2 Feeding your baby and young child - Public Health Agency
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2 Feeding your baby
and young child
This chapter provides
advice on feeding your
baby and young child,
from the early days
through weaning on
solid food and beyond.
Feeding your baby and the longer you breastfeed, is breastfed. Breastfeeding
the longer the protection lasts. It reduces the risk of sudden infant
Breastfeeding is the healthiest
reduces your chance of getting death (also known as cot death).
way to feed your baby. Exclusive
some illnesses later in life.
breastfeeding (that means
Formula milk cannot give your Breastfeeding also helps
giving your baby breastmilk only,
baby the same ingredients or protect against childhood
with no other food or drink) is
provide the same protection. obesity and diabetes.
recommended for around the
first six months of your baby’s
Breastfeeding helps build a Help with
life. Breastmilk provides all the
strong bond between mother breastfeeding
nutrients your baby needs and
and baby, both physically and
helps to protect them from Midwives, health visitors and
emotionally.
infections and diseases. trained volunteers such as
Breastfeeding significantly peer supporters or voluntary
After six months giving your
reduces the chance of your baby breastfeeding counsellors
baby breastmilk alongside solid
being admitted into hospital to can all offer information
food will help them continue
be treated for a chest infection and practical help with
to grow and develop. The
or a gastric intestinal infection. breastfeeding. Peer supporters
World Health Organization
Ear and kidney infections are are mothers who have
recommends exclusive
also less likely if your baby breastfed their own babies and
breastfeeding for six months,
have had training to help them
and breastfeeding along with
support other mothers. Talk to
solid foods into the second year
your midwife or health visitor
of life and beyond.
about the help that is available
Breastfeeding protects your in your area.
baby from infections and
diseases. It also offers health For more information
benefits for mums. Every day breastfeeding support groups
makes a difference to your baby, in your area visit
www.breastfedbabies.org
22
Breastfeeding
Just like any new skill,
breastfeeding takes time and
practice to work well. In the first
few days, you and your baby will
be getting to know each other.
Any close contact and holding
your baby against your skin can
really help with this.
2
Feeding your baby and young child
The more time you spend with ‘Liquid gold’: the
your baby, the quicker you perfect food for your
will learn to understand each newborn
other’s signs and signals. The Colostrum is sometimes called
next few pages will help you to ‘liquid gold’. This extra-special
understand how breastfeeding breastmilk is full of germ-
works. And remember, it’s OK to fighting antibodies that will
ask for help. help protect your baby against
infections that you have had
Immediately after your baby in the past. The first few feeds
The first few days
is born ‘coat’ your baby’s gut to protect
Each time your baby feeds, they them from germs and reduce
Every pregnant woman has milk
are letting your body know how the chances of them developing
ready for her baby at birth. This
much milk it needs to produce. allergies as they get older.
first milk is called colostrum and
The amount of milk you make
it is sometimes quite yellow in
will increase or decrease in line Later on, your breastmilk will
colour.
with your baby’s needs. Around still contain antibodies, and as
days two to four, you may notice you come across new infections
It is very concentrated, so your
that your breasts become fuller you will have new antibodies
baby only needs a small amount
and warmer. in your milk. This means that if
at each feed, which might
be quite frequent. It is full of you get colds or flu while you
This is often referred to as your are breastfeeding, your baby
antibodies to boost your baby’s
milk ‘coming in’. To keep yourself will automatically get some
ability to fight off infection.
as comfortable as possible, feed immunity from those illnesses.
your baby as often as they want.
Holding your baby against your
Your milk will vary according
skin straight after birth will calm
to your baby’s needs. It will
them, steady their breathing
look quite thin compared with
and keep them warm. It will also
colostrum, but gets creamier as
encourage them to breastfeed.
the feed goes on. Let your baby
Babies are often very alert in
decide when they have had
the first hour after birth and
enough.
keen to feed. Your midwife can
help you with this.
23
Sometimes, breastmilk may You can learn more about You can try feeding lying
leak from your breast. You may breastfeeding from the Public on your side or in a bed or
need to wear breast pads and Health Agency booklet Off to chair, supported in an upright
to change them frequently. If a good start. Ask your midwife position. This will make it easier
you need to quickly stop your for a copy or visit pha.site/good- to hold your baby so their
milk flowing you can apply some start neck, shoulders and back are
pressure to your nipple with supported and they can reach
the flat of your hand for a few First steps: starting to your breast easily. Their head
seconds. breastfeed and body should be in a straight
You might like to watch the line.
In the beginning, it can seem Bump to Breastfeeding video as
that you are doing nothing but you read this part of the chapter Attaching your baby
feeding, but gradually your baby so you can see what to expect. To begin breastfeeding, hold
will get into a pattern of feeding To view this video visit pha.site/ your baby close to you with their
and the amount of milk you bump-to-breastfeeding nose level with your nipple.
produce will settle.
Getting comfortable Let their head tilt a little so the
Your baby will be happier if you top lip can brush against your
keep them near you and feed You can breastfeed in a number
of different positions. Finding nipple. This should encourage
them whenever they are hungry. your baby to open their mouth.
