# data[].attributes.body
Swallowing

# data[].attributes.attachment_link.title
How to recognise when a  baby is drinking well

# data[].attributes.body
Debate

# data[].attributes.attachment_link.title
Sarah Ockwell-Smith's Blog - The Great Baby Reflux Epidemic (or not....) - October 10, 2014 06:31

# data[].attributes.attachment_link.description
How many people do you know whose baby has, or had, reflux? A lot I'd imagine.Reflux medications such as infant Gaviscon, Losec, Omeprazole, Domperidone...

# data[].attributes.body
Positions Welsh

# data[].attributes.body
https://www.nhs.uk/conditions/stress-anxiety-depression/ways-relieve-stress/Breathing exercise

# data[].attributes.body
Therapeutic breast massage

# data[].attributes.attachment_link.readable_text
We detected a high number of errors from your connection. To continue, please confirm that youâ€™re a human (and not a spambot).

# data[].attributes.attachment_link.title
The Basics of Breast Massage and Hand Expression

# data[].attributes.attachment_link.description
"The Basics of Breast massage and Hand Expression" video by Maya Bolman, IBCLC and Ann Witt, MD, FABM, IBCLC

# data[].attributes.attachment_link.description
There is a vast selection of bottles and teats available online or in the High Street. Many of them claim to be closer

# data[].attributes.body
Reverse pressure softening

# data[].attributes.attachment_link.description
We use cookies to improve your experience. By continuing to use this site you are agreeing to our use of cookies.

# data[].attributes.attachment_link.description
We use cookies to improve your experience. By continuing to use this site you are agreeing to our use of cookies.

# data[].attributes.attachment_link.readable_text
There is a lot of confusion and poor breastfeeding advice arising from the idea that there are two sorts of breast milk-namely foremilk (watery, low calorie) and hindmilk (high fat, high calorie). And, depending where you live, the confusion may go one step further, you may hear about three kinds of milk; watery soup, dinner and pudding.

Support us on Social Media

Follow us on Facebook and Twitter

All breast milk is good

As a result of not understanding that all breast milk is good, and not really understanding how breastfeeding works, mothers are being told to stay on one breast per feed or feed from one breast for random blocks of time to "get to the hindmilk". After all, the watery soup is no more than water and without that fatty pudding a baby can't gain weight, right? Wrong. Even if that was right, why stop short of offering the "three course meal" from the second breast? Especially if a baby is having trouble gaining weight.

This article

This article looks at how babies grow, how breastfeeding works, the facts about foremilk and hindmilk, and how staying on one breast to get to the hindmilk can sabotage a breast milk supply.

How babies grow

Babies grow and gain weight from drinking lots of breast milk. All breast milk is good, it is a nutritious and complete diet and babies need plenty of it. As a rough guide babies need about 800ml or 27 fluid ounces per day in the first six months. Whether it is foremilk or hindmilk or in-the-middle-upside-down-milk, babies need lots of milk to grow.

Quantity not quality

It is the volume of breast milk that is the important factor determining a baby's weight gain not the fat content in a particular feed. Kelly Bonyata explains:

The research tells us that baby's milk intake (the volume of milk - not the amount of fat in that milk) is the only thing that has been correlated with infant growth in exclusively breastfed babies. [...] average fat content of human milk is highly variable, but has not proven to be significant when calculating baby's total energy intake or weight gain.

Whether it is foremilk or hindmilk or in-the-middle-upside-down-milk, babies need lots of milk to grow. Click To Tweet

How breastfeeding works

Your breasts make milk on demand; so that the faster your baby drinks the available milk, the faster your breasts will make more milk to replace it, indefinitely. Breasts gauge demand by their degree of fullness:

Whenever a breast is full, milk production slows down

Whenever a breast is emptied regularly, milk production increases

Storage capacity

The ideal way to make plenty of breast milk in the volumes your baby needs, is to feed your baby as often as he wants-letting him finish the first breast before offering the second side. Only your baby knows when one side is empty and whether he needs one breast or two, because breasts vary in how much milk they can hold (storage capacity). Storage capacity is explained more fully in One Breast or Two per Feed:

Breasts vary in their breast milk storage capacities. Where one mother's baby might only want one breast per feed and not be hungry for two hours, another may need both breasts per feed and be hungry again in an hour. Let your baby decide how many breasts he wants at a particular feed by looking for his feeding cues and offering him plenty of opportunities to breastfeed.

Ignoring your baby's cues and keeping to one breast to reach the hindmilk i.e. keeping your baby on one breast after he has emptied it, means the opposite breast gets little drainage, and slows down milk production. It's like trying to build a milk supply by only pumping from one breast instead of pumping from both breasts.

If you have a low storage capacity then keeping to one breast is potentially denying your baby half his milk or more. Your baby may need the "hindmilk" from both breasts.

Increasing milk supply

If your baby falls asleep after less than ten or twenty minutes into a feed, breast compressions (gently compressing and releasing the breast during a feed) can get him to start sucking again by simulating another let-down of milk. By offering the other breast when the first is finished, and repeating breast compressions if needed, your baby will get the correct balance of foremilk and hindmilk automatically. Using both breasts when needed (and sometimes three or four!) will drive up and maintain your supply.

But what about foremilk and hindmilk?

Foremilk and hindmilk are the names given to subtle differences between breast milk at the start and at the end of a breastfeed.

Foremilk describes the breast milk at the start of a breastfeed, it has a lower fat content, but has plenty of lactose the principal sugar in breast milk, not to mention all the other great ingredients in breast milk. Lactose is important for developing the brain and central nervous system, and provides 40% of a baby's energy needs. Lactose helps with calcium and iron absorption and, along with other oligosaccharides (short chain carbohydrates) promotes the growth of friendly bacteria such as Lactobacillus bifidus to fight pathogens. As the breastfeed progresses, the fat content of "foremilk" steadily increases.

Hindmilk is the name coined for the breast milk towards the end of a feed as the breast empties. There is less of it but it has a higher fat content and all the other nutritious ingredients found in milk.

All milk is good

There aren't two distinct types of breast milk with one being inferior to the other, it is a continuum of subtle changes. Hindmilk is released with every milk ejection (let-down). By the time feeding finishes on the first breast, the first milk from the second breast will contain more fat compared to the start of the feed on the first breast. The more frequently you breastfeed, and the emptier the breasts become; the higher the fat concentration in all the breast milk.

Quantity not quality

Remember, weight gain depends on the quantity of milk not just the fat content in the last few drops. Kelly Bonyata's analogy with a hot water tap is useful. When you turn on the tap (start feeding) the water starts cold (low fat milk) but as it continues to run (as the feed progresses) the water gets warmer and warmer (higher fat). If you turn the tap off and on again quite soon, the water will still be warm (high fat milk will still be present at the start of the next feed). And you don't need to run your tap for 30 minutes or an hour to get to the warmer water (if you do, call an engineer!)

What is foremilk hindmilk imbalance?

If a mother has lots of milk, more than her baby can comfortably handle, her supply will usually adjust downwards over time to meet her baby's actual needs. In the mean time some babies may get an excess of lactose rich foremilk. This is sometimes referred to as foremilk hindmilk imbalance. Babies may also get foremilk hindmilk imbalance if a mother has a robust supply and continually takes her baby off the breast before he has finished feeding i.e. switches sides too soon.

