hold your baby close in a semi-upright position, in skin-to-skin contact if possible and maintain eye contact by turning baby inwards towards your body
rub the teat gently over the upper lip, this will encourage them to open their mouth and draw in the teat
hold the bottle horizontally with a slight upright tilt to prevent both air entering the teat and the milk flowing too fast
allow your baby to set the pace of the feeding, enabling your baby to pause frequently
towards the end of the feed remove the teat and wind (burp) your baby
if your baby shows continued feeding cues, offer the remaining milk
don’t try and force your baby to take more than they want
limit the number of people who feed your baby to yourself and one or two others – this helps with building a relationship and bonding with your baby
always use a first infant formula in the first year of your baby’s life
make up feeds one at a time as your baby needs them
never warm up formula in the microwave
the water needs to be above 70°C in order to kill any bacteria in the milk powder, as it is not sterile
always put the water in the bottle first, then add the powder
only use the scoop enclosed in the packaging, as they can differ in size between brands
follow manufacturer’s specific instructions on how many scoops of powder to volume of water ration, to make sure the milk is not too diluted or concentrated
ensure to measure a level scoop of formula as instructed on the packet
before giving to your baby, check the formula is cool by dripping a few drops on the back of your hand
throw away any unused formula when your baby has finished feeding.
These tips will help you keep your baby safe whether you are feeding expressed breast milk or formula milk via a bottle.
Preparing bottles
Bottles and teats need to be thoroughly cleaned and sterilised in order to kill any harmful bacteria. Formula milk powder is not sterile. Follow the instructions on your chosen steriliser regarding this. Formula milk should be made up in line with the packet instructions, always read the label carefully.
To express colostrum or milk to give your baby, if they are unable to feed from the breast.
To relieve fullness or engorgement of the breast or blocked milk ducts.
To stimulate your breasts to produce more milk.
Some women find using a breast pump easier, some prefer hand expressing and some do both. Using a pump in the early days is not an effective way to collect small volumes of colostrum.
How to hand express
Have a clean sterilised container to hand before you start.
Cup your breast and place your thumb and finger about 2-3 cm from the base of the nipple.
Using your thumb and the rest of your fingers in a C shape, gently squeeze this area – this shouldn’t hurt.
Release the pressure and then repeat again and again, building up a rhythm. Avoid sliding your fingers over the skin. At first, only drops will appear, but just keep going as it will help build up your supply. With practice and a little more time, milk will flow freely.
When the flow slows down, move your fingers round to try a different section of your breast and repeat. When this happens again swap to the other breast. Keep changing breasts until the milk is dripping very slowly or stops altogether.
If the milk doesn’t flow, try a gentle breast massage, cuddle your baby or someone you love, smell your baby or loved one, or gaze into their eyes – this will help to release the hormone oxytocin (the “love hormone”) which releases the milk in your breasts.
Storage and use of expressed breast milk:
Expressed breastmilk can be kept for 4-6 hours at room temperature.
You can store expressed breast milk in a sterilised container in the fridge for up to five days, or in a freezer for up to six months.
Frozen milk is best defrosted slowly in the fridge. Expressed breast milk can be given straight from the fridge or warmed up by placing the bottle in a jug of warm water.
Once defrosted, use within 12 hours and do not refreeze. Dispose of any unused milk following a feed.
Use the following charts and related links to determine how well your baby is feeding.
Sign of good feeding
Signs that you need to support
Regular wet and dirty nappies (see section on nappy content)
Minimal/no wet and dirty and nappies
Day 3-5 less than 8-10% weight loss
Day 3-5 weight loss of more than 8%
At least 8 feeds in 24 hours (from day 3 onwards)
Less than 8 feeds in 24 hours (from day 3 onwards)
Good skin colour, alert and good tone
Newborn jaundice in combination with reluctance to feed and unusual sleepiness
Baby feeds for 5-30 minutes at most feeds
Feeding consistently for less than 5 minutes or more than 40 minutes
Initial rapid sucks changing to slower sucks with pauses and swallowing (may be less audible until milk comes in)
Rapid sucking pattern or noisy feeding (clicking)
Baby calm and relaxed during and after feed, content after most feeds
Baby comes on and off during feeds, or does not latch on at all, becoming unsettled after feed
Nipples not painful during a feed, breasts feel comfortable following feeding
Nipples sore or damaged, breasts very full, hard, lumpy or painful
Many breastfeeding problems can be resolved with adjustments to positioning and attachment. If you have signs suggesting that you may need support it is essential to seek help straight away. Many sources of support are available 24 hours.