This will quickly help your body one that is comfortable for both
to produce the amount of milk of you will help your baby feed
as well as possible. Once the baby’s mouth is wide
your baby needs. At night, your open, bring them to your breast,
baby will be safest sleeping in chin first, head tipped up and
a cot in the same room as you. If you are lying back in a well-
supported position with your nose clear of the breast. Make
This will make feeding easier sure your baby takes in a large
and will reduce the risk of baby lying on your tummy, they
will often move themselves onto mouthful of breast, not just the
sudden infant death. Try to take nipple. Your nipple should go
each day as it comes. If you are your breast and begin to feed.
towards the roof of your baby’s
very uncomfortable or sore, ask mouth.
for help as soon as possible. Remember at all times to
keep your baby safe. Never
breastfeed your baby lying down The let-down reflex
Health professionals
recommend that babies and on a sofa. Your baby’s sucking causes milk
adults should be given extra stored in your breasts to be
vitamin D. It is recommended Helpful tips squeezed down ducts inside your
that babies who are consuming breasts towards your nipples.
Breastfeeding should feel
less than 500ml of infant comfortable. Your baby should
formula a day are given a This is called the ‘let-down’
be relaxed. You should hear
supplement of 8.5–10mcg of reflex. Some women get a
a soft swallowing. If it doesn’t
vitamin D. If you are not eligible tingling feeling which can be
feel right, start again. Slide
for Healthy Start vitamins, you quite strong, while others feel
one of your fingers into your
can buy vitamin D infant drops nothing at all. You will see your
baby’s mouth, gently break
from your local pharmacy. baby respond and their quick
the suction and try again.
24
sucks change to deep rhythmic baby crying or when you have a
swallows as the milk begins warm bath.
to flow. Babies often pause
after the initial quick sucks If you have any concerns about
while they wait for more milk any of these points, talk to your
to be ‘delivered’. If your baby midwife, health visitor or peer
falls asleep quickly before the supporter.
2
deep swallowing stage, check
that they are properly latched Note that if your baby seems
on. It might be easier to get unusually sleepy and/or is slow
someone else to check for you. to start feeding, they may be ill,
Feeding your baby and young child
Sometimes you will notice your so contact your GP as soon as
milk flowing in response to your possible.
How do I know that my baby
is feeding well?
1
Bring your baby in close to
2
Check their head and body
• Your baby has a large
mouthful of breast.
• Your baby’s chin is firmly
your body so that they don't are in a straight line facing
touching your breast.
have to stretch to reach your the same way as they will be
breast. Support their neck, uncomfortable if they are twisted • It doesn’t hurt you to feed
shoulders and back. Make sure when feeding. Move your baby so (although the first few sucks
their head is free to be able to that they start the feed with their may feel strong).
tilt back. nose pointing to your nipple.
• If you can see the dark skin
around your nipple, you
should see more dark skin
above your baby’s top lip
than below their bottom lip.
3
Starting ‘nose to nipple’ like
4
With the chin firmly touching, and
•
•
Your baby’s cheeks stay
rounded during sucking.
Your baby rhythmically takes
this allows them to reach up with the nose clear, the mouth long sucks and swallows
and get a mouthful of breast is wide open, and there will be (it’s normal for your baby to
from underneath your nipple. much more of the darker skin pause from time to time).
visible above your baby’s top lip
than below their bottom lip – and • Your baby finishes the feed
their cheeks will look full and and comes off the breast on
rounded as your baby feeds. their own.
25
Tips for breastfeeding • Breastfeeding can be a • Try not to give your baby any
• Make sure your baby is well nice chance to sit down and other food or drink before the
attached to your breast (see rest. It can soothe, comfort age of about six months. This
pictures on page 25). This and calm both you and your will reduce your milk supply
will help your body make the baby. and could increase the chance
right amount of milk and stop of your baby getting ill.
your breasts getting sore.
The more you breastfeed How do I know my baby is getting enough milk?
your baby, the more milk • Your baby should be healthy and gaining weight.
you will produce. When your
baby comes off the first • In the first 48 hours, your baby is likely to have only two or
breast, offer the second. It three wet nappies. Wet nappies should then start to become
doesn’t matter if they are more frequent, with at least six every 24 hours from day five
not interested or don’t feed onwards.
for long, or even if they feed
• Most babies lose weight initially. They should be weighed by a
for longer on the second
health professional sometime around day three to five. From
breast. This is fine – just start
then on, they should start to gain weight. Most babies regain
with this breast next time.
their birth weight in the first two weeks.
Sometimes your baby might
seem hungrier than usual • At the beginning, your baby will pass a black tar-like stool
and feed for longer or more (poo) called meconium. By day three, this should be changing
often. Your body responds to a lighter, runnier, greenish stool that is
Colour
automatically and makes easier to clean up. From day four and for guide for a
more milk to provide the extra the first few weeks, your baby should pass baby’s
needed. This is why you can at least two yellow stools every day. These stools for
feed more than one baby at stools should be at least the size of a £2 coin. the first
the same time (see page 27). few days
Remember, it’s normal for breastfed babies to
pass loose stools.
