Breastfeeding your baby

Responsive breastfeeding

Responsive breastfeeding involves recognising and responding to your baby’s feeding cues, as well as your own desire to feed your baby. It is important to remember that feeds are not just for nutrition, they also provide your baby with protection, love, comfort, and reassurance.

Responsive breastfeeding also involves feeding your baby to meet your own needs. For example, you may wish to offer your baby a feed before you have a shower, tend to the needs of other children, or complete a household task. Alternatively, you may want to sit down, rest, have a cuddle and feed your baby.

The timing and length of a feed will vary, depending on the reason for the feed.

For more information on responsive breastfeeding, please visit:

https://vimeo.com/555588759

Breastfeeding: positioning

Breastfeeding is a skill that you and your baby learn together. It takes time and practise. There are several different positions you can adopt when you are feeding your baby, these include sitting, laying back and lying down. Allow yourself time to try them all, so you can find the positions that suit you and your baby. The positions you choose may change throughout the day and night and whether you are at home or out and about.

Positioning is also about how you hold your baby while you are feeding. The acronym ‘CHINS’ explained in the table below, describes the principles of good positioning which are important for effective attachment.

 

C

Close

Keep your baby close to you, ensuring their hands and clothing are not in the way, so they can scoop enough breast into their mouth.

H

Head free

Support your baby’s neck, shoulders and back, so they can tilt their head back and allow their chin to come to your breast first, making it more comfortable for them to swallow. Even a finger on the back of your baby’s head will prevent this important movement.

I

In line

Your baby’s head and body should be in a straight line so they aren’t twisting their neck, which would make feeding and swallowing difficult.

N

Nose to nipple

Hold your baby close to you with their nose level with your nipple. Let your baby’s head tip back a little so that their upper lip can brush against your nipple. This will make your baby root and open their mouth wide. As they open their mouth, they will tilt their head back further and your nipple will slip under your baby’s upper lip and rest at the back of their mouth (at the junction between their hard and soft palate).

S

Sustainable

Ensure you are in a comfortable position before you start the feed, as you may be there for a little while. Bring your baby to your breast and let them attach themselves. Avoid putting your breast into your baby's mouth, as this can lead to poor attachment.

 

When your baby is in the right position, they will be able to effectively attach to your breast. Whichever position you choose, it is important to make sure your baby is able to attach effectively to your breast. Effective attachment is the key to successful breastfeeding.to enable them to attach well to your breast and feed

For more information about breastfeeding positions, please visit:

www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/how-to-breastfeed/breastfeeding-positions

www.globalhealthmedia.org/videos/positions-for-breastfeeding

Attachment

Attachment is the term used to describe how your baby takes your breast into their mouth. Effective attachment is the key to successful breastfeeding.

Your baby is well attached to your breast if:

  • their chin touches your breast.
  • their mouth is wide open, and their tongue is down.
  • their lower lip is curled back. 
  • their cheeks are full and rounded.
  • more areola (the area of dark skin around the nipple) is visible above your baby’s upper lip.
  • they have a co-ordinated suck and swallow sequence with pauses. At the start of a feed, your baby will suck rapidly to encourage your milk to flow or ‘let down.’ This will then change as your milk flows to a slower and more rhythmic suck and then little sucks or flutters as the feed finishes.
  • it is a pain-free feed for you (at the end of a feed or if your baby comes off during a feed, your nipple should look rounded and not flattened or lipstick-shaped. If your nipple is misshapen, you need to adjust your baby’s position to improve their attachment.

For more information about attachment, please visit:

www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/off-to-the-best-start

www.globalhealthmedia.org/videos/attaching-your-baby-at-the-breast   

For further UNICEF resources, please visit: 

www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources

Breastfeeding your baby - the right amount

A baby’s stomach is very small when they are born (approximately the size of a cherry), so they need to feed little and often.

Day one

 

Day three

 

One week

 

One month

Size of a cherry

Size of a walnut

Size of an apricot

Size of a large egg

5-7ml/0.2oz

22-27ml/0.75-1oz

45-60ml/1.5-2oz

80-150ml/2.5-5oz

 

All parents and babies are different, and you and your baby will work out your own feeding pattern together. Both the length of time between feeds and the length of an individual feed can vary. However, breastfed babies normally feed 8 to 12 times in 24 hours, with each feed lasting between 5 and 40 minutes.

When your baby comes off the breast, offer your other breast. If your baby has had enough milk and is content, they may not want to feed from the other breast during this feed. This is normal. If this is the case, remember to start with this breast at the next feed.

It is important to feed your baby during the night as this is when levels of your milk-making hormone prolactin are higher which supports your milk supply.

If your baby ‘cluster feeds’ (feeds very frequently), at certain times of the day and goes longer between feeds at other times this is normal.

It is important to note that you cannot overfeed a breastfed baby or spoil your baby with cuddles, so do not worry about feeding your baby whenever you want to or whenever your baby is hungry or in need of comfort. If your baby feeds all the time and you are worried, speak to a midwife, health visitor or breastfeeding specialist. You may need some help with positioning and attachment.

Your let down reflex.

During the first few days after giving birth, the volume of milk (colostrum) you make will be small to match your baby’s small tummy size. After the first few days, your milk will come in and the volume of milk you produce will increase. Your baby will also develop a more rhythmic suck-swallow pattern.

When your baby breastfeeds, the hormone oxytocin is released, this causes the muscles in your breasts to squeeze milk towards your nipples. This action is called the ‘let-down reflex’. You may feel the let-down reflex as a mild to strong tingling feeling or feel nothing at all.