Temporary lactose intolerance

In these situations the baby can find it difficult to digest all the abundant lactose in the plentiful foremilk causing temporary lactose intolerance or lactose overload. They may be fussy and uncomfortable with copious green, frothy and foamy nappies. The sheer volume of milk and high sugar content often means babies gain weight very well with foremilk hindmilk imbalance-even though they aren't getting their "pudding". However occasionally some babies may not gain enough weight in this situation. Advice to stay on one breast per feed or for a block of time can be very helpful with true foremilk hindmilk imbalance to ensure babies get a good proportion of higher fat milk. See Lactose Intolerance in Babies for further information and consult your breastfeeding specialist.

Confusion about green nappies

Health visitors who are already hooked on the idea of staying on one breast to get to the hindmilk may think this is an absolute certainty if you mention your baby has lots of green nappies. However the frequent scant green nappy of a baby not gaining weight is NOT the same as the copious frothy green nappy of a baby with lactose overload. Staying on one breast is not the answer for a baby with green "starvation stools". See your IBCLC lactation consultant for further information if you are not sure what your baby's nappies mean or whether block feeding is a good idea for your baby.

I kept to one breast per feed and my baby gained weight just fine!

Keeping to one breast may work perfectly if your storage capacity suits this regime. But be guided by your baby and his weight chart, not by any pre-set rules or clock-watching instructions to reach that elusive hindmilk at the bottom of the barrel.

My baby isn't gaining weight

When a baby isn't gaining weight they most likely need more milk, not more time on an already empty breast which will further reduce a mother's supply. An extra 7-8 ml of high fat milk from the same breast is no substitute for the extra 70-80 ml of fore-hind-and-in-the-middle-milk they might need from the other breast. Check with your IBCLC lactation consultant for the reasons for low weight gain for your baby and see Baby Not Gaining Weight. For increasing milk supply see How to Make More Breast Milk.

Supplements are sometimes needed

If you have been following the advice to "stay on one breast to get to the hindmilk" for quite some time, your milk supply may be quite low. If your baby has not been gaining weight properly, or has been losing weight, he won't be able to wait while you build your supply. He may need supplements ( donor milk or formula) to build back his body weight so that he is strong enough to drive your milk supply all by himself.

Summary

Confusion about how breastfeeding works is causing some health professionals to unwittingly sabotage breastfeeding by recommending staying on one breast to get to the hindmilk: either as a general rule or as specific advice when a baby is not gaining weight. It is not helpful to think of breast milk as two or three different kinds of milk. All breast milk is good and babies need lots of it to grow. Breasts have different storage capacities and what works for one mother and baby may not work for another. Contact your breastfeeding specialist for tailor made recommendations for your unique situation. And forget about foremilk and hindmilk.

# data[].attributes.attachment_link.description
There is a lot of confusion and poor breastfeeding advice arising from the idea that there are two sorts of breast milk-namely foremilk (watery, low calorie) and hindmilk (high fat, high calorie). And, depending where you live, the confusion may go one step further, you may hear about three kinds of milk; watery soup, dinner and pudding.

# data[].attributes.attachment_link.description
Sometimes a mother may seem to have far more breast milk than her baby needs. Some babies will be very happy with

# data[].attributes.attachment_link.title
Can a change in position help relieve nipple pain?

# data[].attributes.attachment_link.readable_text
Nipples (and breasts) come in all shapes and sizes and not always in matching pairs. Not all nipples protrude like half a cherry on a cup cake. Some nipples may be quite shallow or flat, perhaps level with the areola (the darker skin around the nipple), others can be dimpled or folded, very long or wide. Some nipples are inverted or retracted-where the nipple points into the breast instead of sticking out. This article looks at whether flat or inverted nipples can affect breastfeeding and how to deal with any challenges.

Sign Up to the Newsletter

Get breastfeeding articles in your inbox

Can you breastfeed with inverted nipples or flat nipples?

Many mothers can breastfeed with flat or inverted nipples because breastfeeding relies on a baby having a big mouthful of breast to stimulate the milk glands behind the nipple rather than simply being a matter of hanging on to a nipple. However, while some babies find breastfeeding with inverted nipples or flat nipples quite straightforward, others find it more difficult. Potential issues include:

Latching

The way a baby attaches to the breast is often referred to as latching. A protruding nipple can be easier for a baby to find and grasp and guides a baby's latch. However, a flatter, short shanked nipple may be quite difficult for a baby to find and grasp, especially at first while a baby is learning to breastfeed. The after effects of birth medications or birth trauma can also be causes of difficulty latching or coping with variations in anatomy.

Knowing when to suck

The stimulus of a nipple deep in a baby's mouth triggers the sucking reflex by stroking the baby's hard palate. Faced with a soft, flat nipple, a baby may feel confused and disorientated. Barbara Wilson-Clay explains:

Some parents may notice that the baby will suck strongly on a finger, pacifier or bottle nipple, but appear apathetic, disinterested or frustrated by the breast. This may be because the nipple is not elastic or everted [protruding] enough to reach back to stroke the palate. When this happens the baby doesn't know what to do next. The baby may bob back and forth and seem unable to "locate" the nipple, may pull away and cry, or may fall asleep each time the breast is offered. Skilled help from an IBCLC and close follow-up from the physician will make it easier to overcome this challenge.

Forming a teat

If the nipple is flat and the breast tissue is very firm instead of soft and stretchy, a baby may find it difficult to shape the breast into a teat shape to suckle and stay latched. If a baby is premature, has low muscle tone (floppy) or has high muscle tone, a small mouth, poor latch or has a restrictive tongue-tie, it may compound his difficulties.

Sore nipples

If a baby doesn't have a big mouthful of breast as well as the nipple in their mouth (a shallow latch), a mother's nipples can rub against a baby's hard palate and quickly become sore. Careful attention to the way a baby is held (positioning) can help with this and certain positions may be more helpful than others when a mother has flatter nipples. Reclining while breastfeeding with baby on their tummy may help some mothers, or for others, a more upright position such as cross cradle may give more control for a deeper latch. A couple of weeks of continuous sucking (or pumping with a good pump) can gradually draw out flat or inverted nipples permanently and improve comfort levels for some mothers.

Ongoing nipple pain

Occasionally pain might continue even when breastfeeding is going well because the nipple has undergone major changes or because the bands of tissue that are inverting the nipple stay tight and may crack or blister (Mohrbacher, 2020 p741) .

Risk of low milk supply or low weight gain

If it is difficult for a baby to get a deep latch due to the shape of his mother's nipples, there is a higher risk of having a low milk supply. This is because the breasts may not be emptied thoroughly and efficient breast drainage is the stimulus for a good milk supply. If this is the case, a baby could be at risk of low weight gain.

Sometimes when a baby latches to an inverted nipple, it can compress the buried nipple rather than squeezing the breast tissue behind the nipple as usual. This can prevent the baby getting any milk and will also be painful for the mother. In this situation a breast pump may be helpful as this will tend to draw the nipple out rather than squeezing the buried nipple (Mohrbacher. 2020 p 740).

How flat is a flat nipple?

There is a wide variation of normal, but some authors describe an average nipple diameter as 16mm and height as 7mm. However, whether there will be any problems for your baby if your nipples are much flatter (or much larger) than average will depend on the size of your baby's mouth, how stretchy the breast tissue is and whether you have good help to get breastfeeding started.

What is an inverted nipple?