• There is no need to offer
Day 1
formula milk in addition to • Your breasts and nipples should not be sore. If
breastmilk. If your baby feels they are, do ask for help.
hungrier, feed more often,
rather than offer formula milk. • You can look at the feeding checklist in Off to
Days 2–3
a good start if you think your baby isn’t getting
• Breastfeeding mums are enough milk.
now encouraged to practice
responsive feeding. This • Your baby will be content and satisfied after
Day 4
means offering feeds before most feeds and will come off the breast on
crying starts (such as when their own.
your baby is restless or
sucking her fingers). It also If you are concerned about any of these points,
involves offering the breast speak to your midwife or health visitor. After four
for food and comfort, which weeks or so some breastfed babies will only poo
helps maintain a good supply. once every few days and some will occasionally
only poo once a week.
26
• Try not to give your baby a
dummy until breastfeeding is
going well, as this can also
reduce your milk supply.
• If you decide to give formula,
keep your milk supply going
by breastfeeding as much as
possible. 2
Breastfeeding while out and Visit www.breastfedbabies.org to born prematurely and to have
Feeding your baby and young child
about see where your local members a low birth weight, breastmilk
When you are out and about, are. is especially important for their
wear something that will make wellbeing. To start with, you may
it easier for you to breastfeed, Dummies find it easier to feed each of
like a t-shirt or vest top and a Try not to give your baby a your babies separately, until you
cardigan so that you can lift yourdummy until breastfeeding is feel confident about handling
top up from the waist to feed. If established, usually when your them at the same time and
you are worried about showing baby is a about month old. feeding is well established.
your tummy you can wear a belly Using dummies has been shown
band or a second vest. to reduce the amount of milk This may take some time, so it
that is produced. If your baby can be really helpful to accept
The Public Health Agency becomes accustomed to using a any offers of help around the
Breastfeeding Welcome Here dummy while sleeping, it should house from family and friends.
scheme helps support mums not be stopped suddenly in the
who are breastfeeding by first six months. But you should Twins Trust provide information
asking businesses stop using a dummy when your and support on feeding – for
to display a baby is between six and 12 more information visit
sticker which says months old. www.twinstrust.org
breastfeeding
mums are particularly welcome Make sure the dummy is Over time, you will learn what
– look for a pink and white sterilised and don’t dip it in works best for you and your
heart. honey or sugar to make the babies.
baby suck it. They will suck it
anyway. Using sugar will only Triplets can be breastfed either
encourage a craving for sweet two together and then one
things, which are bad for their after, or all three rotated at
teeth. each feed. Alternatively, you can
use a combination of breast
Breastfeeding more than and formula, depending on the
one baby babies and your milk supply. See
page 40 for more on combining
Twins, triplets or more can be breast and formula feeding.
breastfed. Because multiple
babies are more likely to be
27
you still want to give them
breastmilk.
If you have to be away from your
baby – for example, because
your baby is ill or premature, or
because you are going back to
work – you may wish to express
milk so that somebody else can
feed your baby.
How long should I many feeds they need while you
breastfeed? are apart, but it’s often easier to You can express milk by hand
manage than people think. Your or with a breast pump. Different
Exclusive breastfeeding (with
peer supporter, midwife, health pumps suit different women, so
no other food or drink) is
visitor or local support group ask for information to compare
recommended for around the
can explain the options and talk them. A pump needs to be clean
first six months of a baby’s
them through with you. and sterilised each time it is
life. After this, you can carry
used.
on giving your baby breastmilk
alongside other foods for as If you stop breastfeeding, it can
be difficult to restart. Giving Expressing by hand
long as you and your baby want.
formula milk to a breastfed It is usually more effective to
This can be into the second
baby can reduce your supply of express milk by hand than to
year or beyond. For information
breastmilk. See page 40 for more use a pump in the first few
about introducing your baby to
information on combining the two. days. If you want to collect the
solid foods.
milk, you will need a sterilised
Breastfeeding can continue with container. The following
Every day you breastfeed makes
minimal planning and a little suggestions should help:
a difference to you and your
baby. There is no need to decide support for a planned trip (such
1. Before you start, wash
at the beginning how long you as a friend’s hen weekend,
your hands thoroughly then
will breastfeed. Many mothers business trip) or separation from
gently massage your breast
continue to breastfeed if or your baby.
to stimulate the milk to start
when they return to work or flowing.
college. Download the Best Beginnings
Baby Buddy app at
www.bestbeginnings.org.uk STEP 1
To find out more about
breastfeeding and returning
to work, see the Public Health Expressing milk
Agency leaflet Breastfeeding Expressing milk means
and returning to work at removing milk from your breast.
pha.site/breastfeeding-work You may want to express milk
if your breasts are feeling
The practicalities will depend on uncomfortably full, or if your 2. If you are going to collect
how old your baby is and how baby is not sucking well but the milk, use a sterilised jug
or bowl to catch the milk.
