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Unsure about how to feed your new baby? Read on...
Feeding your new baby - breast or bottle?
If you are reading this you are probably a new or expecting mum or dad, still unsure as to how you are going to feed your newborn.
* Some breast feeding worries dispelled
* Breastfeeding positioning check-list
* How often to breastfeed and for how long – the first weeks
* Eating well when you are breastfeeding
* Help with common breastfeeding problems
* Links to sources of more help with breastfeeding
* About Healthy Start food vouchers for mothers on low-incomes
Breastfeeding is undoubtedly the best nutrition for your newborn, and is all the food and drink your baby needs up until 6 months. It can be a lovely experience for both you and your baby and has lots of other benefits:
Why breast is best for your baby:
* breastmilk changes content in response to the weather, your baby's age and the amount of milk your baby takes, to be the perfect nutrition for their bodies and brains to grow well
* breastmilk contains antibodies that boost your baby's immunity and so reduces your baby's risk of getting colds, tummy bugs and ear aches
* brestfeeding may also help protect your child against some diseases in later life such as obesity and diabetes
Why breast is best for mum:
* it is free
* it is convenient - your breastmilk is always ready, and you don't need to sterilise any equipment, or carry any equipment round with you (and with no packaging, it's better for the environment too)
* it is quick - with no preparation time and no clean up time, that you would need for bottle feeding
* it helps you to regain your figure a bit quicker, by helping your womb contract after birth, and burning off more calories
* you will probably have less dirty nappies (and spit-up) to clean up than if
your baby is on formula
Some breastfeeding worries dispelled
Breastfeeding does not make your breasts sag - if you don't believe us, read this report from the American Society of Plastic Surgeons . Pregnancy alone can change the shape of some women's breasts, but breastfeeding does not make breast sagging more likely, even if you feed for months.
If you want a break from your baby, you can do - you can express milk and store it in the fridge or freezer for someone else to feed your baby while you are out. Also, if you want to have an alcoholic drink or two, you can - but beware that small amounts are passed through your milk, so if you plan to drink more than a couple of units, feed your baby milk that you have expressed earlier, before drinking. Read more about diet and drinking during breastfeeding here.
Breastfeeding is easily the best nutrition for your newborn up until 6 months or longer. It can be a lovely experience for both you and your baby and has lots of benefits.
Women have been breastfeeding babies for thousand of years, but it is not unusual to for it to take a while to feel right. Like any new skill, it takes time to learn – for both you and your baby, and only practice makes perfect.
Try following these step-by-step instructions to start you off:
1. Watch out for cues your baby is hungry – so that you can start feeding before he is crying - an alert face and open mouth, moving tongue and hands.
2. Some babies are too sleepy to demand many feeds in the first few days after birth. Aim to feed them every 2-3 hours at first. If they sleep for longer than 4-5 hours, coax them awake for a feed by moving their legs and arms gently, undress them to their nappy, hold them upright, talk softly to them and walk your fingers up and down their back.
3. Before starting a feed, get yourself a drink of water or milk and a snack, and get comfortable lying down or sitting in bed, on a chair or on a sofa. Use cushions and footrest, if you like, to get comfy; you want to be able to feed your baby without straining your back, neck, arms or shoulders.
4. Now get your baby in a comfortable position, with his body against yours either tummy to tummy, across your lap, or under your arm. His head needs to be facing your breast, looking straight ahead at your breast with her head, back and bottom in one line, neck not twisted. A cushion or v-shaped pillow can sometimes help to get him at the right height. Support your baby’s back and neck, not his head.
5. If you need to support your breast, have 4 fingers resting on your rib cage, and thumb lightly on top of your breast – away from your nipple and areola – the dark bit around your nipple. Make sure your baby’s mouth or nose is in line with your nipple.
6. Now relax, ignore distractions and concentrate on your baby. If your baby doesn't immediately suckle, you can usually trigger the rooting reflex by gently stroking her cheek with your finger or your nipple.