When a nipple is inverted it points into the breast or lies flat on the breast instead of protruding outwards. This may be due to short milk ducts, tight bands of connective tissue pulling the centre of the nipple into the breast or an absence of connective tissue supporting the nipple. Pressing on the areola either side of and about an inch behind your nipple (sometimes called "the pinch test") can reveal whether a nipple is inverted. An inverted nipple will pull into the breast (retract) but everted or protruding nipples stay out like a cherry on a cake. If you can coax the nipple out, that's a good sign that your baby will be able to do the same if he is latched well.

There can be different degrees of inversion or retraction from mild to severe, descriptions in the breastfeeding literature include;

Retracted.⁶ Some nipples appear "graspable" but on stimulation e.g. with the pinch test, pull into the breast which can make latching difficult. The degree of retraction might be minimal or moderate to severe affecting whether an infant can pull the nipple forward during breastfeeds or not (Wambach and Spencer, 2021 p64).

Pseudo-inverted (Core Curriculum, 2012. p271) or simple inversion (Wambach and Spencer, 2021 p64). Nipples may look inverted but become erect on stimulation which should not present a problem to the breastfed baby.

Dimpled nipples. A dimpled or folded nipple is a partially inverted nipple where only part of the nipple protrudes. This nipple may extend during a breastfeed but after the feed it folds back over and may become damp and sore inside. Patting the nipple dry after a feed or holding it open until it is dry can help avoid soreness or skin breakdown.

Inverted, truly inverted or complete inversion. The inverted nipple that is retracted both before and after stimulation is not common but where present it makes it more difficult for a baby to latch (Core Curriculum, 2012; Wambach and Spencer, 2012 p 64).

Inverted nipples may resolve

Nipples continue to develop during pregnancy under the influence of hormones so that many inverted nipples turn out (evert) by the end of pregnancy and may even protrude a little further with each subsequent pregnancy (Wambach and Spencer, 2012 p 64). If a baby can manage to latch and feed regularly this can loosen the adhesions that keep some nipples inverted. A good pump may also do this.

Tips for breastfeeding with flat or inverted nipples

Some babies may not have any difficulties breastfeeding with inverted nipples or flat nipples. But some will. Paying careful attention to latch and positioning can help your baby breastfeed successfully. Useful articles providing general information to help all babies latch include Breastfeeding Tips for Newborns, Latching Tips, Breastfeeding Positions for Newborns and Why Skin to Skin? Further tips include:

#1 A natural birth (and a breast crawl)

Where possible, a baby will be better able to master latching after birth if he isn't too sleepy and disorientated from drugs such as strong pain killers that have crossed the placenta. Also, in certain positions, a baby's natural breastfeeding instincts and reflexes are primed which helps them to breastfeed. Letting a baby crawl to the breast when first born (and at other times during the first few weeks) can also help with this (Mohrbacher 2020). For videos see Why Skin-to-Skin?

#2 Getting a good latch

A breastfeeding specialist such as an IBCLC lactation consultant can help to get breastfeeding off to a great start and can help you one-to-one with latching techniques and helpful positions whether reclining or using more upright holds. Ideas to help a baby latch to a flat or inverted nipple include:

Help baby to use their reflexes

Holding a baby in skin-to-skin contact to breastfeed, removing scratch mittens and trying reclining positions can enable a baby to use their feeding reflexes to help them latch.

Shaping or flattening the breast

In more upright breastfeeding positions, variations of breast shaping, sometimes called an assisted latch, nipple tilt, flipple or breast sandwich may help a baby get a deeper latch. Ensure your fingers are far enough back from your nipple so your baby can get a big mouthful of breast. See Latching Tips for a description and video clips. You may need to continue to support the breast through the feed if the latch is fragile.

A nipple shield

A nipple shield can help some babies to latch to a very flat or inverted nipple. See Nipple Shields Good or Bad? for further information about shields. If used, it's important that the nipple shield fits well. Listen for your baby's swallows and keep an eye on his weight gain and dirty nappies to ensure he is getting enough milk. Pumping regularly will protect your milk supply until you're sure feeding is going well. Wetting the shield can help keep them in place either with breast milk or some mothers use a little lanolin around the edges of the shield. Avoid using a shield during the first few days before your milk comes in as thick and sticky colostrum doesn't flow well through a shield; hand express instead and feed this to your baby by cup, spoon or syringe.

#3 Try to bring your nipples out before a feed

Some flat nipples or inverted nipples can protrude with a little stimulation and provide the latching focus a baby is looking for. To bring out the nipple before a feed try:

Stimulation

Rolling the nipple between your finger tips, cold stimulation, or letting baby lick and bob about on the breast can help a flat nipple become erect or protrude.

Pulling back on the breast tissue or areola during a latch

Pulling back on the breast tissue as baby gapes to latch can help a nipple to protrude more (Mohrbacher, 2020 p739).

The "nipple nudge"

This involves pushing up into the breast through the areola and behind the nipple to help expose the nipple for the latch i.e. push it inside out.

Commercial gadgets

In addition to using a breast pump prior to feeding, there are a number of purpose built gadgets that can help bring out a nipple before a feed. See below for further details.

#4 Keep breasts soft

Nipples can flatten out when breasts are very full or engorged and nipples that were already quite flat may seem to disappear completely. It can help to practice latching in the days before your milk comes in while your breasts are still soft. A little hand expressing, pumping or reverse pressure softening can help soften an engorged breast so your baby can latch.

#5 Avoid bottles and dummies

Bottles and dummies differ from the average human nipple and are very differently shaped to a flat nipple. Using bottles and teats can cause nipple confusion or bottle preference for some babies and can be a particular issue for the baby who is learning to breastfeed with inverted nipples or very flat nipples. A baby may quickly favour the bottle-particularly if he associates the breast with frustration and hunger. Try using a cup, spoon or syringe for top-ups to keep your baby well fed if he can't latch. If you do need to use a bottle see our Tips to Bottle Feed a Breastfed Baby.

Preferring one nipple over another

If one nipple is inverted or very flat and the other sticks out, a baby may prefer the easier breast with the protruding nipple. A nipple shield on the inverted nipple helps some mothers to use both breasts. Alternatively, pumping the side baby refuses can stimulate the milk supply to supplement back to your baby and it may help evert the nipple. Some mothers allow milk production from the side with the inverted nipple to dry up while continuing to feed on the other breast. The breast that is still used will compensate by increasing milk production.

Gadgets to evert nipples

If the ideas in #3 above do not help to evert nipples before a breastfeed, and baby is struggling to latch on, the use of breastfeeding gadgets may help some mothers. Devices that temporarily draw out the nipple may be particularly helpful when a mother has flat nipples or pseudoinverted nipples. Some devices have been designed to provide more sustained suction over a longer time period (weeks to months) to modify the nipple shape when nipples are inverted or tethered. Bear in mind the success or otherwise of some of these devices hasn't been proven, and care should be taken not to cause nipple damage by over use of suction.

A breast pump

A breast pump can help pull out a flat or inverted nipple and can help stretch and break any underlying adhesions with repeated use. Sometimes however the adhesions under the nipple will remain tight and repeated pumping or latching could create cracks or blisters (Mohrbacher, 2020 p741).

Suction devices

Various commercial suction devices (nipple everters) are available to buy and it is possible to make a homemade version using a syringe. Popular commercial brands often cited in breastfeeding books include Supple Cups, Latch Assist, Evert-it Nipple Enhancer and the Niplette. Some of these specific brands may not be available outside USA. Follow manufacturers safety instructions carefully and read customer reviews for further information. As noted above, care must be taken not to cause nipple damage by too much suction.

