading and cuddling and other kinds of physical connection occur. It would be sensible to discuss in the morning what will happen at the reunion. Another caregiver could mention it and remind the child during the day. The parent might even be able to speak to them on the way home via a video call to prepare them for what is going to happen.

Alongside introducing a new language around connection and physical affection, other boundaries around breastfeeding are progressively being put in place. Breastfeeding might still happen in the day, but only in certain places. Perhaps no longer on a particular chair or restricted to a less interesting and stimulating room. You might agree to do a feed for a short period of time and then offer a different activity that may be more appealing. If you are saying, 'not right now', you can give them a choice about what might happen instead to help them feel they have some control over the process.

What about night weaning? What can be helpful is the concept of habit-stacking (a term used by Lyndsey Hookway). We want the child to have more than one association with safe and soothing bedtime and the process of falling asleep. Then as the breastfeeding is removed, they are left with something familiar that already helps their brain to think, 'Ahh, yes, sleep time now.' After all, being a creature of habit is a normal human state of affairs. Adults would also not be thrilled if our familiar routine was yanked out from under us overnight. Parents can introduce one or two additional habits alongside breastfeeding. It is something that involves the parent, so they are still offering co-regulation once the breastfeeding goes. It will differ for every child. Some would be irritated by stroking or patting and may prefer something auditory. A parent might choose a gentle phrase that can be repeated. They might tell a narrative along the lines of, 'You are sleeping now. Mummy is sleeping now. Granny is sleeping now. Cats are sleeping now. The birds in the trees are sleeping now.' When it later comes time for night weaning, the parent can add in, 'Boobies are sleeping now.' Some families might choose gentle singing or a white noise machine with ocean sounds.

For older nurslings, a guided meditation can also be a valuable tool at bedtime and the peaceful language repeated during the night in smaller chunks. An older child may also be able to express an opinion on what they would like to use as their additional sleep habit. At the same time, it can be useful to have conversation in the day about the process of falling asleep, to help reinforce that this is a process that involves an element of choice. How does Daddy fall asleep at night? How does a friend? What do they do when they can't fall asleep easily? A parent might role play falling asleep with cuddly toys during playtime. What is teddy going to choose? And teddy might be angry with Mummy because booby isn't happening throughout the night. A parent might 'play bedtimes', where they are the child, and the nursling becomes the parent. Or original roles might be maintained, and the parent offers alternatives to the breast. Role play can be a useful way to work through emotions.

Breastfeeding toddlers often haven't attached to a cuddly toy at bedtime. Why would they? The parent is their cuddly toy. However, it might be useful to introduce a transitional object for the first time, to provide one further means of support if night weaning is going to happen. Again, with an older nursling, this is something they may to like have agency over. A parent might explain that one day boobies will go away, and they can choose a new friend to be with them at night to help them.

In the nights prior to the onset of night weaning, daytime conversation is valuable. This is not something that comes out of the blue. However, weeks of preparation are unlikely to be helpful. Being gentle is not always the same thing as being very slow. A young child is unlikely to have a sophisticated sense of time and concepts like 'next month' or even 'next week' are fairly meaningless. Something like 'in a few days' might be more useful. You might discuss it on the bus, walking back from the park, at dinner time. You could eventually remind their child that, 'tonight is the last night that booby happens all night. Then tomorrow booby is sleeping at night.' Or you might say, 'tonight is the last night booby happens all night. Tomorrow, we can only do two boobies at night.' You remind them that it will be hard, and you will be there to help them. Then the during the day, prior to the big night, there are lots of reminders.

What is important is to emphasise that you will be there to support your child, whatever they are feeling. We are not implying that we are asking them to be a 'good boy' or to 'try hard'. Equally, the next morning, we are not praising them for not being upset. All feelings are welcome because the child is loved unconditionally. If you have a partner, they can provide important support for both of you, but it is not ideal if your approach to weaning involves you stepping away entirely and leaving your partner to take over (or for you to leave the home entirely). Your child is scared and experiencing their first major loss in their life. They need to know they are not losing you entirely. You are there to support them through this loss. And you'll also need to practise your new skills of providing comfort and co-regulation. Sometimes when parents do attempt to use separation as a weaning technique, it can leave a child feeling more vulnerable and even more desperate for breastfeeding to continue. Sometimes there is no alternative other than to face difficult feelings and to be there for your child during their time of loss.

