Frequently asked questions

Please be aware that this is general information. If you are a little worried about your baby please get help from your midwife or medical practitioner. If you are concerned, call 111 for NHS advice, or visit A&E with your baby if necessary.

If you have a specific question about feeding that isn’t answered here or you just need more information, please feel free to call or email me. I do not charge for an initial conversation.

My baby won't latch onto the breast

As a starting point, try placing your baby in skin to skin contact with her body lying on top of yours in a laid back position. Many babies seek the breast and latch on this way with relatively little help. Click here to find out more.

Is baby lined up correctly? Baby needs to be placed so that he can get onto the nipple without turning his head or pulling on the nipple. Take a good look at where the nipple belongs without you holding it, and move your baby so that he is right beside it.

Have a look at the nipple. If it is large and flat or inverted, baby may need more of a teat shape to suck on. Try shaping the nipple with one hand while bringing your baby on quickly with the other.

Be quick – when your baby has his mouth open bring him onto the breast quickly and deeply.

When your baby is on well his cheeks will touch the breast evenly on either side and you shouldn’t see much (if any) of the coloured part of your nipple. You should see him sucking and swallowing – his chin and jaw will move rhythmically and he will “huff” out of his nose as he swallows.

Is your breast hard and engorged with milk? You might need to hand express or use a pump to soften the nipple enough for baby to get on effectively.

It is 2am and my baby is screaming for food but won't breastfeed. What shall I do?

Try to calm your baby before attempting to feed. If none of the tricks above work, try expressing milk by hand or pump and feeding it to your baby in a sterilised baby feeding bottle. If you have no success with expressing milk, give your baby some newborn (number 1) formula milk from a bottle. Call me or your midwife in the morning.

My baby is sleepy and won’t wake for feeds

As a rule of thumb, a newborn baby should really be waking for food within 2.5 – 4 hours of his last feed, or sooner.

If your newborn baby is sleepy and doesn’t wake for feeds, you will need to wake him. Try undressing him, change his nappy, even put a cold flannel on him. Baby might feed even when not fully awake. If baby won’t feed, or feeds lethargically for a couple of minutes and then fall back to sleep, you need some help straight away. It might be necessary to express milk into a bottle (or syringe in hospital) or even feed some formula in order to give baby some energy. Don’t worry, most babies who have had a bottle will return to breastfeeding given some help.

Your baby could be dehydrated if:

  • He is very drowsy or hard to wake
  • He has not had a wet nappy for more than 6 hours
  • He has concentrated or smelly urine
  • Orange or pink crystals have appeared in his nappy
  • His mouth and lips are dry
  • The fontenelle on the top of his head is sunken
  • His skin looks “baggy” and stays pinched-looking if you gently squeeze it

If you suspect your baby is dehydrated please seek urgent medical help. Baby needs milk from a bottle as soon as possible. In many cases, one or two bottles of expressed milk or formula will help to restore his energy levels and allow you to restart breastfeeding.

IF YOUR DEHYDRATED BABY WILL NOT DRINK AT LEAST 1 oz (30 mls) of any milk then he may need to be admitted to hospital. Please do not delay ringing the hospital or emergency services for advice, even in the middle of the night.

My nipples are really sore!

This is most often caused by incorrect positioning (and the excessively long feeds that go with it!); often your baby is pulling at the breast or not getting enough breast tissue into his mouth. Baby needs to be really close, so that you can barely see the coloured part of your nipple. Your breast tissue shouldn’t be pulled in any direction, so take a look to see if it is moving as baby sucks. If it is pulling to one side, or above or below, move baby towards the pull and notice how that feels. If it still hurts, enlist some help.

Is baby tongue-tied?

Sometimes a baby might not be attaching well because of a tongue tie or confusion over how to use his tongue. If you rub your finger on baby’s bottom lip, he should be able to extend his tongue past his bottom gum. Sometimes you will notice that your baby’s frenulum (the thin piece of skin between the bottom of the tongue and floor of the mouth) is attached close to the end of the tongue, which might give a little v-shaped indentation in the tip of the tongue. Babies with tongue tie need help to get a good feeding position, and sometimes a routine medical procedure is performed to snip the tie and allow full movement of the tongue.

Click here to find out more

Are you a qualified tongue-tie practitioner?

While I can often assist in the diagnosis of tongue-tie, I am not trained to release tongue-ties in your home. I can recommend a number of local qualified tongue-tie practitioners, or you might like to use this site by clicking here

My breasts are huge, full, hot and heavy

This could be engorgement, most common on day 3-5 post birth but possible at other times, for example when reducing the number of breastfeeds in day. It is often a sign that baby is not in step with the stage of lactation, but can occur when feeds are delayed or restricted, or if baby is not well attached and able to drain the breasts.

You might get some relief with cold flannels, or cabbage leaves from the fridge, on the breasts. If you are not deliberately weaning, baby needs to feed frequently. It might be necessary to drain off some milk through gentle expressing, perhaps in order to soften the breasts so that baby can attach well. This is unlikely to over-stimulate your supply. If the problem is severe it is necessary to use a pump to empty the breasts before it becomes to difficult for your baby or the pump to remove the milk. It is possible to freeze excess milk in a breast milk freezer bag for up to 6 months.

Kelly Mom Engorgement resource
La Leche Engorgement resource

I feel like I have flu

If in hospital, tell your midwife. If at home, get to the GP straight away or call 111 out of hours. If you also have sore lumps or a red flush to the breast, you might have mastitis. Click here for more information. If you have mastitis you will be encouraged to keep feeding or expressing from the affected breast.