At the beginning of a feed, your baby will make quick, shallow sucks to stimulate your let-down reflex and encourage your milk to flow. Once your milk starts to flow, your baby will take one or two deeper sucks before swallowing. If you listen carefully, you may be able to hear your baby swallowing or breathing out after they have swallowed. After breathing out, your baby will breathe in and swallow again, repeating the feeding cycle.

If your baby seems to be falling asleep before the ‘deep swallowing’ stage of a feed, or is sucking three or four times before swallowing, ask your midwife or health visitor to check your baby’s positioning and attachment. Your baby may not be effectively attaching to your breast. You may also wish to ask for help and support if your let-down reflex is too strong and causes your baby to cough or splutter.

Your ‘let-down reflex’ may also be triggered at other times, for example when your baby cries, when you are thinking about your baby or when you are having a warm bath or shower.   

Signs that your baby is getting enough breast milk.

When you first start breastfeeding, you may wonder if you are producing enough milk for your baby. This is normal and it can take a while to feel confident that your baby is getting what they need.

You can use the guide below to see if breastfeeding is going well or if you would benefit from some support from your midwifery or health visiting service.

 

Signs that breastfeeding is going well.

 

Signs that breastfeeding may not be going well.

Talk to a member of your midwifery or health visiting service.

Your baby is alert, has good muscle tone and is a normal skin colour.

 

Your baby is sleepy, floppy or appears jaundiced (a yellow discolouration of the skin, whites of the eyes, gums, or roof of the mouth).

Your baby has at least 8 to 12 feeds in 24 hours.

Your baby has less than 8 feeds in 24 hours.

Your baby’s suck and swallow pattern is rhythmic, with deep sucks and audible swallows.

Your baby is not sucking frequently during a feed, and you can only hear a few swallows.

During most feeds, your baby feeds for between 5 and 40 minutes.

 

At each feed, your baby consistently feeds for:

  • less than 5 minutes or
  • longer than 40 minutes

Your baby spontaneously comes off your breast at the end of a feed (or does so when you lift your breast).

Your baby always falls asleep on your breast and/or never finishes a feed.

Your baby is calm and relaxed during a feed and content after most feeds.

 

Your baby comes on and off your breast frequently during a feed, and/or is not content after a feed or may refuse your breast.

Your breasts and nipples are comfortable during and after a feed.

 

The shape of your nipple remains the same rounded shape at the end of a feed as it was at the start.

Your breasts or nipples are painful, and the pain doesn’t disappear after your baby’s first few sucks.

Your nipple looks flattened or lipstick-shaped after a feed.

Your baby has the expected number of wet and dirty nappies according to their age.

 

Your baby does not have the expected number of wet and dirty nappies according to their age.

There are no concerns about your baby’s weight gain and/or growth.

There is a concern that your baby is not gaining enough weight or is slow to gain weight.

Your baby is not using a dummy or a teat. You are not using formula milk.

You feel you need to give your baby formula milk and/or a dummy.

Wet and dirty nappies

Your baby’s nappies are a good guide to the amount of milk they are drinking. 

 

When

Wet nappies (wee)

Dirty nappies (poo)

Day 1 

  +

A minimum of 1 wet nappy in 24 hours.

Your baby’s nappy may contain rust (orange-brown) coloured spots of concentrated urine. These are known as urates. At this age, they are not a problem, but if they continue beyond the first couple of days, you should tell your midwife as they can be a sign that your baby is not getting enough milk.

   +

 

A minimum of 1 dirty nappy in 24 hours.

Your baby’s poo will be a dark green or black colour and tar-like. This is known as ‘meconium.’ 

Day 2


 +                                                     

A minimum of 2 wet nappies in 24 hours.

Your baby’s nappy may contain rust (orange-brown) coloured spots of concentrated urine. These are known as urates. At this age, they are not a problem, but if they continue beyond the first couple of days, you should tell your midwife as they can be a sign that your baby is not getting enough milk.

+

 

A minimum of 1 dirty nappy in 24 hours.

Your baby’s poo will be a dark green or black colour and tar-like. This is known as ‘meconium.’ 

Day 3 


+

A minimum of 3 wet nappies in 24 hours.

Your baby’s nappies should feel heavier.


+

 

A minimum of 2 dirty nappies in 24 hours.

Your baby’s poo will change to a brown, green, or yellow colour and be looser in consistency. This is known as a ‘changing stool’.

Day 4

+

A minimum of 4 wet nappies in 24 hours.

Your baby’s nappies should feel heavier.

 

+

                               

A minimum of 2 dirty nappies in 24 hours.

Your baby’s poo will change to a brown, green, or yellow colour and be looser in consistency. This is known as a ‘changing stool’.

Day 5

+

A minimum of 5 wet, heavy nappies in 24 hours.

 

+

 

A minimum of 2 dirty nappies in 24 hours.

Your baby’s poo will change to a yellow colour and should be at least the size of a £2 coin and runny.

By day From day 6


+

A minimum of 6 wet, heavy nappies in 24 hours.


+

 

A minimum of 2 dirty nappies in 24 hours.

Your baby’s poo will be a yellow colour and should be at least the size of a £2 coin and runny.

4 to 6 weeks



+

A minimum of 6 wet, heavy nappies in 24 hours.

After 4 to 6 weeks, when breastfeeding is more established, some babies may go a few days or more without opening their bowels. This is normal.

A breastfed baby is unlikely to become constipated, and when they do poo, it will still be soft, yellow, and plentiful. If you are concerned your baby is constipated, please discuss this with your midwife, health visitor or GP.

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