Ending breastfeeding is hard. Even the most careful and loving parent who approaches the weaning process sensitively and gently may find it upsetting and difficult. Just as we make space for little people to feel sad, we may need to allow ourselves to have mixed feelings too. As AA Milne says (as quoted in the weaning book, 'Booby Moon' by Yvette Reid): "How lucky am I to have something that makes saying goodbye so hard." Then, when you are done, take a moment to look back and celebrate your breastfeeding achievement. Remember those early days and weeks. Remember the special times. IBCLC Glenni Lorick says that parenting is a 'series of weanings'. This has probably been your first. Well done for getting through it.
Emma's book: SUPPORTING THE TRANSITION FROM BREASTFEEDING: A GUIDE TO WEANING FOR PROFESSIONALS, SUPPORTERS AND PARENTS will be published by Jessica Kingsley Publishers soon.
References:

1. Brown, A. and Harries, V. (2015) 'Infant sleep and night feeding patterns during later infancy: association with breastfeeding frequency, daytime complementary food intake, and infant weight.' Breastfeeding medicine 10, 5, 246-252. doi: org/10.1089/bfm.2014.0153

2. Drugs in Breastmilk information service: https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/

3. NHS Better Health Start for Life (2023) What to Feed Your Baby. UK: NHS Public Health England. https:/www.nhs.uk/start4life/weaning/what-to-feed-your-baby/7-9-months/

4. First Steps Nutrition Trust (2021b) Infant milks: A simple guide to infant formula, follow-on formula and other infant milks. London: First Steps Nutrition Trust. https://www.firststepsnutrition.org/parents-carers

5. Perry, P. (2019) The Book You Wish Your Parents Had Read (and Your Children Will Be Glad That You Did). London: Penguin. P.79

6. Hookway, L. (2021) Still Awake: responsive sleep tools for toddlers to tweens. London: Pinter & Martin.

7. Reid, Y. (2021) Booby Moon: a weaning book for toddlers. New Zealand: Yvette Reid.

8. Lorick, G. (2009) 'Life is full of weanings', Conservative Granola Mommies, 2 March. https://conservativegranolamommies.blogspot.com/2009/03/life-is-full-of-weanings.html.

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Ending your breastfeeding journey: some approaches to parent-led weaning - The Breastfeeding Network

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Emma Pickett IBCLC Making the decision to end breastfeeding Breastfeeding support is all about helping you to breastfeed for as long as you want to. We want families to reach their breastfeeding goals, and that means Breastfeeding Supporters are here for parents at the end of their breastfeeding experience, as well as at the start.

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Find breastfeeding and infant feeding support

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Find breastfeeding and infant feeding support

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Find breastfeeding and infant feeding support - The Breastfeeding Network

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Peer support is at the heart of what we do. It means you can talk to someone who has experience of breastfeeding who is also trained to provide evidence-based information and support to other parents. We offer a range of services in many areas across the UK.

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This link has information around starting solids at 6 months, the signs that a baby is ready for solids, and tips for introducing solid foods using baby-led weaning (BLW)

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Breastfeeding Out and About

Information for families - The Breastfeeding Network

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

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

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https://www.breastfeedingnetwork.org.uk/breastfeeding-information/getting-started-with-breastfeeding/how-do-i-know-if-my-baby-is-getting-enough-milk/

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Train with us - The Breastfeeding Network

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Train with us - The Breastfeeding Network

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Training is a big part of what we do. Whether you are looking to volunteer as a peer supporter, learn more about how you can better support local parents or you are already working closely with families and would like to learn more about supporting breastfeeding families we would love to hear from you. What […]

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Mastitis Information - The Breastfeeding Network

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This information was updated in December 2022. A PDF version is available here.

"I was surprised by how suddenly I felt ill. We went to a wedding and I only missed one feed.
Within a couple of hours I felt fluey and achey. My GP was reluctant to prescribe antibiotics,
saying they were often not needed if I kept feeding. I also took ibuprofen tablets which helped
me cope. I was surprised how well the self-help worked and that I never needed a prescription.
I felt very miserable and depressed when I had the symptoms, wondering whether
breastfeeding was worth all this - but once I felt better I remembered how good it feels."

Mastitis means inflammation of the breast.

The first sign of mastitis is a swollen usually painful area on the breast. On darker skin tones
there might be a darkening of the skin and on lighter skin tones this might be visible as a red
area on the breast. However, it is important to note that there could be no visible change in
skin colour at all. The inflammation and swelling is not always a sign of infection (WHO, 2000).
Harmful bacteria are not always present: antibiotics may not be needed if self-help measures
are started promptly. Very rarely mastitis can develop into a more serious condition which
needs urgent hospital admission and IV antibiotics (RCOG, 2012).

You may get mastitis when milk leaks into breast tissue from a blocked duct. The body reacts
in the same way as it does to an infection - by increasing blood supply. This produces the
inflammation.
NB You may not have all of the above signs during mastitis.
Prevention of Mastitis

A localised area in the breast which is painful to the touch, often in the outer upper
area. Some mums might notice a change of colour or a red area on their breast.

A lumpy breast which feels hot to touch.

The whole breast aches and may appear swollen and skin may be reddened or darker,
depending on skin tone.

Flu like symptoms - aching, increased temperature, shivering, feeling tearful and tired
(Jahanfar et al., 2013). This feeling can sometimes start very suddenly and get worse very quickly.

Signs that the Baby is Well Attached

Try to avoid suddenly going longer between feeds. If you are intending to reduce breastfeeding, cutting down gradually reduces the risk of mastitis.