Homemade device: the modified syringe

The authors of The Womanly Art of Breastfeeding discuss making your own suction gadget from a plastic syringe that is a little larger in diameter than your nipple:

Take the plunger out. Using a serrated knife, cut the needle end off and put the plunger in the "wrong" end. Now you have a little suction device with a smooth end that you can put over your nipple. Pull out on the plunger far enough to draw your nipple out, but not so far that it's uncomfortable, and keep the suction up for about a minute

Commercial devices

Lactation consultant Catherine Watson Genna provides more comprehensive information about suction devices in Selecting and Using Breastfeeding Tools Improving Care and Outcomes.She notes that:

The Evert-it Nipple Enhancer is a commercial version of the homemade syringe to temporarily evert flat nipples.

The Latch Assist uses a bulb syringe device to evert flat nipples prior to a feed and is based on the same principle as using a breast pump briefly before a feed.

Supple cups are small flexible cups made of silicone. The cups attach to the breast by suction and the negative pressure inside the cup draws out the nipple. One small study showed positive results when the cups were worn for up to four hours a day after 37 weeks of pregnancy in women with inverted nipples, and prior to a breastfeed postnatally in women with flat nipples.

The Niplette uses a syringe to remove air from a hard plastic cup to create a vacuum around the nipple. The syringe is then removed and the cups can stay on for several hours providing sustained pressure to help evert the nipples and encourage the ducts to lengthen. This product cannot be used in late pregnancy as the pressure will remove colostrum, fill the cup with fluid and break the vacuum, the Niplette could also potentially increase the risk of premature labour. (Watson Genna, 2009)

Breast shells

Worn inside the bra these used to be recommended to provide pressure around the base of the nipple to encourage it to protrude. However a research study found they weren't helpful and shells caused pain, discomfort, skin problems, and embarrassment. Another study also found no advantage to using breast shells. Some mothers may find them useful but if used, breastfeeding charity La Leche League GB says:

If you decide to try breast shells, wear them for no longer than 30 minutes before feeds to reduce the risk of nipple soreness due to lack of air circulating around the nipple and blocked ducts due to pressure. You may need a bra with a larger cup size than normal. Breast shells need to be washed daily and any milk collected should be discarded because of the risk of bacterial growth.

The Hoffman technique or Hoffman exercises

This technique involves placing a thumb either side of the base of the nipple and pressing into the breast while you move your thumbs apart and stretch the nipple. It can be tried in pregnancy as long as it isn't painful but the research by Alexander et al did not find the exercises were beneficial.

Your partner

Your partner may be able to help draw out your nipples with gentle oral suction.

Other nipple variations

Other nipple variations are possible in addition to flat or inverted nipples. A mother may have quite different nipples on each breast. Very large or long nipples can fill a baby's mouth and not leave any room for a good mouthful of breast tissue. However after a few weeks, baby's mouth will have grown to accommodate these normal nipple variations. An IBCLC lactation consultant can be a helpful partner to get breastfeeding working smoothly with more unusual nipple anatomy.

Summary

Some babies can breastfeed quite happily with flat or inverted nipples, but others, such as a premature baby or a baby with a small jaw or poor tongue function may find it very difficult. If your baby can't latch, hand expressing initially, followed by frequent pumping will stimulate your milk supply and provide a supplement to keep your baby well fed until you can get skilled help with positioning and latch. Latching may naturally improve once your baby's mouth has grown or your nipple becomes more stretchy. It's a good idea if possible to avoid bottles and dummies while your baby learns to breastfeed so that he doesn't develop a preference for the bottle teat.

# data[].attributes.attachment_link.title
Breastfeeding With Inverted Nipples and Flat Nipples

# data[].attributes.attachment_link.description
Nipples (and breasts) come in all shapes and sizes and not always in matching pairs. Not all nipples protrude like half a cherry on a cup cake. Some nipples may be quite shallow or flat, perhaps level with the areola (the darker skin around the nipple), others can be dimpled or folded, very long or wide.

# data[].attributes.attachment_link.readable_text
After a few weeks or months, breastfeeding has often settled into an easy rhythm. But what if you're still dealing with a fussy breastfed baby or breastfeeding feels a struggle? Assuming any illness has been ruled out by your baby's doctor, contacting an IBCLC lactation consultant can help brainstorm why your baby seems unsettled at the breast at any age or stage. There are many possible reasons-from your baby having a sensitive personality or being easily distracted by the world around him, to being hungry and just needing more breast milk. Cows' milk allergy, reflux or temporary lactose intolerance could also be involved in unsettled behaviour as could sensory processing issues or high muscle tone. This article reviews ten common causes of fussy, restless behaviour in a breastfed baby.

Find an IBCLC

Search for a breastfeeding expert near you

#1 Fussy personality

Sometimes what may seem like fussy or sensitive behaviour is normal baby behaviour. For example it is normal for a newborn baby to protest when they are put down; they love to be held and feel safest next to an adult body. It's normal for newborn babies to feed very frequently, they are doubling their weight in a matter of months! It's normal for an older baby to go through a phase of hating to be strapped in a car seat. The Womanly Art of Breastfeeding has several useful chapters on ages and stages which explain the normal behaviour of a breastfed baby as he grows. For example in the chapter "Six Weeks to Four Months: Hitting Your Stride" we are reminded that babies are individuals and sometimes being quite intense is a character trait:

Maybe you've got a sparkler - an intense, sensitive baby who needs input, input, input! His only settings are high and off. That's the downside. The upside is how truly bright and curious he is likely to become. You'll work hard as a mother to this baby. Look for other mothers of sparklers, to share notes with. Keep your sense of humour and try not to compare your busy days with those of your placid-baby friends. And keep your little sparkler close to you - your presence and touch will often go a long way toward calming him.

Fussy baby at four months

If your baby has been breastfeeding well for several months but then becomes a fussy baby at four months (or five or six or older!) it can be puzzling to find a reason for the change. Around this age is a common time for babies to refuse some breastfeeds and become easily distracted with noises, activities, new surroundings and siblings-particularly during the day time. The Womanly Art of Breastfeeding calls this The Four-Month Fussies. It's a stage that will soon pass but you may need to remind your busy baby to breastfeed in the day and it may help to cut down on distractions at feed times such as closing the curtains to lower the lighting or putting subtitles on the television to reduce background noise.

#2 Fussy breastfed baby, hungry baby?

A restless baby who constantly feeds or has trouble sleeping may not be getting enough breast milk especially if these behaviours are accompanied by poor weight gain. In Dr. Jack Newman's Guide to Breastfeeding the authors believe that the most common cause of fussiness at the breast is when a baby is frustrated with slow milk flow resulting in hungry babies who fuss. They add that a tendency for mothers to feed by the clock instead of on demand can have the same result; a hungry baby. Their reasons for frustrated behaviour are listed in the following excerpt:

Pulling at the breast-slow milk flow

Babies pull at the breast, pull off the breast, fuss or cry at the breast and get angry for several reasons:

1. The flow is too slow for them (this is the most common reason).

2. The flow is too rapid for them. In this case the baby may actually choke, cough or sputter at the breast as well. However, if the flow is too slow it can also cause choking.

3. The baby is full but wants to continue to suck, and the milk is flowing faster than he wants.

4. The baby is reacting to something in the milk (i.e., something the mother has eaten or drunk).

5. The baby is on nursing strike (this is discussed in the chapter "Late-Onset Decreased Milk Supply").

6. The baby is experiencing reflux. This "diagnosis" is made far too often.

7. A combination of 1 and 2 (too fast early in the feeding, too slow later).

Jack Newman writes more about the possible reasons for a reduced milk supply after two to four months in his blog post Late Onset Decreased Milk Supply or Flow.