7. Latching-on: When your baby opens his mouth wide (like a yawn), bring your baby’s body and head quickly and firmly onto your breast (remember this - baby to breast, not the other way around). He should take a big mouthful of your breast – your areola as well as your nipple, and your nipple will be towards the top of his mouth. His gums will be on the areola, centred around the nipple. This bit takes practice for both you and your baby, so be patient. It may be uncomfortable for a moment or two, but if it continues to hurt, the positioning is not right. Gently break the suction by using your finger to release the nipple. Take a minute for a few calming breaths. Then try again. Some babies take a while to learn how to latch on well, but keep releasing your nipple and trying again if its uncomfortable, because incorrect latching-on quickly leads to sore nipples.
8. When your baby is in the right position, she will have her mouth open wide, with her chin right up against the lower part of the breast. Her nose will be near the breast but with nostrils clear so she can breathe well. Her lips will be open and flattened outward. At first, you may notice the feeling of the nipple being drawn back into your baby's mouth at the start of the feeding, and you might also feel a mild to strong tingling sensation in your breast - this is the let-down reflex.
9. When your baby is latched on well, he will take a few quick sucks and then begin to suck a bit more slowly, deeply and rhythmically. He might pause from time to time and then continue sucking. The pauses will get longer as the feeding continues until it is complete. After your baby finishes on one side, give him a few minutes to rest, then offer your other breast – he might take some, or might be full.
10. Adjust your position and hers as necessary while she's feeding. The more relaxed you feel, the better the feeding will go.
11. After she's finished with each breast, burp her by patting gently on her back as you hold her against your shoulder or in some other comfortable position (some babies prefer a sitting up position on your lap). Put a clean cloth under her as you do this, to catch the milk that sometimes comes up with the burp.
Breastfeeding positioning checklist
Use this list to check that you and your baby are positioned well for pain-free feeding
* Mum is in a comfortable position
* baby is facing the breast and his neck is not twisted
* baby’s upper back and neck rather than his head are supported whilst feeding
* baby’s mouth opens wide before putting him on nipple
* baby’s bottom lip is curled back, and their chin is touching your breast
* there is more areola visible above their top lip than their bottom
* baby’s bottom jaw is pressing into the underside of the breast
* after an initial burst of short sucks, rhythm becomes long and with whole jaw movements
* the baby seems settled at the breast
* once the feeding rhythm is established, you shouldn’t feel discomfort on the nipple
* the breast isn’t pulled to one side or up or down – this can be uncomfortable. Move the baby so that his mouth is square onto the nipple, so there is no pulling on the breast, or dimpling – use pillows or cushions to get your baby in the most comfortable position for both of you
Read more about positioning and attachment including pictures here http://www.breastfedbabies.org/article.aspx?aId=13
How often to breastfeed and for how long – the first weeks
All babies have different feeding patterns, but all newborns need to be fed regularly. Some want to breastfeed from a few minutes after they are born, others take longer to show an interest. Holding your baby as soon as you can and letting him nuzzle up to your skin helps you to get to know each other, and sets you both up well for feeding. In the first day the baby might only take a few feeds as he is so sleepy. Your midwife will check this is ok, and advise if extra feeds are needed. Sometimes your midwife might advise to give your baby some expressed milk by cup or spoon - this can help to give your baby the energy they need to start breastfeeding well.
Feed your baby as often as he likes and for as long as he wants to be fed - when he has had enough he will let go or fall asleep - if he falls asleep on your breast, you can put your little finger in the corner of his mouth to break the suction, then after a couple of minutes offer the other breast. Your baby might demand a feed soon after they finished one – this is normal in the first weeks, as they are not yet used to knowing how hungry they are, and how long they need to feed for at each feed. In hot weather it is particularly important to give in to demands for extra feeds.
If you follow your baby’s cues, you'll probably be breast-feeding every two to three hours around the clock (8-12 times a day) for the first few days, or more often. In the first few days it might seem that your baby only has a small appetite – this is quite normal - feeds may only take 10-15 minutes, and your baby may only be taking a couple of teaspoons of milk a feed – this is normal. The milk you produce for the first few days after birth is called colostrum, and is quite thick and yellow, and is only produced in small amounts, but it is concentrated and nutritious, containing lots of protein and antibodies to protect your baby against infections.
Around day 3 your mature milk starts to be produced. Around this time, if your baby wants more milk, try feeding him more often and your breasts will respond by producing more milk. By the end of the first week, you may be feeding 6-9 times a day (or more often), every 3-4 hours, and each feed will take anything from 10 to 60 minutes. From 4 weeks your baby might start to fall naturally into more of a routine, and then from 6 weeks your baby might start sleeping more at night. But remember that every baby is different!