Make sure your breasts don't become overfull

Avoid pressure on your breast from clothing and fingers

Start self-help measures at the first sign of any lumpy or swollen areas on your breast

Factors which make mastitis more likely:

Difficulty with attaching your baby to the breast - this may mean that the milk is not

being removed effectively and milk may leak into the breast tissue

Pressure from tight fitting clothing, particularly your bra, or a finger pressing into the

breast during feeds

Engorgement or a blocked duct

Sudden changes in how often the baby is feeding, leaving the breasts feeling full

Injuries, such as bumps or knocks from toddlers

Self-Help Measures
Mastitis starts with poor milk drainage. If your baby is not effectively attached to your breast,
or has difficulty feeding, it may be hard for the baby to remove the milk and some parts of
your breast may not be drained during a feed. Improving the way your baby is attached at
the breast will reduce the chance of you getting mastitis again. If in doubt, contact your
midwife, health visitor or breastfeeding peer supporter for help with attaching your baby for
feeding. You can also contact the National Breastfeeding Helpline.

Your baby's chin is firmly touching your breast.

Your baby's mouth is wide open

Your baby has a large mouthful of breast.

If you can see the darker skin around your nipple, you should see more dark skin above your baby's top lip than below your baby's bottom lip.

It doesn't hurt you when your baby feeds (although the first few sucks may feel strong).

No change in shape or colour of the nipple after feeds e.g. it should not be lipstick shaped or have a pressure line across the nipple

Your baby's cheeks stay rounded during sucking.

Your baby rhythmically takes sucks and swallows (it is normal for your baby to pause from time to time).

Your baby finishes the feed and comes off the breast on his or her own.

Your baby produces 6 or more heavy wet nappies every 24 hours (from 7 days old)

Your baby produces at least two yellow poos at least the size of a £2 coin every 24 hours (from 7-28 days old). See UNICEF's breastfeeding checklist for more details.

If your mastitis comes back after you have taken a full course of antibiotics, or is unusually severe, it is good practice to send a sample of milk for bacteria tests. This will help the GP chose the correct antibiotic for your symptoms (Jahanfar et al., 2013). For public health reasons doctors try to avoid antibiotics that are not essential or are unlikely to be effective. It is important that you finish the whole course of antibiotics to make sure that you recover fully and to help prevent the mastitis coming back with resistant bacteria (NICE NG15).
When should I contact my GP or health visitor? If you do not begin to feel better after 24 hours despite using self-help measures, or especially if you start to feel worse, you should speak to your GP or health visitor. You may need to take antibiotics.
These will also help to clear blocked ducts and engorgement. Most cases of mastitis can be improved or resolved with self-help measures.
When should I seek help urgently?

Keep on breastfeeding - you may feel ill, in pain, tearful or discouraged but continuing to breastfeed will help you to get better, and your breastmilk is still the best food for your baby

Feed your baby frequently and responsively (whenever your baby seems like they want to feed), and/or pump to your normal routine (Mitchell et al., 2022; Douglas 2022)

Don't attempt to "empty the breast" by prolonging feeds or expressing extra milk between feeds. You may see this suggested in some places, but the current research suggests you should aim to meet your baby's needs, but avoid increasing your supply beyond that as it could make the inflammation worse. (Mitchell et al., 2022; Douglas 2022)

Try to rest as much as you can, as this will help you recover

Check that your baby is effectively positioned and attached to your breast - if in doubt seek help from your midwife, health visitor or breastfeeding supporter, as even a minor tweak can make a difference.

Try feeding with your baby in different positions.

If necessary, soften your breast, by expressing a little milk or running warm water over it, so that the baby finds it easier to feed well.

Some mothers find warm compresses are soothing, and warmth on the nipple can aid let-down. However, take care using these as compresses that are too hot or used frequently could increase swelling and inflammation. Cool compresses may ease symptoms in between feeds. (Mitchell et al., 2022; Douglas 2022)

Avoid any firm pressure or massage to the breast, or use of items such as an electric toothbrush to massage lumps or sore areas. This could cause tissue damage and increase inflammation (Mitchell et al., 2022; Douglas 2022). Any pressure you apply to your breast should be no firmer than stroking a cat.

Check for clothing or anything else which is pressing into your breast. This includes a bra - some women find it helpful to go without.

Medical Treatment for Mastitis
If you feel these symptoms beginning again, start self-help measures right away.

You should contact your GP if the area becomes round and swollen or, if you can see redness or a change of colour on your skin and the pattern of the colour change/redness changes. Redness may be less visible on darker skin tones. Mastitis can develop into an abscess (a painful collection of pus). There is more information about this here: https://www.nhs.uk/conditions/breast-abscess/.
The World Health Organisation (WHO) recommend Flucloxacillin 500 milligrams four times a day as first line treatment with erythromycin 250-500 milligrams four times a day or cefalexin 250-500 milligrams four times a day if the mother is penicillin allergic. Other options have been suggested by Jahanfar et al., (2013).
If you feel seriously unwell, dizzy, confused, develop nausea, vomiting or diarrhoea or slurred speech along with the symptoms of mastitis you need to seek urgent medical attention. These can be signs that mastitis is developing into sepsis. If severe, this is a medical emergency which needs urgent hospital admission and IV antibiotics. (NHS Choices: Sepsis, RCOG, 2012:6.1)

This information comes from the Drugs in Breastmilk Service.
References

Ibuprofen reduces the inflammation, relieves pain and reduces temperature. Take 400mg three times a day after food. Ibuprofen should not be taken by women who have asthma, stomach ulcers or are allergic to aspirin. The levels of ibuprofen which pass to the baby are small. Ibuprofen is safe to take whilst breastfeeding. See https://www.breastfeedingnetwork.org.uk/analgesics/ for more information.