28
3. Place your thumb on top of
your breast and the rest of
your fingers below about
2–3 centimetres from the
base of your nipple, with
your thumb and fingers in a
sort of C-shape.
STEP 3 2
Expressing milk if your baby information. Also see the
Feeding your baby and young child
is premature or ill section below for guidance on
It is important to try to express storing breastmilk.
your milk as soon as possible
4. Release the pressure then Your midwife, health visitor or peer
after your baby is born (ideally
repeat, building up a rhythm. supporter can give you practical
within the first two hours of
Avoid sliding your fingers over help and answer any questions.
birth). To ensure that you
the skin. At first, only drops will
produce plenty of milk, you will
appear, but just keep going as Cup feeding
need to express at least eight to
it will help build up your supply.
ten times in 24 hours, including Sometimes, your baby might
With practice, and a little time,
during the night, just as your need some extra milk, or find it
milk will flow freely.
baby might be doing if they were hard to feed from your breast.
STEP 4 able to feed directly. Ask the In this case, your midwife might
hospital staff about having skin- suggest that you give your baby
to-skin contact with your baby. some expressed milk in a cup.
This will help with bonding and Ask her to show you how. In this
keeping up your milk supply. way, your baby is able to taste
and begin drinking your milk.
5. When no more drops are Hospitals often have machines You should not pour milk directly
coming, move your fingers for expressing milk, and will into your baby’s mouth.
round to try a different section show you how to use one. If you
of your breast and repeat. go home from hospital before Storing breastmilk
your baby you may need to use You can store breastmilk for up
6. When the flow slows down, an electric breast pump for to five days in the fridge at 4ºC
swap to the other breast. many weeks. You can borrow a or lower. This means putting
Keep changing breasts until breast pump from Tiny Life, the the milk in the coolest part of
the milk is dripping very premature baby charity. Contact
slowly or stops altogether. them on 028 9081 5050 or
visit tinylife.org.uk
7. If the milk doesn’t flow, try
moving your fingers slightly
If you are freezing breastmilk
towards the nipple or further
because your baby is premature
away, and try giving your
or ill, ask the staff caring for
breast a gentle massage.
your baby for support and
29
the fridge, usually at the back or defrost breastmilk as this can This can happen very suddenly.
(do not keep it in the door). alter the proteins in your milk and It is very important to carry on
Breastmilk can be frozen in a there is a risk of scalding. breastfeeding as this will help
domestic freezer for up to three you get better more quickly.
months. Breastmilk should be Some common
labeled with the date and time breastfeeding problems and Sore or cracked nipples
expressed. Breastmilk should be how to solve them If your nipples hurt, take your
given at around the same time baby off the breast and start
of day it was expressed. Tender breasts, blocked ducts again. If the pain continues
and mastitis or your nipples start to crack
Breastmilk must always be Milk can build up in the ducts for or bleed, ask for help so you
stored in a sterilised container. If a variety of reasons. The most get your baby latched on
you use a pump, make sure you common are wearing a too- comfortably.
wash it thoroughly after use and tight bra, missing a feed, or a
sterilise it before use. blow to the breast. It’s important It can sometimes take a little
that you deal with a blocked while to sort out how to prevent
Milk should be defrosted in the duct as soon as possible so the soreness, but it is important to
fridge. Once it’s defrosted, you that it doesn’t lead to mastitis get support as soon as possible.
will need to use it straight away. (inflammation of the breast).
The following suggestions may
Milk that has been frozen is still If you have mastitis, your breasts also help:
good for your baby and better will feel hot and tender. You may
than formula milk. Milk should not see a red patch of skin which • try squeezing out a drop or
be refrozen once thawed. Don’t is painful to touch. You can feel two of your milk at the end
use a microwave oven to warm quite ill, as if you have flu, and of a feed and gently rubbing
you may have a temperature. it into your skin;
Helpful tips with mastitis • while your baby is feeding, gently stroke the
lumpy area with your fingertips towards your
If you think you might have mastitis (or a
nipple - this should help the milk to flow;
blocked duct), try the following:
• get lots of rest - go to bed if you can;
• take extra care to make sure your baby is
attached well to your breast; • take a painkiller such as paracetamol;
• feed your baby more often; • ask for help with how you get your baby
latched on properly (see page 25 for
• let your baby feed on the tender breast first;
information);
• if your breasts still feel full after a feed, or
• mastitis may also be a sign of infection. If
your baby cannot feed, express your milk
there is no improvement within 12 to 24
(see page 28 for more information on how
hours, or you start to feel worse, contact
to do this);
your GP or healthcare professional.
• warmth on your breast before a feed can
help milk flow and make you feel more If necessary, they can prescribe antibiotics that
comfortable; are safe to take while breastfeeding.
30
infection known as thrush. Ask
for help to check that your baby
is latched on properly, and make
an appointment with your GP.