* Your body automatically adjusts to produce the amount of breastmilk your baby needs for nutrition, hunger and thirst. However, if your baby was born very premature, or if you were very undernourished before and during pregnancy (for example if you were ill or a heavy drinker or drug user), your doctors will advise you on what supplements you or your baby needs on top of breastfeeding. For more advice on eating well during breastfeeding, click here.
* When breastfeeding, you don’t need to give your baby other drinks, even during hot weather. You, however, may need to drink more than you are used to, and your baby may demand more feeds in hot weather.
* If you want to leave your baby for a night or a few hours, or let someone else feed him, you can express your own breastmilk. This will be easier after a few weeks, when your baby needs less feeds, and feeding is well established. Milk can be expressed by hand or by using a pump, and then given to your baby by spoon, cup or bottle (all equipment must be sterilised). For some really good instructions and illustrations for expression see this page on breastfedbabies.org.
Store your expressed milk in a sterilised container, and keep it in the fridge for up to 24 hours, or in the freezer for up to 3 months. Remember, if you have time away from your baby, you will still be producing milk, so will need to express regularly, around the times your baby would normally feed, to keep your milk supply going, and ease the engorgement.
* After giving birth, many mums are exhausted and emotional, particularly after the hormonal changes after day 4. Dads, family and friends can help with all the practical issues of housework, cooking and making the new mum comfortable, and supporting her emotionally. It often takes 3-6 weeks for breastfeeding to become fully established, which may feel like a very long time, but family and friends can help with reassurance and back rubs during this time – a more relaxed comfortable mum produces milk easier, and feeds a lot better. Dads can get involved in burping the baby, changing nappies and bathing, to help them to feel fully involved.
Eating well when you are breastfeeding
It can be difficult to find the time to eat properly when you're looking after a young baby but it is important to eat regularly to keep your energy levels up. Try keeping meals simple so they don't take too long to prepare and eating small meals regularly. Make eating regularly a high priority.
There are many old wives tales about foods to avoid when you are breastfeeding, but in reality, you can enjoy a very varied diet. Read on for a summary of foods to eat more of, foods to limit, and advice to manage your weight.
Foods to eat more of when breastfeeding
* Aim to eat fish twice a week, choosing oily fish at least once a week. This is because they are a good source of omega 3 fats. Other goods sources of these healthy fats are rapeseed oil, olive or omega 3 rich spreads, omega 3 enriched eggs, omega 3 enriched milk, nuts and seeds.
* Wholegrains - beans, lentils, wholegrain cereals, wholegrain bread, wholegrain rice and pasta. The fibre in these foods can help ease the bowel problems and constipation some women have after childbirth, so try to have some every day.
* Drink lots - at least 6 to 8 glasses of fluid, or more, a day. When you're breastfeeding you need to drink more than usual. If you feel thirsty, this means you're already dehydrated. If your urine is dark and has a strong smell, this is also a sign that you are not drinking enough. Try having a drink by your side (water or milk are best) every time you breastfeed.
* Take supplements containing 10 micrograms (mcg) of vitamin D each day. If you receive Income Support or Jobseeker's Allowance, you're entitled to some free vitamin supplements from maternity and child health clinics.
* milk and dairy foods - aim to eat twice a day for essential calcium and protein.
Foods to limit
* Don't have more than two portions of oily fish a week. Oily fish includes fresh tuna (not canned tuna, which does not count as oily fish), mackerel, sardines and trout.
* avoid eating more than one portion of shark, swordfish or marlin a week because of high levels of mercury.
* If you think that some foods that you eat are upsetting your baby, don't stop eating them without talking to your GP or health visitor first. Remember, that it's normal for breastfed babies to have loose stools.
* If you or the baby's father, brothers or sisters have a peanut allergy, you may wish to avoid eating peanuts and peanut products while you're breastfeeding.
* If you drink alcohol, avoid breast feeding for 2 to 3 hours after having a drink, as some can pass through into your milk. Use some previously expressed breast milk instead if your baby is due for a feed.