Paracetamol relieves pain and reduces temperature but has no anti-inflammatory action. Take two 500mg tablets four times a day.

Aspirin should not be taken by breastfeeding mothers.

Antibiotics may be needed if no improvement is seen with self-help measures. Mostantibiotics can be safely taken whilst breastfeeding.

It is essential that breastfeeding is not interrupted during mastitis.

Note: Antibiotics can make the baby produce loose, runny motions and become irritable, colicky and restless. This lasts for a short time and will get better when you finish the antibiotics.

Jahanfar S, Ng CJ, Teng CL. Antibiotics for mastitis in breastfeeding women. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD005458. DOI:10.1002/14651858.CD005458.pub3 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005458.pub3/abstract (accessed 19 November 2020)

Crepinsek MA, Crowe L, Michener K, Smart NA. Interventions for preventing mastitis after childbirth. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD007239. DOI:10.1002/14651858.CD007239.pub3. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007239.pub3/full (December 2022)

Hale T., Medications and Mothers' Milk 2014 (16th Ed),

NICE guideline [NG194] Published: 20 April 2021 https://www.nice.org.uk/guidance/ng194/chapter/Recommendations (accessed December 2022)

World Health Organization. 2000, Mastitis: causes and management, WHO: Geneva http://apps.who.int/iris/bitstream/10665/66230/1/WHO_FCH_CAH_00.13_eng.pdf?ua=1.(accessed December 2022)

NICE guidelines [NG15] Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use www.nice.org.uk/guidance/ng15 (accessed December 2022)

NHS Choices: Sepsis www.nhs.uk/conditions/Bloodpoisoning/Pages/Introduction.aspx (accessed December 2022)

Royal College of Obstetricians and Gynaecologists (RCOG) (2012) Green-top Guideline No. 64b. Bacterial Sepsis following Pregnancy: 6.1. www.rcog.org.uk/globalassets/documents/guidelines/gtg_64b.pdf (accessed December 2022)

Unicef: https://www.unicef.org.uk/babyfriendly/wpcontent/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf (Accessed December 2022)

Mitchell, K. B., Johnson, H. M., Rodríguez, J. M., Eglash, A., Scherzinger, C., Zakarija-Grkovic, I., Cash, K. W., Berens, P., Miller, B., & Academy of Breastfeeding Medicine (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022 Breastfeeding medicine : the official journal of the Academy of Breastfeeding
Medicine, 17(5), 360-376. https://doi.org/10.1089/bfm.2022.29207.kbm
Please note this information is not yet available in print. The previous print version has now been withdrawn and should no longer be used. A new print version is planned for 2023.
Douglas P. (2022). Re-thinking benign inflammation of the lactating breast: Classification,
prevention, and management. Women's health (London, England), 18, 17455057221091349.
https://doi.org/10.1177/17455057221091349

Original leaflet compiled by Wendy Jones MBE Pharmacist and Phyll Buchanan
Breastfeeding Network Supporter and Tutor, in 2015. With thanks to Magda Sachs who
developed earlier versions

This version revised 22 December 2022.

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Information on mastitis and breastfeeding, updated December 2022 and provided by the Breastfeeding Network

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

What is skin-to-skin contact?

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Skin-to-skin contact - Baby Friendly Initiative

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

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

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

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

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Breast compressions are a technique to increase milk flow by gently squeezing the breast while a baby is feeding. It helps babies get more, richer milk, keeps them actively swallowing longer, and can boost milk supply by better emptying the breast. This video from Kathryn Stagg IBCLC is a lovely demonstration and explanation.

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As new parents, we suddenly find ourselves examining our babies’ poo more closely than we could ever have imagined. We pay attention to the colour, quantity, texture and smell, and notice the slightest changes. We then go to the internet looking for answers and fear the worst. There are many versions of normal, and these are shared in this article

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As new parents, we suddenly find ourselves examining our babies' poo more closely than we could ever have imagined. We pay attention to the colour, quantity, texture and smell, and notice the slightest changes. We then go to the internet looking for answers and fear the worst. There are many versions of normal, and we will share some of these below.

When your baby is born, your colostrum (first milk) has laxative and diuretic compounds in it to make your baby wee and poo. In the first few days your midwife and health visitor will ask how many wet and dirty nappies your baby has had, so you may find it helpful to take note of how many nappies you change.

Your baby may not poo much at first but this will increase as your milk comes in. For an idea of how many poos to expect, see https://laleche.org.uk/is-my-baby-getting-enough-milk/#dirtynappies

It can be tricky to tell if disposable nappies are wet - after five full days, when copious milk comes in, they should be heavy.
Many disposable nappies have a faint line down the middle of the nappy which changes colour when wet.
You can feel what a properly wet nappy should feel like by putting three tablespoons (45ml) of water onto a clean, dry one. Urine should be pale and mild smelling.
This post on signs of effective feeding has more information.