You can obtain more information
on breastfeeding and thrush from
www.breastfeedingnetwork.org.uk
You and your baby will both 2
need treatment. You can easily
give thrush to each other, so if
Feeding your baby and young child
your baby has it in their mouth
they will need oral gel and you
will still need some cream for
• let your nipples dry before Put the ointment on the your nipples to stop it spreading
covering them; crack (rather than the whole to you. You may want to ask
nipple) to help it heal and your pharmacist for advice.
• if you are using breast pads, prevent a scab forming. Some antifungal creams can be
they need to be changed
bought over the counter from a
at each feed (if possible, It can be hard to ask for help, pharmacy.
use pads without a plastic but tackling any problems as
backing); soon as they start will give Tongue-tie
you more time to enjoy these Some babies are born with a
• avoid soap as it dries your
early days. In lots of cases, tight piece of skin between the
skin out;
the solution is as simple as underside of their tongue and
• wear a cotton bra, so air can changing your baby’s position the floor of their mouth. This is
circulate; slightly or feeding them a bit known as tongue-tie, and it can
more often. sometimes affect feeding by
• some mothers treat any
making it hard for your baby to
cracks or bleeding with a Unsettled feeding attach to your breast. Tongue-tie
thin smear of white soft If your baby is unsettled at does not always need surgical
paraffin or purified lanolin. the breast and doesn’t seem treatment.. But if after getting
satisfied by feeds, it may be that help with positioning and
they are sucking on the nipple attachment it is still difficult to
alone, and so are not getting achieve pain free breastfeeding,
enough milk. Ask for help to get it could be helpful to be
your baby into a better feeding assessed to see if getting the
position. tongue-tie snipped would help.
If you have any concerns talk
Thrush to your midwife or health visitor
If you suddenly get sore, bright and if necessary ask to be seen
pink nipples after you have by a breastfeeding specialist
been feeding without problems within your Health and Social
for a while, you might have an Care Trust.
31Staying healthy
You don’t need to eat
anything special while you are
breastfeeding, just make sure
you have a varied and balanced
diet.
• plenty of fibre, found in
Helpful tips
Your milk is good for your baby wholegrain bread and
whatever you eat, but there are breakfast cereals, pasta, rice, • Eat when you feel hungry,
foods to avoid (see page 33). pulses (such as beans and and choose healthy snacks.
Being a new mother is hard lentils), fruit and vegetables; • You will probably feel
work though, so it’s important to after childbirth, some women quite thirsty. Have a drink
look after yourself and try to eat experience bowel problems beside you before you sit
as varied and balanced a diet as and constipation – fibre down to breastfeed.
you normally would. Aim to eat helps with both of these;
• Try to eat a wide variety
healthily as a family. A healthy
• protein, such as lean meat of foods.
range of food includes:
and poultry, fish, eggs and • Try not to restrict your
• at least five portions pulses; diet unless you think a
of a variety of fruit and food is upsetting your
vegetables a day (including • at least two portions of fish
each week, including one baby. Always talk to your
fresh, frozen, tinned, dried health visitor or doctor
and juiced); portion of oily fish;
before cutting out foods.
• a low alcohol intake as • dairy foods, such as milk,
alcohol in breastmilk can cheese and yogurt, which Healthy snack ideas
affect your baby’s feeding contain calcium and are a
The following snacks are quick
or sleeping; avoid drinking useful source of protein.
and simple to make and will give
alcohol shortly before you the energy and strength you
feeding your baby; It’s also important to drink plenty
need:
of fluid. Aim for at least 1.2 litres
• not too much strong tea or (six to eight glasses) each day. • Fresh fruit.
coffee; It’s a good idea to have a drink
beside you when you settle
down to breastfeed. All non-
achoholic drinks count towards
your fluid intake, but milk and
water are your best choices.
To find out more about • Sandwiches or pitta bread
healthy eating, go to filled with salad vegetables,
• starchy foods such as pha.site/healthy-eating grated cheese, salmon or
wholemeal bread, pasta, sardine or cold meat.
rice and potatoes;
• Yogurt and fromage frais.
32• Hummus and bread or professionals recommend that drops for your child and these
vegetable sticks. everyone aged five years and contain vitamin D. If you are not
over should consider taking a getting Healthy Start vouchers
• Ready-to-eat dried apricots, vitamin D supplement during the you can ask your local pharmacist
figs or prunes. winter months (October to late about buying a suitable vitamin
• Vegetable and bean soups. March/April). D supplement for your baby. You
can find out more about vitamin D
2
• Fortified unsweetened Breastfed babies from birth from the PHA leaflet at
breakfast cereals, muesli to one year of age should be pha.site/vitamin-d-and-you
or other wholegrain cereals given a daily supplement of
with milk. 8.5–10 micrograms of vitamin Foods to avoid
Feeding your baby and young child
D throughout the year to make Breastfeeding mums should
• Milky drinks. sure they get enough, as eat no more than one portion
• Baked beans on toast or their bones are growing and a week of shark, swordfish
baked potato. developing very rapidly in these or marlin. These types of fish
early years. contain high levels of mercury.