If your vaginal blood loss is suddenly heavier or smelly there might be an infection; likewise if your caesarean scar or wound is infected. This needs urgent medical attention.

I don't have enough milk

A normal baby will be:

  • gaining weight (at least 20+ grams per day from Day 7. It is normal to some weight in the first week (up to 10% of birth weight)
  • alert and has a firm skin tone and good colour and feeds 8-12 times in 24 hours
  • producing plenty of wet and soiled nappies (click here for more information)
  • feeding comfortably for you
  • settling to sleep and waking up hungry sometime later (most likely after 1.5-3 hours)

If baby always seems hungry, even after a feed, then one of several things could be happening. For example, baby might not be effectively draining the milk that is there, so you need some help with positioning or attachment. If this situation has gone on for some time, then milk supply might be low and can often be increased by more frequent well positioned feeding and some expressing. It is possible that baby is having a growth spurt, and your breasts need a couple of days of frequent feeding to catch up with the increased demand.

Click here for a useful resource to start with

Some mums don’t produce enough milk. Please try not to feel guilty and enjoy your happy mixed fed or formula fed baby.

Baby only likes to feed on one side

No two breasts are the same, and some babies have a clear preference. You might need to be sneaky with positions to get baby onto both sides. If baby clearly likes lying on one side, you can always keep him on that side while swapping breasts, e.g. using the “rugby hold”. It is possible that baby has a sore neck from pregnancy or delivery, and it is worth getting that checked, especially if baby always sleeps with his head on one side too.

My baby starts feeding and then gets really uncomfortable

It is possible that discomfort is caused by wind, try winding your baby and carrying on. Some babies get put off if mum has a very fast flow – try expressing for a minute before putting baby on, and/or feed with baby’s head higher than his bottom for example in the laid back positions. For a useful source of information on fast flow click here.

Some babies suffer from reflux, which might show as vomiting or severe discomfort during feeds. Go to the GP for a check up. The NHS website has some useful information on reflux here.

My nipples are sore, itchy and pink, and I have horrible pain during and after feeding

Thrush on the nipples is quite common, especially after antibiotics. Mothers talk about shooting pains, or a feeling of “broken glass” in both breasts during and after feeds, and sore nipples that will not heal. Often baby will have thrush in his mouth too, seen as a white patches on the back of the tongue (which isn’t milk). GPs will prescribe antifungal mediation for both of you. Find out more here.

If feeding has never been pain free, or if the pain is only on one side, it is more likely to be something else such as an issue with the latch. GPs should offer a swab to be sure of the diagnosis before providing anti-thrush mediation. There is a useful flow chart to help you decide whether it is thrush here:

breastfeedingnetwork.org.uk

bestforbabes.org

What should my baby’s nappies look like?

The NCT has useful pictures on what you would expect to find in your baby’s nappy in the first week nct.org.uk.

This table shows how your babies nappies should look in their first month of life if they are feeding properly. Click the image to download a PDF version you can print.

Nappy Filling Guide

How can I best care for my baby at night?

There is a lot of misinformation out there, and it can be very hard for new parents to work out what to do for the best. For evidence based information, try the Lullaby Trust and Basis

There is an easy to read leaflet “Caring for your baby at night” here

The La Leche book “Sweet Sleep” is an excellent resource offering information about various ages and stages.

I am concerned about mediation in my breastmilk

Please talk to your pharmacist about this. There is useful information here as a starting point.

How do I feed my twins or triplets?

Feeding multiple babies can be a joy and a challenge. The best place to start is at the TAMBA website

I have had breast surgery, can I still breastfeed?

I have supported many women after breast surgery, commonly reductions and enlargements. Some women go on to feed their babies with no problem, and others find that additional supplementation with formula is necessary. Some good places to look are:
BFAR
What To Expect

 

My baby is premature

You will receive care and support from your hospital team in breastfeeding and/or expressing milk for your little one. Most London hospitals also have screened donor breastmilk available for vulnerable babies. I have worked with many new mothers in this situation.

Unicef – The Baby Friendly Initiative
Best Beginnings

Hospital grade breastpump hire for home use:
Express Yourself Mums

What about advice online?

Kelly Mom is a recognised source of evidence based information online, and is written by qualified lactation consultants.

NCT has excellent, evidence based online resources.
You can speak to an advisor at NCT on 0300 3300 700.

La Leche offers online and local support.

How can I safely prepare bottles of formula milk for my baby?

Please click here for up to date information on preparing bottles

Which formula milk shall I choose?

Unless advised otherwise by your doctor, choose any cow or goat milk formula that is suitable from birth. It will have a number 1 on the packaging. Other types of formula, including those marketed for “hungry babies” or “anti colic” or “lactose free” are not recommended. Number 1 formula is suitable from birth to twelve months, when your baby may be given full fat cows milk to drink.

For detailed information on each type of formula milk, please visit First Steps Nutrition

 

Do you recommend any local osteopaths for my baby?

Many parents find that gentle osteopathy on their baby can work wonders in helping them to feed, and also in reducing some symptoms such as colic and reflux.

I have worked closely with the brilliant, calm and experienced Mr Alex Jones at Putney Osteopaths for many years, 73 Putney Hill, SW15 3NT www.putneyosteopaths.co.uk 020 8788 7895

There are excellent practitioners at The Putney Clinic, 266 Upper Richmond Road, SW15 6TQ www.putneyclinic.co.uk 020 8789 3881

The Osteopathic Centre for Children is based at 22A Point Pleasant, SW18 1GG, www.occ.uk.com 020 8875 5290. This is a cheaper option, your baby may be treated by a newly qualified osteopath under supervision.

Please feel free to get in touch on 07720 425 897 or send me a message

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