Get specialist help

Difficulty with controlling milk flow or a low milk supply can be due to a poor latch, poor positioning or poor tongue function. An IBCLC lactation consultant is the ideal specialist to help you identify which of these factors could be involved or help identify other causes for fussy behaviour. For self-help with slow flow of breast milk, or low milk supply have a look at How to Make More Breast Milk, Reasons for Low Milk Supply, Is My Baby Getting Enough Milk? and What is Breast Compression?

#3 Bottle preference or nipple confusion

If a baby has started to have quite a few bottles as replacement feeds whether with expressed breast milk or formula, some babies can seem to start to fuss at or turn away from the breast in preference for the bottle. This is sometimes called bottle preference or nipple confusion. This is more likely to happen if a baby associates breastfeeding with frustration and slow milk flow but finds the bottle more rewarding. Or if a baby has a lot of bottles before they have got the hang of breastfeeding. If your baby is having more and more bottles and is starting to seem grumpy or unsettled at the breast, options to try include:

#4 Allergies as a cause of fussy behaviour

Babies who are allergic to something from their mothers' diet passing into breast milk may appear unhappy at the breast-they might pull off once milk starts to flow because it hurts their inflamed oesophagus (eosinophilic oesophagitis) or gives them tummy ache. They may prefer to breastfeed in unusual positions and may be very tense and seem to clamp down or bite the breast causing pain and sore nipples. They may have symptoms of reflux (#6) and/or tend to have very runny, copious and often green dirty nappies with symptoms of lactose overload (#7). Allergy is thought to be a cause of infant colic (unexplained crying). Author Maureen Minchin describes a characteristic set of allergy-related fussy behaviours including disturbed sleep, erratic and persistent crying:

[Babies] who are either hyperactive before [in the womb], and persistently miserable after birth, or

[Babies] who start screaming in the second or third week of life, and

[Babies] who give many indications of gut discomfort

[Babies] who progressively develop other minor symptoms, like night sweats, cradle cap, or patches of rough skin

[Babies] who do not respond more than briefly to mothercraft skills

See Milk Allergy in Babies for an in depth discussion of dairy or other allergies in breastfed babies.

#5 Fussing with a fast let-down or too much milk

Some babies may find it difficult to cope with a very fast flow of milk causing them to cough, choke and constantly come on and off the breast. Babies have to coordinate sucking, swallowing and breathing during breastfeeding and, when the flow of milk is very fast, they may find feeding quite stressful causing them to restless and wriggly and keep releasing the breast. Fast flow can also accompany having "too much milk" which can also be a cause of unsettled behaviour or cause a temporary lactose overload with signs of discomfort and fussing (see #7 below). Babies who are getting a lot of milk quickly may also spit up frequently (#6). For more information see Oversupply of Breast Milk and What is a Fast Let-Down?

#6 Reflux and fussing

Spitting up some breast milk after a feed is quite normal baby behaviour and most babies are "happy spitters". However if your baby has reflux and is very fractious and miserable-see Reflux in Newborns for more information. Reflux can be connected to allergy (#4 above) and too much milk (see #5).

Spitting up is a normal event for babies and doesn't usually cause them a problem although more severe forms are possible e.g. GORD or GERD [gastroesophageal reflux disease]. Certain underlying causes such as allergy or oversupply can make reflux worse. Working with an IBCLC lactation consultant alongside your health professional can help find ways to reduce reflux or identify other possible reasons for an otherwise healthy breastfed baby to be miserable and fussy.

#7 Lactose overload

Lactose is the main sugar in breast milk. If a baby gets too much lactose too quickly (e.g. when there is "too much milk" see #5 above) or if anything prevents lactose being digested properly in the intestines it can cause a temporary lactose overload. An overload of lactose might cause severalsymptoms that can make a baby miserable such as wind, tummy ache and frothy copious green poop. It can be caused by and associated with cows' milk allergy (#4 above) and may be one explanation for infant colic. For more information and how to resolve it see Lactose Intolerance in Babies.

#8 Sensory processing or high muscle tone

Some babies may have sensory processing issues, or high muscle tone that may contribute to intense and unsettled behaviour. Reading the linked articles may help to discover whether any of these could be an issue for your baby and what to do.

#9 Not enough physical contact

Sensory deprivation or lack of physical contact can cause a baby to be fractious. Jack Newman describes this as the common fear of "spoiling" a baby and he calls it the English Nanny Approach;

Babies cry for many reasons-it is the only way they have to communicate their needs. Many people believe that if you pick up or otherwise respond to a baby who cries, he will cry more and more; if you ignore his cries, he'll stop. But research has shown just the opposite. The babies who are responded to most quickly and consistently cry less by the time they are a year old. Even more importantly, they tend to talk earlier and make more efforts to communicate, apparently because they have learned they will be listened to.

For those babies who crave physical contact, carrying them in a sling and accepting they need to be with you much of the time can help to meet their need for closeness. In a short time in the future they will not want to be held close or even hold your hand, enjoy it while you can! For some babies the opposite-over stimulation-can create unhappy behaviour.

#10 Other causes of fussy behaviour

Other ideas that may explain unhappy or restless behaviour could include minor dehydration (let your baby breastfeed frequently to quench his thirst), baby being too hot, too cold, being smoked over, wearing an overly tight nappy, having sore skin from an allergy, having sore gums from teething or thrush or being poorly e.g. having an ear infection.

Medications

Some mothers may notice a connection between their baby's behaviour and certain supplements or medications they take themselves or their baby takes. Fenugreek can affect some babies if the mother takes medicinal doses for her milk supply. And vitamins or iron supplements can affect some babies and cause discomfort .

Vaccinations

Some babies could be fussy if they have had a reaction to a recent vaccination. Parents can access patient information leaflets listing side effects for vaccines in the UK from the NHS Childhood Vaccines Timeline.

My older baby is still fussy!

Some of the ideas above might still be useful to problem solve the reasons for a fussy older baby, or you may enjoy reading The Fussy Baby Book by Dr William Sears which covers birth to five years. If the fussing is happening particularly at night you may find Baby Waking Up At Night or Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family helpful.

Summary

There are lots of reasons why a breastfed baby might sometimes seem unhappy or fussy such as being hungry, having allergies, sensory processing issues or lactose overload and more. Checking with your doctor will rule out a medical cause for your baby's unsettled behaviour and the best way to rule out any breastfeeding related reason is to contact a breastfeeding specialist to help you.
* Extracts reproduced by permission from Pinter & Martin.

# data[].attributes.attachment_link.description
After a few weeks or months, breastfeeding has often settled into an easy rhythm. But what if you're still dealing with a fussy breastfed baby or breastfeeding feels a struggle? Assuming any illness has been ruled out by your baby's doctor, contacting an IBCLC lactation consultant can help brainstorm why your baby seems unsettled at the breast at any age or stage.

# data[].attributes.attachment_link.title
How to Increase Milk Supply When Pumping

# data[].attributes.attachment_link.description
How often should a mother pump to build up her milk supply and how long for? When is the best

# data[].attributes.body
Cluster feeding

# data[].attributes.attachment_link.readable_text
This material was developed by Jane Morton, MD and produced for educational purposes only. Reproduction for commercial purposes is prohibited. Utilization of the materials to improve care of pregnant women and their newborns is encouraged with proper citation of source.