Pictures 1-9 below show the contents of one baby's nappy in the first few days of their life, to give you an idea of what to expect from a healthy, full-term baby. If you have any concerns about your baby's poo, or if you see blood in the nappy (beyond the first few days, when baby girls can have a mini period caused by birth hormones), don't hesitate to contact your midwife, health visitor or GP.

Picture 1
Baby's first bowel movement, called meconium, is tar-like, sticky and hard to remove.

Picture 2
Baby's second bowel movement.

Picture 3
Poo from the first day of baby's life. Reddish pink urate crystals are visible in this nappy; see picture 10 for more about urates.

Picture 4
Bowel movement on day two. Your baby's poo will gradually change colour, from black to green to brown. It becomes a lot easier to wipe off as your baby begins to drink more milk.

Picture 5
Day three bowel movement. Looking a lot paler, heading towards a yellowish colour, and much less sticky.

Picture 6
Day four bowel movement.

Picture 7
Day five bowel movement.

Picture 8
Day six bowel movement.

Picture 9
Day ten bowel movement. By this age most fully breastfed babies' poo will be this pale yellow colour. It is common for babies to have what are described as "explosive" poos, which may take you by surprise if your baby poos while you are changing their nappy!
The following pictures show some ways in which your baby's poo may look different from the typical pattern shown above.
Picture 10
In the first few days, you may see reddish pink crystals called urates in your baby's nappy. They are often described as looking like brick dust. As your baby begins to take more milk, the urates should stop appearing in her nappy.

Picture 11
Sometimes your baby's poo may be light green rather than yellow, and have small lumps in it like cottage cheese. This is common and not significant by itself, unless your baby has other symptoms that you are worried about.

Picture 12
This poo came from a three-week-old baby who was given Gaviscon because of reflux. When the medication was stopped, the baby went back to having runny yellow stools.

Picture 13
After the 12-week injections this baby had green poo, which went back to being yellow after a few days.

Picture 14
This dark green poo came from a baby who was later diagnosed with cow's milk protein intolerance.

Picture 15
This poo, containing mucus, came from a baby diagnosed with allergies. Mucus in the poo is also common when a baby has a heavy cold, but this should be temporary and should stop when the baby is well again. If your baby's nappy has persistent or unexplained mucus in it, seek medical advice.

Picture 16
As your baby starts to eat solid foods, you will see the results in his nappy. It is common for your baby's very first foods to come out looking almost exactly as they did when they went in, as his digestive system is not used to dealing with these other foods yet. This is much easier to spot if your baby is eating finger foods rather than mashed food; the mashed foods are passing through semi-digested in the same way, but are less obvious in the nappy.

With time, your baby's poo will gradually change from yellow liquid to soft brown lumps, and you won't generally see pieces of food. However, some foods are hard to digest and tend to pass through the body unchanged (even for older children or adults). This picture shows an 11-month-old's nappy with partially digested grapes visible in it. Strongly coloured foods (like blackberries or beetroot) can also affect the appearance of your baby's wee and poo.

Written by Amanda Dunbar and Emma Taylor for LLLGB, 2017

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As new parents, we suddenly find ourselves examining our babies' poo more closely than we could ever have imagined. We pay attention to the colour, quantity, texture and smell, and notice the slightest changes. We then go to the internet looking for answers and fear the worst.

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If you've decided to bottle feed, you may be worried about what to buy, what equipment you'll need and how to get the hang of feeding your baby when everything is so new.

This article provides lots of helpful information and advice on bottle feeding. If you have any worries or concerns, the best thing to do is speak to your midwife or health visitor.

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Bottle feeding - Best Start in Life - NHS

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From making formula feeds to how to bottle feed your baby, we have lots of useful advice and tips.

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Infant milks information for parents & carers

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Infant milks information for parents & carers

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The different types of infant formula, and other infant milks, marketed for babies and young children can seem confusing when you see lots of different ones on the supermarket shelf, but the information you need as a parent or carer is really quite simple. This link contains some very useful information.

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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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Reflux and Breastfeeding - The Breastfeeding Network

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

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Parents who stop breastfeeding 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.

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Can I drink alcohol when I am breastfeeding? 

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Can I drink alcohol when I am breastfeeding? 

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This factsheet from the Drugs In Breastmilk Service is all about Alcohol and Breastfeeding.

You can have occasional, small amounts of alcohol but should not drink regularly or heavily (e.g. binge drinking) without considering how to limit your baby’s exposure.

If you drink any alcohol DO NOT bed share with your baby or fall asleep in the sofa/chair.

If you do drink heavily, your baby should be cared for by an adult who has not had any alcohol.

It is not necessary to express breastmilk to clear it of alcohol.

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

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

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

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

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

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

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

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

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

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

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

Other websites

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

Guidelines from the NHS

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

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

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

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

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

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Alcohol and Breastfeeding - The Breastfeeding Network

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

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What are the recommendations for giving water during infancy?