* Don’t drink too much caffeine – it can pass into your breastmilk and cause irritability and reduced hunger in your baby. More than 300mg per day can also reduce the iron in your milk. 300mg is 3 mugs of instant coffee (100mg each); 3 cups of brewed coffee (100mg each); 6 cups of tea (50mg each);8 cans of cola (40mg each); 4 cans of energy drink (80mg each);8 (50g) bars of plain chocolate (50mg each); or 16 bars of milk chocolate (25mg each). So, a bar of plain chocolate plus 3 cups of tea, a can of cola and a cup of coffee in a day, would reach the 300mg limit.
‘Dieting’ whilst breastfeeding is not a good idea, because you need to keep up your energy levels. However, following these tips for sensible healthy eating, combined with breastfeeding should help you to achieve a healthy weight.
* Eating regular meals - breakfast, lunch and dinner, plus healthy snacks
* At each meal have some starchy carbohydrate – potatoes, bread, pasta, rice, etc. If you are gaining weight too quickly you may need to cut down your portion sizes.
* Eat protein foods at each meal – meat, fish, eggs, cheese, beans or lentils, soya or Quorn. Choose low fat versions unless you are not gaining weight fast enough.
* Fill up on plenty of nutritious fruit and vegetables
* Cut down on fatty foods, such as fried foods, chips, snack foods, crisps and full-fat spreads.
* Cut down on sugary foods, such as sugary drinks, sweets and puddings
* Be as active as you can – take your baby out for walks as often as you can
Help with common breastfeeding problems
My baby doesn’t seem to want to feed – he fights at the breast or cries
When trying to establish breastfeeding this can be a problem – sometimes because the fast flow of milk from a full breast is overwhelming your baby. Try expressing a bit of milk before a feed to reduce the initial flow. This also gets the taste and smell of your milk on your nipple to tempt your baby to taste it. If you are trying to feed your baby less than 1½ hours since he was last fed, try settling him by taking him for a walk, bathing or a nappy change – he might not actually be hungry. If you still have problems ask for help from your midwife or health visitor or ask to see a lactation consultant.
My nipples are sore
Tender nipples are normal when you first start breastfeeding, but not sore or painful ones. The common cause is that the baby is not attaching to your breast well – if they are only sucking on the nipple rather than suckling on the areola, you will get sore nipples. Use our positioning checklist, and keep trying to reattach until it feels right. Ask for help from your midwife, health visitor or a lactation consultant if you feel you need to. Other things that can help are rubbing some breastmilk onto the nipples after each feed, and letting them dry in the air. Avoid soap, alcohol wipes and nipple creams. Cracked and sore nipples might also be a sign of thrush – get advice from your health visitor or doctor.
My boobs are sore
In the first day after your milk comes in (around day 3, but might be later if you haven’t been feeding regularly), it is common for your breasts to feel sore and tender – it’s called breast engorgement. Try the following to help – taking a warm shower or using warm compresses before feeding, hand expressing a little bit before feeding, breastfeeding frequently (every 1-2 hours), using both breasts at each feed and/or putting an ice pack on your breasts and underarm after feeding until swelling goes down. If the problem continues, ask help from your midwife or health visitor.
Another cause of sore breasts is mastitis – an infection in an area of the breast, and this area may seem swollen and inflamed. If you think you have mastitis, get advice from your doctor who may prescribe baby-friendly antibiotics. During mastitis it is important not to stop feeding, and to take plenty of rest, and drink lots of fluids.
My baby wants to feed all the time
In the first week it is normal for your baby to want frequent feeds, particularly after your milk comes in around day 3. However, if your baby is still wanting more than 10 feeds a day after the first week, it may mean that they are not attaching to the breast well, so ask advice from your health visitor.
I’m worried I’m not producing enough milk
Ask your doctor / midwife / health visitor for reassurance if you are worried, but generally, you know a baby is getting enough milk if they are healthy and happy, and have wet nappies at least 3 times a day in the first week (6-8 times a day as your baby gets older). A breastfed baby often loses weight in the first few days of life, and then gets back up to birth weight by 2 weeks old. After that their weight is measured against a special growth chart by your health visitor to ensure they are growing well. A breastfed baby produces bright yellow, soft stools from a few times a day to only once every few days.