# data[].attributes.attachment_link.description
This material was developed by Jane Morton, MD and produced for educational purposes only. Reproduction for commercial purposes is prohibited. Utilization of the materials to improve care of pregnant women and their newborns is encouraged with proper citation of source.

# data[].attributes.attachment_link.readable_text
Kathryn Kelly, NCT antenatal teacher, explains: 'The Fourth Trimester is a way of describing the period after birth when both parents and baby are adjusting to their new lives.

'We think of other trimesters as being three months long, and we can think in terms of roughly another three months after the birth to make the adjustments to being a new family.'

What's the fourth trimester like for babies?

Having been in your warm womb for nine months, your baby has now got to get used to a sensory overload of sights, sounds and smells, as well as a frequently colder environment where they're not constantly supported by your protective amniotic fluid.

Kathryn says: 'Babies have been used to being fed continuously, sleeping when they want to, and being rocked in the cosy embrace of their mum's tummy. When babies are born we introduce gaps between feeds, and put them in a different place to sleep. It's no wonder that they can find this scary, and it's natural that they cry to express their fears.'

Understandably, babies are likely to cry more in this three-month period than any other time in their life. But however logical it might be, it doesn't make this period any easier for new parents. Knowing that other parents are going through the same experience, and thinking of this period as the fourth trimester, might help.

'Parents describe it as a very useful concept, which reminds them that it is OK to find the early days with a baby hard. It is a period of transition, where women become mums, men become dads, and babies adjust to life outside the womb,' Kathryn says.

What can you do to help your baby in the fourth trimester?

Fundamentally, the closer your baby feels to you, the happier they will be. According to Kathryn: 'Anything that mum, dad or other carers can do to replicate the womb-like world will help their baby feel safe. And when we feel safe, we thrive. For your baby, this means holding them close, perhaps in a sling, so they feel the warmth of your body, hear your heartbeat, and are gently rocked as you go about your day (or night).

'Feeding for babies, just like for adults, is about more than just nutrition, it's also social - a way of sharing and being with those we care for. Feeding your baby whenever they they want to will support their emotional development, as well as their physical and intellectual development.

'Your baby will sleep when they're tired, and you will both feel safer if they're close to you. Many parents tell me that in the early days their baby won't sleep in their Moses basket or crib, but only when they're held by a parent. This is perfectly normal and understandable when you think about the baby's point of view. It's important that parents find out about the safer sleep guidelines, and work out a way of sleeping that suits them as a family.'

Can you 'spoil' your baby in the fourth trimester?

No. Despite some people saying that babies need to 'learn' that you won't rush to pick them up every time they cry, in this crucial Fourth Trimester period you can't care for them too much. In fact, the more you look after them when they're upset, the more reassured and confident they'll be.

How might you be feeling?

Even if you're not an international tennis champion, parents who have gone from living busy, independent lives, can find the sudden change to around-the-clock care for a completely dependable infant hard.

Add to that the need to recover from a traumatic or difficult birth, and you can understandably feel like you're the one in need of a little TLC. Kathryn says: 'With the emotional changes in a woman's body, plus the realisation of the enormous responsibility of having a baby, new mums can feel overwhelmed and tearful at times.

'Partners can be dealing with their own response to the birth, their changing identity, and strong feelings about protecting and providing for the family. All of these feelings can also be affected by the way both mum and her partner were parented themselves.'

As with all stages of early parenthood, it's worth remembering that this stage will pass. In what seems no time at all, you might be looking back at the period with fondness at how tiny and attached to you your baby was when they were first born.

However, that is not to downplay how challenging the Fourth Trimester can be for parents. When you're in it, it's all-consuming. You can feel like you don't know what you're doing and you're constantly one step behind.

So, what should I do?

If you think in terms of the first three months of your baby's life being a Fourth Trimester, it can be easier to take the pressure off getting back to 'normal'. You wouldn't have been trying to rush around tidying the house and welcoming endless visitors when you were heavily pregnant, so don't put pressure on yourself to do it now.

'When women are discharged from healthcare some people might think that means they should be able to return to normal life, but there is a long period of adjustment and care needed at home,' says Kathryn. 'Friends and family can support new parents with food, help around the house, and reassurance that they are doing a great job of looking after their baby.'

This is especially important for mums who are raising their baby alone, in which case asking for help from friends and family in advance can help ensure you get the support you need.

Kathryn adds: 'Having very modest aims in the early days - getting outside most days (perhaps a short walk around the block), eating well, resting as much as possible - will change over time to meeting up with friends regularly, getting some exercise every day, and doing the most necessary housework.'

When will the crying settle down?

'As babies grow and change, things that seemed easy one day might feel very difficult another,' Kathryn says. 'A baby's crying tends to peak at around week six, which can mean that parents feel they must be doing something wrong, or that there is a problem with their baby. However, this is normal, and has usually reduced by three months.

'Parents report the excitement and happiness that comes when they see their baby is starting to interact with them, including smiling for the first time.'

Where can I get more help?

'Part of the challenge of this early period is the feeling that there is so much to learn, and to worry about,' explains Kathryn. 'Using safe sources when looking for information about caring for yourself or your baby will reduce anxiety.

'Reputable sources such as NCT practitioners and the website, or NHS health professionals and are a good place to start. Avoid sources of information (including people or media) who make you feel bad about your parenting, and stick with people who you trust and who support you.

'Although things can feel like they're getting harder in the early weeks, most people are feeling much better by around three months after the birth, and some will feel fine before that. If parents are still finding life a real struggle at that point they might consider talking to a health professional, or seeking more support from friends and family, to help them until they are feeling more in control.'

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby. To find out when an NCT nearly new sale is happening near you, search here.

You might find attending one of NCT's New Baby groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

# data[].attributes.attachment_link.title
What is the fourth trimester? | Baby & toddler articles & support | NCT

# data[].attributes.attachment_link.description
Everyone knows that pregnancies last three trimesters - so what exactly is the Fourth Trimester? We explain what this crucial stage is, and what it means for you and baby

# data[].attributes.attachment_link.title
Breastfeeding after a Caesarean Birth - The Breastfeeding Network

# data[].attributes.attachment_link.description
As part of caesarean awareness month in April, we’re sharing some information on breastfeeding after a caesarean section. Your caesarean may be planned or unplanned, but either way it needn’t derail your breastfeeding journey – the key is to be informed so you can be as prepared as possible. First,…

# data[].attributes.attachment_link.title
3.2K views · 44 reactions | I've had lots of questions recently about expressing colostrum before your baby is born so here's my video and post explaining more...

Colostrum is the first milk you produce (from around 16wks of pregnancy). It’s there for your baby until the transition to mature milk on around day 3-4. It’s produced in small amounts (perfect for your baby’s tiny tummy!), is yellowish in colour and is full of antibodies to kick-start your baby’s immune system 😊

Why? 
• Collecting colostrum antenatally may be recommended if you have gestational diabetes, you’re expecting multiples or having a planned caesarean.
• It can be helpful for all women to try as sometimes unexpected bumps in the road (e.g. blood loss, a particularly long labour, tongue tie or lack of support with feeding) may impact your breastfeeding journey. Having some colostrum stored can be a reassuring back up and ease stress!
• It helps you become familiar with how to hand-express before your baby is born.
• If your baby is having trouble latching on, is separated from you, has low blood sugar or needs some extra milk, you can top up with your own.

How?
• Have a look at my video which talks you through it!
• Find somewhere you feel comfy, warm and relaxed and have everything you need to hand.
• Most importantly, don’t worry if you don’t get any colostrum – this is perfectly normal and doesn’t mean you’ll have problems with breastfeeding.