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Water for infants — 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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If you’re planning your return to work, you might be wondering what your options are for continuing to breastfeed. Maintaining breastfeeding is often more do-able than people imagine, and there are lots of benefits to doing so.

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Breastfeeding continues to provide health benefits for you and your baby. Every feed is of value.

Breastfeeding is a great way for you and baby to relax and reconnect at the end of the working day.

The familiarity of breastfeeding can ease the change that returning to work brings to you both.

Breastmilk is free and the perfect natural and normal food for your baby.

You won't need to buy or prepare formula.

"I've returned to work now twice, full time. My first child was bottle-fed so I was apprehensive the second time about how breastfeeding would go when I returned. I had excellent information from a breastfeeding counsellor about different options and I'm really happy that I kept breastfeeding and working."

Your options
Depending on the age of your baby, your work pattern and your preferences, you're likely to have a number of options to choose from. Talk to other mothers who have successfully worked and breastfed. You can also talk through your options by calling the National Breastfeeding Helpline on 0300 100 0212.
What will baby drink, and how?
Do you want your baby to have expressed breastmilk, formula, water or a combination of these when you're apart? The needs of a very young baby whose mother is returning to work full time, will be different to that of an older baby whose mother is returning part time. A baby of eight months who has started taking solid food, will have less need for milk while you're at work, and can have some water in a beaker rather than milk as long as breastfeeding is plentiful for the rest of the time.

Babies don't necessarily need a bottle, although for a baby under around five months, bottles may be the most practical solution. An older baby may be happier with a plain or soft spouted beaker, or a cup with a straw. Some families like to get baby used to drinking from a cup/bottle before mum returns to work. It may help to get someone else to do this for you since some babies refuse cups or bottles from mum. The person who's going to be looking after your child may be a good option for this.
Expressing at work?
Some mums want to express at work, and some don't. Expressing at work is easier in some jobs than in others. However, even if you don't express while you're at work, and you decide to use formula, breastfeeding can continue while you are with your baby. It's not all or nothing.

If you're planning to express milk for your baby, practise can really help. Don't be put off if you only get a few drops at first. Remember too that if you're expressing in addition to full breastfeeding, there might not be much extra milk to express. When you're back at work, expressing will be in place of a feed and you'll have more milk available to express. If you're going to be able to express regularly during the working day, you won't need a large supply of frozen milk, as you should be able to express enough milk each day for the following workday. This will allow you to keep up your supply and provide fresh milk for your baby. However, some mums like the reassurance of having some frozen milk in reserve for an emergency, or if baby needs more milk than anticipated on any given day.

Try to express at regular intervals while you are at work, ideally when your baby would normally feed. It can help to have photos of your baby with you as looking at them or thinking about your baby, while expressing, can help the milk to flow.

If you're not going to be expressing at work, it's still useful to know how to hand express if you find yourself feeling full.

See our article Expressing Breastmilk for some more tips on expressing, storing breastmilk, and keeping equipment clean.
Different days, different patterns
Don't feel that baby must have the same feeding pattern every day. Many mums continue to breastfeed as usual whenever they are with their baby, while baby drinks from a cup or bottle when she's at work. Once established, your milk supply is very flexible, so you can do different things on different days.
Plan with your employer
Be open with your employer, talk with them, and put your needs or requests in writing. Maternity Action ( www.maternityaction.org.uk) has lots of information to help you and your employer. If you're going to be expressing, find out if there are adequate facilities: you'll need somewhere private, and shouldn't be expected to use the toilet. You may be able to use a medical room or a vacant office for example. Discuss breaks for expressing milk, and dedicated space in a convenient fridge to store it in. If this is new territory for your employer, they might find Maternity Action's information helpful. If your employer is unhelpful, contact your union rep or Maternity Action.

Health and safety legislation should safeguard your health. By not breastfeeding, you're at a higher risk of developing certain health problems. It's in your employer's interest to help safeguard your health while at work. There are also rules about exposure to hazardous chemicals, the Health and Safely Executive (www.hse.gov.uk) has information about this.
Childcare
Explore how different options will fit into different working patterns, such as childcare close to your work or nearer to your home. Childcare close to work might mean that you can fit in a feed or two during the working day. Make sure that your chosen carer knows what you need them to do. For example, to use 'paced bottle feeding' if baby's going to be using a bottle; how to store and use expressed milk; or not feed baby just before you're reunited, so that you can breastfeed straight away.

"I could only get a few drops of milk with my hand pump when my baby was small but when I went back, I found it much easier. The first day the milk took a little while to come, possibly because I was a bit anxious, but after that it wasn't a problem. I used to express about five ounces every lunchtime and put the bottle in an ice cream carton in the fridge."
What about when I actually return?
Some mums start work near the end of the week so that mum and baby can adjust gradually to the new routines.

Expect your baby to feed more often when you are at home, at least at first. Your baby will need to do this to increase your milk supply again after you have been apart, and to 'welcome you back'. Arrange a little extra help if possible or ignore household chores for a bit.