Our bodies are designed so that the more you feed your baby, the more milk you make, until you are making the amount he needs – you don’t run out. Your baby will go through days where he wants to feed more – this may be due to hotter weather, fighting off illness or he is getting ready for a growth spurts. These days of having more appetite do not mean your baby is no longer satisfied by your milk, it just means they need to be fed more frequently until your milk supply increases.
Getting more help with breastfeeding
- NHS Breastfeeding helpline - www.breastfeeding.nhs.uk - 0300 100 0212
- www.breastfedbabies.org - a good page on breastfeeding problems http://www.breastfedbabies.org/article.aspx?aId=18
- National Childbirth Trust Breastfeeding Line 0870 444 8708 www.nctpregnancyandbabycare.com
- www.breastfeeding.co.uk
- La Leche League 0845 120 2918 www.laleche.org.uk
- Association of Breastfeeding mothers 0870 401 7711
- http://www.readysteadybaby.org/
There are always exceptions to the rule, and breast is not best if 1. you have a virus that can be passed on to your baby through your milk, such as HIV, 2. you are taking essential medications that could harm your baby, such as heart medication, 3. your baby has a rare illness such as galactasaemia. In these cases you will be advised to bottle feed, as long as you live in a country like the UK where safe water is easy to come by.
For lots of reasons, many women choose not to breastfeed, and for their babies, baby milk (infant formula) comes in as a good second choice to breastmilk - the content is regulated to be as close to breastmilk as possible. Normal cow's milk, goat's milk or any other type of milk is not suitable as a drink until your baby is over a year old. All brands of baby formula on sale in the UK are strictly regulated to be safe and nutritious for your baby.
Bottle feeding - step-by-step
1. Clean and sterilize bottles and teats
2. Boil the kettle and leave water to cool for up to 30 minutes
3. Wash your hands well
4. Make up your formula by following the manufacturers instructions – measure the right amount of cooled boiled water into the bottle, then add the correct number of level scoops of powder
5. Ideally bottles should be made up just before feeding, but instead you can make up all your bottles once a day – run under a cold tap to cool quickly and then store in the fridge for up to 24 hours
6. Serve the bottle cold, room temperature, or slightly warm. (To warm a bottle, put it in a pan of warm water for five minutes. Don’t microwave as it may heat the milk unevenly) If you're using bottled breast milk, serve it at room temperature (bring it to room temperature after freezing or refrigerating by running the milk container under a warm tap)
7. Test bottle temperature by shaking a few drops of milk onto your wrist
8. Settle into a comfortable position with your baby – e.g. cradled so his face is at chest level
9. Tip the bottle so that the formula always fills the neck of the bottle –to keep the baby from swallowing too much air
10. After every two to three ounces and at the end of the meal, burp your baby by gently patting his back as you hold him against your shoulder or as you sit him in your lap. Put your baby on a clean cloth as you do this, to soak up any milk that comes up with the burp
11. Let your baby tell you how much he wants to eat. If he fusses, pushes the bottle away, or turns his head, he's probably done. Don't try to cajole him into finishing the bottle if he's not interested
12. Tip away any milk left in the bottle at the end of a feeding
13. Scrub the bottles, teat and lids thoroughly in hot soapy water, rinse and sterilise – e.g. boil submerged in a large pan for at least 10 minutes
How much and how often?
Feed your baby little and often. Each baby's needs are different, and it is important to follow your baby's cues. But, as a rough guide:
A baby less than 1 week old will take about an ounce or two (30-60ml) per feed, 7-8 times a day and night.
From week 2 to 2 months, they will consume two to four ounces (60-120ml) per feed, 6-7 times a day (possibly without a night feed
From 2 to 6 months they will increase by one ounce (30ml) per month until they reach eight ounces (240ml) per feed, 4 times a day
In the first weeks, if 4 hours have passed since the last feed, wake your baby to feed him by gently moving his arms and legs.