Storing?
• In small sterile syringes - 1 or 2ml - which your midwife may provide (or you can get easily on Amazon), kept in a Ziploc bag in the freezer (can be stored for up to 6 months).
• Remember to label each syringe with your name, DOB & date you expressed.
• Take with you to the birth centre/hospital in a cool bag with ice blocks & ask your midwife to put it in the fridge/freezer.

If it’s something you’d like to try, it’s best to wait until 37wks and to talk it through with your midwife first. Please don’t try if you’re at risk of early labour. Any questions, pop them below! | Nest and Nurture

# data[].attributes.attachment_link.description
I've had lots of questions recently about expressing colostrum before your baby is born so here's my video and post explaining more...

Colostrum is the first milk you produce (from around 16wks of...

# data[].attributes.attachment_link.readable_text
By Kelly Bonyata, BS, IBCLC

Some babies will fuss, cry or pull off the breast during breastfeeding. There are a number of reasons why this might be happening. It's pretty common to see this type of behavior at around 6-8 weeks, though it can occur at any time. If your baby is generally fussy (not just when nursing) see My baby is fussy! Is something wrong?

Determining the problem

Here are some of the problem-solving steps I go through when my baby is fussy at the breast or a mother asks me why her baby is fussing while breastfeeding:

How old is baby? Most babies go through growth spurts during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months, 9 months, etc. Many babies are fussy during growth spurts.

Is baby working on anything new developmentally? Babies who are starting to notice the world around them can be notoriously distractible. Any kind of new developmental step that baby is working on can affect nursing temporarily, whether it be fussy nursing behavior or simply more frequent nursing.

When is baby fussing? To figure out the cause it's helpful to pay attention to when the fussy behavior happens, both during the nursing session and during the day.

If baby is fussy right when your milk is letting down (or immediately after), there's a good chance that the fussy nursing is related to a fast let-down. If baby is fussy before let-down, or a few minutes into nursing (and a while after let-down), then baby may be impatient for the fast flow of milk that comes with let-down. Fussing at the end of a nursing session (or what seems to be the end) may mean that baby needs to burp, or is ready to finish nursing, or just wants to suck (and doesn't want to deal with a new let-down at this point), or wants to continue nursing on the other side or with a faster flow of milk.

If the fussy behavior is mainly in the mornings, it might be due to a faster than usual let-down if baby has just had a longer sleep period and mom's breasts are fuller than usual. If baby is fussier during evening nursings, it may be due to the normal fussy time that most babies have during the evening. Although most babies don't react to foods that mom eats, some do. If you eat a particular food at about the same time each day (or most days) and baby has a regular time where she fusses during nursing, try not eating that food for a week or two to see if things improve.

Does fussing occur on both sides equally or only on one side? Most moms have a faster let-down and/or a more abundant milk supply on one side than the other, so if your baby fusses more on one side, it may be due to these differences.

What else is going on with baby? Is she sick or teething? Is something new or different going on in her environment? Has she started solids or is she trying a new food? Is she exhibiting other symptoms besides the fussy nursing?

Below are discussions of some of the different things that can lead to fussy nursing behavior. Keep in mind that the problem may also be a combination of several things.

Does baby need to burp?

Many babies will cry, fuss, pull off the breast, etc. if they need to burp. Try to burp between breasts and after a feeding, but don't worry if baby does not burp and is content. Breastfed babies overall don't take in as much air during a feeding as bottle-fed babies do, so usually don't need to burp as often. If baby has been crying before she nurses, or is so hungry that she nurses "frantically" or if mom has a fast let-down, baby could be taking in more air and may need to be burped more often.

Burping is usually only necessary during the first few months, though it may extend longer. Once your baby is moving more freely, she will be able to relieve the gastric gas herself. This usually will occur between the 4th and 6th month, but may be shorter in some children and longer in others.

If baby has a hard time burping, try burping more often during a feeding. The best burping position is one that applies firm pressure to the baby's tummy. Placing baby over the shoulder way up so that there is pressure on baby's abdomen often works well. Walking around while doing this might distract her long enough to get a good burp. You may even want to lie baby down on her stomach and burp her that way.

Growth spurt

Babies often pull off and fuss during growth spurts. Most babies go through growth spurts, sometimes called frequency days, during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months (more or less). More growth spurt information in this link.

Distractible baby

If baby seems to be pulling off the breast at any distraction (real or imaginary), then see The Distractible Baby.

Forceful let-down

Some babies will pull off the breast soon after let-down if mom has a forceful let-down. Baby may be frustrated by the too-fast flow of milk with let-down. A too-forceful let-down can also cause excessive gas or spitting up/vomiting. There is more information here on symptoms of and how to deal with a fast let-down reflex.

Slow let-down

Some babies get very impatient if mom has a slow let-down. There is more information here on speeding up a slow let-down reflex.

Baby wants a faster milk flow

Even very young babies can be quick to notice that pulling off, kneading the breast, etc. can cause an additional let-down, and can facilitate a faster, easier milk flow. Some babies become impatient with the slower milk flow following the initial fast flow at let-down. This may or may not be related to a slow let-down.

When a feeding begins at the breast there are drops of milk. Then when the initial let-down occurs (several seconds to a minute into the feeding), the milk flow speeds up quite a bit. At that time it may drip very quickly, squirt, or even spray. Some minutes later it slows again and the baby must continue to suck vigorously in order to elicit further let-downs. This pattern can continue through successive, multiple let-downs as long as the baby is continuing to nurse vigorously. Eventually, baby will learn that the flow will pick back up again if she'll only continue to vigorously suck/swallow.

With bottle feeding, the flow is instant and continuous. The baby is required to work very little. Once a baby has had a bottle, especially a lot of bottles, she may begin to prefer the ease of bottle-feeding over the work of breastfeeding. She may become frustrated at the breast after the first let-down occurs and the flow of milk begins to slow.

If baby is getting bottles you might consider putting them away, at least for a while. When you must use a bottle, only use a newborn nipple for as long as baby will tolerate it so that she never gets a really fast flow of milk from the bottle, but has to work a little more to get the milk.

Sometimes babies of moms with oversupply or fast let-down will also get very used to the fast flow and object when it normally slows somewhere between 3 weeks to 3 months.

It can be helpful to do some breast compression when this fussiness starts or right before you expect it to. This will help speed up the milk flow again. Once compression stops helping, try switching baby to the other side when she begins to fuss and back and forth again (after using compression) as you need to.

Baby is done nursing for the moment

If baby is fussing after she's been nursing for a while, and you've ruled out other causes, she may be in the process of changing her nursing pattern. Babies become very efficient at the breast with growth and maturity. They can milk the breast in a lot less time per feeding session than they required before. Baby's frustration may just be a sign that she's finished and wants to move on.

On a similar note, an occasional baby will just want to suck at the end of a nursing session and the flow of milk with let-down frustrates her. You might see if offering her a finger or pacifier (if baby is older than 4-6 weeks) to suck on during these times seems to help.

Baby prefers one side

Sometimes babies will refuse or fuss at a breast when the let-down is slower or too forceful, or the supply a bit lower. They in turn will prefer the side which lets down more/less quickly and in which the supply is more bountiful. See also: Lopsided! What can I do?

Fussy in the evening

Many young babies tend to pull off and fuss at the breast in the evening. See the article Cluster Feeding and Fussy Evenings.