Vitamin D Don’t eat more than two
Babies fed infant formula portions of oily fish per week.
Vitamin D is an essential vitamin will only need a vitamin D
for everyone, to help develop Oily fish includes salmon,
supplement if they are receiving mackerel, sardines and trout.
and maintain healthy bones, less than 500ml (about a pint)
teeth and muscles. Fresh tuna was classified as an
of infant formula a day, because oily fish until recently. Recent
infant formula has vitamin D studies have shown the fish oil
Babies and young children who added during processing.
don’t get enough vitamin D content of fresh tuna is similar
before they are born or in their to that of white fish.
Children aged 1 to 4 years
early lives, can be at risk of require a daily supplement of
developing rickets, which causes Small amounts of whatever you
vitamin D throughout the year. are eating and drinking can
weak and badly formed bones.
We get vitamin D mainly from pass to your baby through your
If you are eligible for Healthy breastmilk, so it’s a good idea to
sunlight and a small amount Start you can obtain free vitamin
from certain foods, but health think about how much alcohol
and caffeine you are having.
These may affect your baby in
the same way they affect you.
If you think a food or foods that
you are eating are affecting your
baby, talk to your GP or
health visitor, or contact the
National Breastfeeding Helpline
on 0300 100 0212.
33Alcohol amount of alcohol your baby If it’s a special occasion and
Generally, adult women should gets through your breastmilk. you know you are going to be
not regularly drink more than It is not safe to get drunk when drinking, consider expressing
two to three units of alcohol per you are caring for your baby milk in advance.
day. During pregnancy, women – whether they are breast or
are advised to avoid drinking. If formula fed. To reduce the exposure of your
they do drink, they are advised baby to alcohol:
to drink no more than one to One unit of alcohol is
approximately equal to a 25ml • avoid breastfeeding for at
two units once or twice a week, least two to three hours
and are advised not to get measure of spirits, half a pint of
beer, or half a 175ml glass of after drinking;
drunk.
wine, although it depends on the • have your drink after the last
When you breastfeed, you strength of the drink. feed of the day – if you can
are giving your baby the predict when that will be!
best possible start in life. It’s The website pha.site/alcohol-
very unlikely that having an units contains more information Caffeine
occasional drink will harm you or on units, including the units
found in typical drinks. Caffeine occurs naturally in lots
your baby. However, we do know of foods and drinks, including
that alcohol passes through to coffee, tea and chocolate.
the baby in very small amounts. If you drink alcohol and
breastfeed, it can affect your It’s also added to some soft
So when breastfeeding it is drinks and energy drinks and
sensible to drink no more than baby in a number of ways:
to some cold and flu remedies.
one or two units once or twice a • your milk may smell different In the early days, it is important
week. and put your baby off that you don’t have too much
feeding; caffeine. Try decaffeinated tea
If you have drunk more than and coffee, fruit juice or mineral
one or two units, it is worth • the alcohol may make your water and limit the number of
remembering that the level baby too sleepy to feed; energy drinks, which might be
of alcohol in your breastmilk high in caffeine.
reduces in the same way as it • your baby may have
does in your body – so waiting difficulties with digestion
an hour or more will reduce the and problems with their
sleeping patterns.
34Smoking You can also speak to your in their breastmilk increased the
Smoking is bad for you, bad for GP or community pharmacist chance of the baby developing
your partner and especially bad about the nicotine replacement a peanut allergy. But this advice
for your baby. One of the best therapy available to help you has been changed because the
things you can do for your own manage your cravings and latest research shows that there
and your baby’s health is to stop become smoke free. is no longer clear evidence to say
smoking. that eating or not eating peanuts
Each year, more than 17,000
Peanuts
Peanuts are one of the most
while breastfeeding has any
effect on your baby’s chances of 2
children under the age of common causes of food allergy developing a peanut allergy.
Feeding your baby and young child
five are admitted to hospital (see page 66). Peanut allergy
because of the effects of affects about 1% of people and
second-hand smoke. can cause severe reactions.
Your baby may be at higher risk
Avoid smoking in the home of developing a peanut allergy if
or car, and ask your partner, you, the baby’s father, brothers
friends and family to do the or sisters have a food allergy
same when they are around or other allergic condition such
your baby. as hayfever, asthma and/or
eczema.
If you do smoke and you
are finding it difficult to quit, If you would like to eat peanuts
breastfeeding will still protect or foods containing peanuts
your baby from infections and (such as peanut butter) while
give them nutrients they cannot breastfeeding, you can choose
get through formula milk. to do so as part of a healthy
Smoking after feeds, rather than balanced diet, unless you are
before, will help reduce your allergic to them or your health
baby’s exposure to nicotine. professional advises you not to.