You will need about 600-800ml of formula a day – so a 450g tin of formula will last from 5 days to over a week
Other tips:
* Your baby may need extra drinks of cooled boiled water in hot weather
* No baby rice, rusks or other foods should be added to a bottle – this increases the risk of choking
* If you want to using bottled or filtered water for making up baby milk, it must still be boiled – and you need to check the sodium content is less than 200mg/l
Bottle feeding - choosing the right milk and equipment
What you need for bottle feeding your new baby
- 6 bottles
- 6 teats
- infant formula (powdered or ready-to-feed baby milk)
- sterilisation solution or equipment
- bottle brush
- bottle warmer (optional)
Choosing an infant formula milk
Infant formula milk is the only alternative to breast milk. It comes ready-made as a liquid in cartons or as a powder, which you make up by adding it to boiled tap water.
Infant formula milk is cow's milk that has been modified to be suitable for babies from birth. There are lots of different brands of infant formula milk, and all provide all the essential nutrients a baby needs up until 6 months of age. Some brands contain extra nutrients such as nucleotides and prebiotics, which may be beneficial to growth and gut health (but this is not yet proven). None of the brands contain the antibodies that breastmilk contains.
Don't give ordinary cow's milk as a drink to any baby under the age of 12 months as it doesn't have the right balance of nutrients and salts. Follow-on formulas, which are not available through Healthy Start, should not be given until after your baby is six months old.
The best milks to give your baby from birth are the ‘first’, ‘stage 1’ or ‘gold’ formula milks. These are the most similar to breast milk.
‘Second’, ‘stage 2’, ‘plus’ or ‘white’ formula milks or ‘formula milks for hungrier
babies’ – are also suitable from birth. They have a slightly different mix of proteins,
which manufacturers claim keep a hungrier baby satisfied for longer.
‘Follow-on’ or
‘stage 3’ formula milks – are not suitable from birth but can be given from 6 months
- they are higher in iron, protein, energy, and calcium than stage 1 and stage 2
milks.
There are specialised feeds for premature babies or babies who suffer from reflux, milk allergy or lactose intolerance. These are available on prescription. Soya formula is not recommended for babies under 6 months old.
Choosing a bottle
Bottles come in lots of different shapes and sizes, and in glass and plastic. Choose a shape you will find comfortable to hold – small 4 oz bottles will be big enough for new babies, but within a few months your baby will be drinking more than this in one feed. Wider necked bottles can be easier to pour powder into and to clean than narrower ones.
Choosing teats
Teats come in lots of different shapes and sizes – if you are planning on mixing breast and bottle feeds you may want to go for one of the wider shapes. Teats come in slow, medium and fast flow rates according to size and number of holes they have. Newborns often prefer slow flowing teats, but all babies are individual.
Choosing a method of sterilisation
Bottles and teats must be sterilised until your baby is a year old. Steam sterilisers - allow you to sterilise bottles, rings and teats by heating a small amount of water into steam, which works quickly to kill off bacteria. Microwave sterilisers work in a similar way to steam sterilisers. They can use up less space in your kitchen if you already own a microwave and are quicker than steam or cold-water sterilisers. Cold-water sterilisers don't require any electricity or heat. You place the feeding equipment in a plastic container of water, then add a tablet to the water which sterilises all the equipment.
Where to buy?
Baby formula milk can be bought from supermarkets and chemists, and larger shops stock good ranges of equipment. Online you can try the supermarket websites, or other online shops such as www.boots.co.uk www.amazon.co.uk or www.mothercare.co.uk
About Healthy Start food vouchers for mothers on low-incomes
Healthy Start is a scheme across the UK to help women eat well and feed their children well if they are on a low income.
Healthy Start is open to pregnant women and families with children under the age of four who are on:
* Income Support
* income-based Jobseeker's Allowance or
* Child Tax Credit (but not Working Tax Credit) with an income of £14,495 a year or less
* Plus all pregnant women under the age of 18 whether or not they are on benefits
Once accepted on the scheme, you get a set of vouchers through the post every four weeks.
Each voucher is worth £3.00 and can be exchanged for any combination of milk, fresh fruit, fresh vegetables and infant formula milk in registered shops. The number of vouchers you get depend on the age of your children.
You also get free vitamin supplements (the ACD vitamins recommended to children, and pregnant women), plus lots of health advice about healthy eating, breastfeeding, infant feeding and using the vouchers.
For more information ask your health visitor, GP or read www.healthystart.nhs.uk
This information was correct on August 7th 2008
Page first published March 2008; last updated August 2009