Some babies will 'reverse cycle', meaning that they catch up for missed feeds by feeding more at night. As long as baby is feeding frequently when you're with them, a longer gap without breastmilk during the day is normally nothing to worry about - instead of going a longer period without feeding at night, this is just happening during the day.

You may leak a little until your body adjusts to a new pattern, so remember breast pads when you first return to work, and it may be an idea to wear patterned clothing at first.

Get your bag and the baby's things ready the night before to give you both a little extra time in the mornings.
Planning your return to work can feel very daunting. In practice, many mums find that the transition back to paid work goes more smoothly than they expected.

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The confusion over the rights of breastfeeding women who want to take lactation breaks challenges both mothers and employers.

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Many parents bring their baby into their bed to sleep. For some babies this is their main night-time sleep space, but for the many babies this is not where they always or usually sleep. Bed-sharing mostly happens for part of the night, or for a couple of nights a week. Sleeping with baby in an adult bed (bed-sharing) is common and may happen intentionally or accidentally and is a type of co-sleeping (parents and infants sleeping together).

This article contains information and links to safe sleep guidance, whether you plan to bed-share or not, please see this safe sleep guidance to ensure you can avoid preventable unsafe circumstances

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How, why, and when parents bed share with their infant

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Learning you are pregnant with twins, triplets or more changes your expectations and plans. But you can still plan to breastfeed.

Breastmilk is a complete and perfect food for your baby. It is especially important for multiples, who are often small at birth. Breastfeeding also helps you create a special bond with each of your babies. Many mothers have nursed their multiples; you can enjoy nurturing your babies this way, too. This article has some great information and links to more resources.

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Learning you are pregnant with twins, triplets or more changes your expectations and plans. But your decision to breastfeed doesn't have to change.

Breastmilk is especially important for multiples, who are often small at birth and need all the health benefits it provides. Breastfeeding also helps you create a special bond with each of your babies. Many mothers have nursed their multiples; you can enjoy nurturing your babies this way, too.

Planning ahead

Attend La Leche League meetings or our Antenatal Breastfeeding classes in pregnancy to learn about breastfeeding and meet breastfeeding mothers. Do read The Womanly Art of Breastfeeding, Mothering Multiples by Karen Gromada and our page on Birth and Breastfeeding.

A healthy diet with plenty of protein, complex carbohydrates and good fats will get you all off to a good start. Gaining healthy amounts of weight during pregnancy is good for your babies' birth weights and may also help prevent premature birth.

Even with good care, you might experience complications during pregnancy so it helps to be prepared. Ask your midwife for information on warning signs for premature labour. Seek medical attention quickly if any occur, or you have any of these symptoms: a severe headache or stomach ache, see spots in front of your eyes, or feel extremely irritable or tense.

Limit visitors

Limit visitors while in hospital and in the early days to those you feel comfortable breastfeeding in front of. When nursing two babies at once, you may feel exposed, at least until you can manage both babies and keeping your breasts covered (if you feel you want to). Tell friends and family you need time to recover and suggest they visit later, or drop round a meal!

Separation

Any separation after birth may make breastfeeding harder, but it's still possible. Hold, or at least touch, your babies immediately after the birth or as soon as you can. You can still touch and stroke a baby in special care and may be able to hold him against you in 'kangaroo mother care'. If he can't breastfeed, express your milk for him. This is the most important thing you can do whilst you are waiting to start breastfeeding. When you are back together, spend as much time as possible snuggling together skin-to-skin or lightly dressed to establish breastfeeding.

If you need to express your milk because one or both babies can't nurse, hand expression is useful in the first few days. Plan to express from both breasts at least eight times in 24 hours, about every two to three hours during the day and at least once during the night. As your milk increases, you can switch to a hospital grade automatic electric pump.

Once breastfeeding is established, mothers of multiples often find nursing two at once is easiest and it saves time to co-ordinate feeds. Biological Nurturing ™ positions can leave your hands free.

Breastfeeding at night lying down gives you more rest. It gets easier as your babies grow. In the meantime, use enough pillows to recline in bed and feed two babies at once. Keep a drink and snack handy plus books or music to pass the time. See Safer Sleep and the Breastfed Baby.

Making enough milk

The more milk your babies take, the more your breasts will make. This is especially important in the first few weeks. Since mothers of multiples usually experience more breast development during pregnancy, mothers of twins can almost always produce enough milk for both babies, and triplets can also be totally breastfed.

See Is My Baby Getting Enough Milk?

Encourage each baby to feed at least 8-10 times in 24 hours. If one of your babies is too sleepy or groggy to rouse himself every few hours, you will need to wake him to feed to ensure he gets enough milk. See our page Sleepy Baby-why and what to do.

At first you may feel you are doing nothing but feeding, but things will settle down as your babies grow and your milk production adjusts. Practical help with everything else will allow you to sit or lie down and concentrate on the important job of establishing breastfeeding.

Looking after yourself

You'll be busy looking after your babies but don't forget to look after yourself too. Try to eat a balanced diet and drink enough. Get as much rest as possible, and sleep whenever your babies sleep.