You may have heard that If you have a child under
some women have, in the past, six months and are not
chosen not to eat peanuts while breastfeeding (for example
they were breastfeeding. This because you are feeding your
is because the government baby on formula), then there is
previously advised women no reason why you should avoid
that they may wish to avoid consuming peanuts or foods
eating peanuts while they were containing peanuts.
breastfeeding if there was a
history of allergy in their child’s If you have any questions or
You are up to four times immediate family (such as
more likely to stop smoking concerns, you should discuss
asthma, eczema, hayfever, food these with your GP, midwife,
successfully with support. Visit allergy or other types of allergy),
www.stopsmokingni.info for health visitor or other health
in case small amounts of peanut professional.
further information.
35Medicines and Medicines that can be taken • hayfever medicines such as
breastfeeding while breastfeeding include: Clarityn and Zirtek;
Many illnesses, including • most antibiotics; • cough medicines (provided
depression (see page 18), they don’t make you drowsy);
can be treated while you are • common painkillers such as
breastfeeding without harming paracetamol and ibuprofen • asthma inhalers;
your baby. Small amounts of (use with caution when
breastfeeding – speak to • normal doses of vitamins.
whatever medicines you take
will pass through your breastmilk pharmacist before purchase.
The lowest dose should You can use some methods of
to your baby, so always tell your
be used for the shortest contraception but not all, so check
doctor, dentist or pharmacist that
duration. Aspirin should not with your GP or pharmacist. Some
you are breastfeeding.
be used; cold remedies are not suitable.
Over the counter medicines for minor ailments when breastfeeding
• Make sure the medicine is safe to take when breastfeeding.
• Watch your baby for side effects such as poor feeding, drowsiness and
irritability. Stop taking the medicine if your baby gets side effects.
• For further information speak to your pharmacist.
Minor ailment First choice Second choice Do not use
Constipation Eat more fibre Bisacodyl
Bulk laxatives that contain ispaghula Senna
Lactulose (occasional use only)
Cough Honey and lemon in hot water Medicines that contain
Simple linctus codeine (co-codamol, co-
dydramol) or guaifenesin
Diarrhoea Oral rehydration sachets Occasional doses of loperamide
Haemorrhoids (piles) Eat more fibre Soothing creams, ointments,
Bulk laxatives that contain ispaghula suppositories or ice packs
Lactulose
Hayfever, house Antihistamine eye drops or nasal sprays Antihistamines – cetirizine Other antihistamines unless
dust mite and Steroid nasal sprays or loratadine. Do not use advised by your doctor
animal hair allergy antihistamines that cause you
to feel drowsy if caring for your
baby.
Head lice Wet combing If ineffective, then head lice
Dimeticone lotion lotions
Indigestion Antacids (indigestion mixtures) On your doctor’s advice: medicines
that reduce acid production, for
example omeprazole
Nasal congestion Steam inhalation Oxymetazoline or Medicines that contain
(stuffy or xylometazoline nasal sprays phenylephrine
runny nose) (maximum of seven days)
Pain Paracetamol Ibuprofen (use with caution Medicines that contain aspirin
(headache, mastitis, when breastfeeding - speak to Medicines that contain codeine
toothache) pharmacist before purchase. The (co-codamol, co-dydramol),
lowest dose should be used for unless advised by your doctor
the shortest duration)
Threadworms (treat Mebendazole
whole household)
Vaginal thrush Clotrimazole pessaries or cream Fluconazole
36It’s fine to have dental • preparing meals and doing being removed regularly
treatments, local anaesthetics, the housework so you can either by breastfeeding or
injections (including mumps, concentrate on feeding your expressing. Long periods
measles and rubella (MMR), baby; between expressing or
tetanus and flu injections) and feeds may lower milk supply.
most types of operations. You • encouraging you, particularly
can also dye, perm or straighten when you are very tired or Knowing what helps
your hair, use fake tan and wear finding things difficult;
false nails. • protecting you from
There are very few women who
cannot breastfeed for medical 2
others’ opinions about reasons. However, many women
Illegal drugs are dangerous breastfeeding which may be
Feeding your baby and young child
experience difficulties if the
for your baby, so talk to your undermining. baby is not latched onto the
midwife, health visitor, GP or for breast properly.
more information go to pha.site/
drugs-in-breastmilk, or call the How partners can help
The more often your baby
Drugs in Breastmilk Helpline on After the first few weeks when breastfeeds the more milk will be
0844 412 4665. breastfeeding is going well, you made – it works on supply and
might decide to express some demand. Most babies will want to
Your GP or pharmacist may milk so someone else can help feed frequently, especially in the
like to look at the information with an occasional feed. first weeks, so some feeds will
from the National Formulary for seem very close together.