If you have any problems with feeding your baby (including painful nipples or breasts, your baby not feeding as well as before) ask for help as soon as possible.Most breastfeeding problems relate to difficulties with positioning and attachment. A medical practitioner or infant feeding specialist may tell you that your baby has a tongue tie.Tongue-tie is a condition present at birth that restricts the tongue’s range of motion.With tongue-tie, an unusually short, thick or tight band of tissue tethers the bottom of the tongue’s tip to the floor of the mouth, so it may interfere with breastfeeding. Someone who has tongue-tie might have difficulty sticking out their tongue. Tongue-tie can also affect the way a child eats, speaks and swallows.Sometimes tongue tie may not cause problems. Other cases may require a simple surgical procedure for correction. Read the information in the Related links below.Your community midwife team works seven days a week, and you can request additional visits or telephone consultations if needed.Breastfeeding is the healthiest way to feed your baby. If you decided not to breastfeed or have stopped breastfeeding, it is possible to restart. This can be difficult because your milk supply will naturally reduce once you are not breastfeeding, but it can increase again to meet your baby’s needs. Look for skilled support to help you.If your midwives are no longer visiting you, ask for help from your Health Visitor, your Children’s and Family Centre or try a local baby feeding support group (your midwife or Health Visitor can give you details).Alternatively, especially out of hours, you can call the following telephone helplines provided by trained volunteers (they can help with breastfeeding or bottlefeeding problems):The National Breastfeeding helpline:Tel: 0300 100 0212 (9.30am-9.30pm)The NCT Breastfeeding line:Tel: 0300 330 0771 (8.00am-midnight)La Leche breastfeeding helpline:Tel: 0345 120 2918 (8.00am-11pm)
Offer a breastfeed to your baby whenever he/she shows early cues that they are ready to feed, such as:
wriggling
rapid eye movements
hand to mouth movements
sucking their fingers, fist or blankets
rooting (turning head to the side and opening mouth)
hand waving
slight murmuring noises.
You can also breastfeed when your breasts feel full, when it is convenient for you (for example, when you want to go out) or when you want a rest or cuddle with your baby.To make sure your baby is getting enough milk, aim for at least 8 feeds in 24 hours from day 3 onwards, but most babies will breastfeed more frequently than this.Babies do not always feed at regular intervals and may feed very often with short gaps in between feeds, followed by periods of longer sleep. Frequent feeding is normal, especially when your milk starts to come in – meaning your supply changes from the first colostrum to mature milk.
How often should my baby breastfeed?
In the first 2-3 days many babies do not breastfeed very often, however, try to offer the breast as often as possible, to see if they might be ready to feed.In the first 24 hours, healthy term babies may feed 3-4 times. Babies who are at risk of low blood sugar due to maternal diabetes, being small or premature will need to feed more frequently, 8 to 12 times in 24 hours. After the first 24 hours and for at least for the first six months of life, all babies should feed at least 8 to 12 times in 24 hours.Feeds are likely to be at different time intervals and for different lengths of time. The introduction of solid food starts around six months of age, when the baby shows signs of readiness.Feeding should be responsive, meeting the emotional needs of mother and baby. There is no wrong reason to feed and your baby cannot be over breastfed.As a guide aim for:
first 12 hours at least 2 feeds in total
first 24 hours at least 3-4 feeds in total
day 2 at least 6-8 feeds in 24 hours
day 3 onwards at least 8 feeds in 24 hours.
These feeding patterns should be accompanied by regular wet and dirty nappies. See both these topics:
If you are concerned about your baby’s feeding contact your midwife, health visitor or local infant feeding group or helpline for advice and support. See:
Breastfeeding has health benefits for you and your baby. For your baby, it provides nutrition, protects against ear infections, chest infections, allergies and diabetes to name just a few. Breastfeeding is about closeness and comfort as well as nutrition. Benefits for you include a reduced risk of breast or ovarian cancer and osteoporosis.