Teething

Teething can cause fussy nursing behavior, as some babies experience gum discomfort with sucking. Baby might start to nurse, but then pull off and cry or fuss and not want to nurse anymore. See Teething for more information and tips.

Thrush

Frequent pulling off the breast can be a symptom of thrush.

Stuffy nose

A stuffy nose can cause fussy nursing behavior. If your baby has a stuffy nose and is having a hard time breathing and nursing at the same time, see colds & congestion.

Allergy or food sensitivity

Some babies with allergies or food sensitivities exhibit fussy nursing behavior. Often when there is a sensitivity to something in mom's diet, baby will come to the breast hungry but when she tastes/smells something in the milk that will cause her GI distress, she pulls off, bats her head back and forth, etc. Sensitivities to foods in mom's diet are rare. If this is the problem, you will most likely notice other symptoms, such as excessive spitting up or vomiting, colic, diarrhea, rash, persistent congestion or runny nose, or excessive gas. More information on food sensitivities in babies and links to more allergy information can be found in my article Dairy and other Food Sensitivities in Breastfed Babies.

Low milk supply

Low milk supply can cause baby to be fussy at the breast. If you feel that your milk supply may be low, see this page for more info: Increasing low milk supply.

Reflux

Reflux can result in baby being fussy at the breast. See Reflux and Breastfeeding for more information.

Tongue-Tie

Tongue-Tie can result in baby being fussy at the breast. See Breastfeeding a Baby with Tongue-Tie (Resources) for more information.

# data[].attributes.attachment_link.title
My baby fusses or cries when breastfeeding - what's the problem? * KellyMom.com

# data[].attributes.attachment_link.description
Some babies will fuss, cry or pull off the breast during nursing. There are a number of reasons why this might be happening. It's pretty common to see this type of behavior at around 6-8 weeks, though it can occur at any time.

# data[].attributes.attachment_link.title
How to breastfeed: breastfeeding positions

# data[].attributes.attachment_link.description
Buying a breast pump can be daunting if you’re a new mum with a hungry baby to feed. How to buy the best breast pump takes you through essential need to know before you buy an electric breast pump, or a manual pump

# data[].attributes.attachment_link.readable_text
This technique can be very useful to make breastfeeding as effective as possible so that your baby gets as much milk as possible for every minute he or she is feeding, you get lots of stimulation to make more milk and the feeds are shorter and more efficient.

Can't see the video above? See it on youtube here

# data[].attributes.attachment_link.title
Breast Compression Teaching Video - Real Baby Milk

# data[].attributes.attachment_link.description
This technique can be very useful to make breastfeeding as effective as possible so that your baby gets as much milk as possible for every minute he or she is feeding, you get lots of stimulation to make more milk and the feeds are shorter and more efficient.

# data[].attributes.attachment_link.readable_text
*More information on this topic can be found in my NEW BOOK on breastfeeding and tongue ties, "All Tied Up! How To Keep On Boobin' Through A Tongue Tie". Available here.
Most babies will latch on the best when they are supported to self-attach on their own, with the mother in the "laid-back" breastfeeding position, or self-attachment in the "koala" hold. Here is a video to show what this process looks like. It's an amazing thing to see (and experience yourself!)...

But what about the babies who cannot latch on well by themselves? What about the babies with tongue ties or other physical issues going on that inhibit their ability to keep enough of the areola in their mouth while breastfeeding? This is where the "flipple" technique can really help. In the following video I discuss how this little breastfeeding trick can work even better if the mother does this while her baby is in the "koala" position which looks like this:

Step 1. Try to get your knees lower than your hips as this can make it easier for some mothers.

Step 2. Put your baby's mouth right at your nipple.

Step 3. Use the "flipple" technique to get as much of your breast tissue into your baby's mouth as possible. Point your nipple very high towards their nose, try to get as much of the bottom part of your areola into your baby's mouth and use your finger to flip their top lip up after they have latched on.

*You may need to use this "flipple" technique before AND after you get a laser or scissor tongue/lip tie revision done. Some mothers find that they need to use this for quite some time as their baby get's the hang of using their new tongue!

Step 4: Watch this video to see it in action!

And here is another video demonstrating the flipple in an upright position but baby is supported from behind by both a pillow and their mother's arm...

Have you used the flipple and/or the koala hold? Share your experiences below! If you need some help getting your baby to latch on or have questions about tongue ties please CLICK HERE.

# data[].attributes.attachment_link.title
How to get a better latch! The exaggerated latch or "flipple" breastfeeding technique... - The Milk Meg

# data[].attributes.attachment_link.description
And here is another video demonstrating the flipple in an upright position but baby is supported from behind by both a pillow and their mother's arm... Have you used the flipple and/or the koala hold? Share your experiences below! If you need some help getting your baby to latch on or have questions [...]

# data[].attributes.body
A video introduction to laid back feeding.

# data[].attributes.body
A set of videos from best beginnings looking at a variety of topics from skin to skin, attachment, overcoming challenges and others.

# data[].attributes.attachment_link.readable_text
This information and videos are available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK. To download Baby Buddy, visit the relevant app store of your choice:

Meet four prospective mums, Melissa, Maria, Teresa and Angela. Melissa has never been through labour - she had a caesarian-section with her previous child. For medical reasons Maria has to have a c-section; Teresa wants to give birth at home; and Angela is expecting her third child. We follow them as they prepare for their births.

All our mums have different birth experiences. Find out why skin-to-skin contact is so important and about breastfeeding for the first time. "It's a great feeling to be able to provide for him without anything else, just me myself," Angela says. Melissa's partner Andy says breastfeeding is healthy, cheaper and much less effort than making up bottles.

Angela is back home with baby Cameron and breastfeeding is going well. "It's a great feeling to be able to sit there and watch him feeding away. It's a really special bond," she says. Teresa is making sure she has plenty of contact with Rufus, ensuring her body is supplying enough milk for him. Breastfeeding can protect you against ovarian cancer and give you stronger bones in later life.

How to make sure your baby is attaching well at the breast.

Meet four mums whose babies have been breastfeeding for a little while and hear their experiences. Linda was troubled by breastfeeding outside the home - until she tried it. "I thought, 'nobody breastfeeds in public,'" she says. "What I realised is, loads of women breastfeed in public, you just don't realise it's happening."

Find out about overcoming challenges like uncomfortably full breasts and mastitis, and how to position your baby so he or she feeds properly.

Linda and Heidi have fed their babies breast milk for six months. Now their babies are ready to try their first solids.

Join a class with specialist midwife Bella Dale, who explains how breastfeeding works and how mums' bodies start preparing to feed their babies before birth.

Three mums tell us how they overcame hurdles with breastfeeding. Thomasina overcame sore nipples, while Lowri encountered mastitis, both of which were caused because their babies weren't attaching properly at the breast.

We meet three mothers who express their milk for different reasons and learnt how to do it in different ways. Find out techniques for expressing, different pumps and ways to store breast milk. We also discover how mothers fit breastfeeding into their return to work.

In their first few weeks, pre-term babies may be fed using a nasogastric tube. But as they progress they will begin to take milk feeds, usually through a tube into the baby's mouth or nose. Breast milk is best for many reasons. Find out why and how as we follow four mothers and their premature babies.

Follow three mothers as they share their tips on the joys and challenges of feeding twins.

Latest

The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

# data[].attributes.attachment_link.description
Your guide to breastfeeding and how to do it successfully.

# data[].attributes.body
If you are ever unsure about what to do, BRAIN can help you work it through!