Looking after your babies will be a full-time job for quite a while so expect to do only the absolute minimum of housework.

Others will offer help with housework or entertaining older children-do accept if you feel you want to and make an effort to ask for help when you need it. Have a list of simple tasks ready to make it easier when people do offer help and you could share information from our pageSupporting a Breastfeeding Mother.

Your partner or support person will have a crucial role both practically and emotionally. Because they are needed so much, non-gestational parents of multiples have the opportunity to quickly develop close relationships with their babies. Other family members may also enjoy the chance to be practically involved. Take moments to appreciate this special time and be proud that you can nourish and nurture two or more little human beings at once!

Other sources of practical help

Midwives, health visitors, clinics and surgeries.

Homestart - a charity which offers support and friendship to families who are struggling to cope for a variety of reasons.

Local college students studying child development or members of local community groups.

Mixed feelings

Parents of twins or more often have mixed emotions about their multiple babies. It's normal to feel overwhelmed by the prospect of caring for two or more babies at once.

It can really help to talk to another family in the same situation. Your local LLL Leader can put you in touch with other mothers who have breastfed multiples, some LLL groups have Facebook support groups specifically for mothers of multiples. There may also be a local twins support group near you (see Further Information section). Adjusting to Motherhood has practical tips on dealing with feelings too.

Practicalities of getting out

It's daunting leaving the house with more than one baby. Start by going out briefly with someone else to help.

Keep a changing bag packed and ready. A backpack leaves your hands free.

Keep valuables and keys safe to hand in a waist pack or small bag across your chest.

Consider using a sling or carrier for one baby even when out with a pushchair. A double pushchair can be useful for carrying shopping too.

Alternate which baby gets carried: it's easy to overlook a quieter baby's need for closeness if one fusses more when out and about.

Think about suitable places for feeding ahead of time. Look out for your babies' early feeding cues so you can offer a feed before they start to fuss and attract attention from others.

Get to know your babies: with time, you will come to know your babies as individuals. Take opportunities to give them a little undivided attention: feeding, nappy changes etc. A few minutes here and there all add up. Their personalities will soon show through.

Finding support

It's OK to ask for help-it can take a while for breastfeeding to become easy, or for your babies to learn to breastfeed effectively. It will get easier as time goes on. You can get skilled help from an LLL Leader by calling our Helpline. Seek support and encouragement from the mothers in your local LLL group.

Written by Sue Upstone and mothers of LLLGB, photos courtesy of Sarah W.

Further Reading

Adjusting to Motherhood
Antenatal Expression of Colostrum
Birth and Breastfeeding
Caesarean Birth and Breastfeeding
Hand Expression of Breastmilk
My Baby Needs More Milk
Sleepy Baby - Why and What to Do
Supporting A Breastfeeding Mother
Mothering through special care

LLLI Resources
Breastfeeding Premature Babies

Other websites
Information on nursing multiples by the author of Mothering Multiples.
Website and blog of Krista Gray, IBCLC and mother of twins.
Breastfeeding Twins and Triplets by Kathryn Stagg, IBCLC

Books

The Womanly Art Of Breastfeeding. LLLI, London: Pinter & Martin, 2010.
Hold your Prem. Jill Bergman and Dr Nils Bergman. Cape Town: New Voices Publishing, 2010.
Mothering Multiples. Karen Kerkhoff Gromada. Schaumburg, IL: LLLI, 2007.
Breastfeeding Your Premature Baby. Gwen Gotsch. LLLI, 2002.

Further Information

Twins Trust provides information and support networks for families of twins or more. Tel: 0800 138 0509 (10 am-1 pm and 7pm-10pm, daily).

Breastfeeding Twins and Triplets UK is a charity providing breastfeeding information and support run by breastfeeding counsellors

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

Copyright LLLGB 2016

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Learning you are pregnant with twins, triplets or more changes your expectations and plans. But your decision to breastfeed doesn't have to change. Breastmilk is especially important for multiples, who are often small at birth and need all the health benefits it provides. Breastfeeding also helps you create a special bond with each of your [...]

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This Padlet by Kathryn Stagg had useful links to help support multiple birth families with breastfeeding

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It's up to you and your baby to decide when you want to finish breastfeeding.

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Thinking of stopping breastfeeding? Find out how to wean your baby off the breast once you’re both ready to stop.

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Donated breastmilk from the country’s network of milk banks helps to save the lives of premature and sick babies.

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UKAMB

Welcome to UKAMB

Donated breastmilk from the country's network of milk banks helps to save the lives of premature and sick babies.

UKAMB is a registered charity that supports human milk banking in the UK and was set up in 1997. Our motto is 'Every Drop Counts' and we believe that the provision of safe and screened donor breastmilk makes an important contribution to the care of the premature and sick infants who receive it. Our goal is to ensure access to donor milk to every child who would benefit from its use.

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UK Human Milk Bank - Breast Milk Donation, BreastMilk Storage, UKAMB

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UKAMB, a registered organization supports human milk banking to save the lives of premature and sick babies. Connect with our network today!