Children (bnfc.nice.org.uk) to see Expressing milk can be done by
what medicines can be given to hand or, more usually, by using a You and your partner may worry
babies and children, as these are pump to collect milk from that your baby is not getting
likely to be safe for mothers to the breast and store it in a enough milk because you can’t
take when breastfeeding. bottle. Your health visitor or measure the amount they get.
community midwife will be able
What partners to give advice on this. See also
should know about www.breastfedbabies.org
breastfeeding
The partner’s support is vital It’s important to remember:
to helping you continue to • Breastfeeding must be
breastfeed, as they can help by: well established before a
• making sure mother and baby bottle is introduced as some
are comfortable while feeding; babies can get confused
or develop a preference for
• explaining to family and the bottle. This is because
friends about the importance the sucking action required
of breastfeeding; to feed from a bottle is
different to that used to feed
• bringing you a drink or a from the breast.
healthy snack to eat, such
as a piece of fruit or a slice • Maintaining a good milk
of toast; supply depends on milkBut if they are having wet and How partners can get
dirty nappies and gaining weight involved
at a normal rate, that means If your baby is breastfed it is
they are getting enough. important for you to feed baby
initially, but partners can be
In fact, as your baby gets both a involved in many other ways
drink and food from the breast, caring for and being close
there is no need for anything to the baby. Here are some
else for the first six months. suggestions that your partner
might like to try:
You and your partner may
feel self-conscious about • change the baby’s nappy;
breastfeeding in public but it
can be done without anyone • settle the baby after a feed
noticing. You can lift your top by winding them;
from the waist and perhaps • hold and soothe the baby;
use a blanket, scarf or shawl. It
can look as if your baby is just • play with the baby;
having a cuddle.
• place the baby on their
Breastfeeding is sometimes bare chest for skin-to-skin energy to make love, but it is
used as a method of contact; possible for you both to enjoy
contraception. If you definitely an active sex life.
• give the baby a massage;
don’t want to have another
baby just yet, it is best to use • carry the baby in a sling or It is a good idea for you to feed
other more reliable methods of baby carrier; the baby first so that you are
contraception which are suitable more comfortable, your baby is
while breastfeeding. • talk, read and sing to the settled and you are less likely to
baby; be disturbed by them crying.
Keeping mother and baby • take the baby for a walk in
together at night is important as Remember that breastfeeding
the pram;
it makes it easier for you to feed may make your breasts feel
baby in a responsive way. • bath the baby. more sensitive.
Breastfeeding is handier than Your partner and your baby
Your relationship with your
bottlefeeding at night and when partner The more your partner gets
away from home as there’s no involved with caring for your
need to worry about keeping Some parents worry that
baby, the more quickly they
milk fresh and heating bottles, breastfeeding will affect the
will develop a strong bond. Try
plus it’s free – bottlefeeding a physical side of their relationship
to enjoy this time – it is busy
baby can cost over £800 a year. with their partner. Some women
and tiring but the rewards
You will lose weight more lose interest in sex after having
are amazing and it won’t last
quickly after the birth if you a baby and for most couples it is
forever!
breastfeed. difficult to find the time and
38Breastfeeding help and 9.30pm) or go to the website All these voluntary organisations
support at www.nationalbreastfeeding provide training for peer
helpline.org.uk supporters.
Don’t be afraid to ask for the
support and information you need You can also get information The Bump to Breastfeeding (Best
to make breastfeeding work for online from the Association Beginnings) video is a useful
you and your baby. No problem is of Breastfeeding Mothers source of information and will give
too small – if something is worrying (www.abm.me.uk) and the you an insight into other mothers’
you, the chances are that other
mothers will have felt the same.
Breastfeeding Network (www. experiences of breastfeeding. You 2
breastfeedingnetwork.org.uk). The can view this video online at pha.
Breastfeeding Network runs a site/bump-to-breastfeeding
Feeding your baby and young child
You can get help from a peer
Support line on 0300 100 0210,
supporter, your midwife or health Informal sharing of breastmilk
and also offers a helpline for
visitor. You might also want to join Informal milk sharing involves
speakers of Bengali/Sylheti on
a local breastfeeding group. It’s a a mother providing extra
0300 456 2421. Lines are open
great way of making new friends expressed breastmilk to another
from 9.30am to 9.30pm.
as well as sharing the ups and mother who may have low
downs of looking after a new baby. For breastfeeding information visit milk supply. This practice is
Most groups usually include a mix the Public Health Agency website not recommended as human
of healthcare professionals and www.breastfedbabies.org milk obtained from outside
local trained volunteer mothers the Northern Ireland Human
(peer supporters). These mothers The following voluntary Milk Bank carries risks as it
have breastfed their own babies organisations can also provide will not have been processed
and have had some training in information: in a way that follows accepted
basic breastfeeding techniques. guidelines. There are significant
Some peer supporters will have La Leche League
risks associated with using
had more in-depth training to help 0845 120 2918
informally shared human milk
them support new mothers. www.laleche.org.uk
as it could be contaminated
NCT (formerly the with disease causing bacteria; it
There may be specialist drop-ins
National Childbirth Trust) may contain viruses as a result
in your area where you can go if
Breastfeeding Line of the mother having unknown
you have a specific concern or
0300 330 0771 infections such as HIV, hepatitis;
difficulty.
www.nct.org.uk and it may contain medications
A list of breastfeeding groups for taken by the mother as well
Northern Ireland can be found The Unicef Baby Friendly site as alcohol, nicotine, drugs and
on www.breastfedbabies.org or at www.unicef.org.uk provides other contaminants.
ask your midwife or health visitor information and links to useful
about your local group. resources about many aspects of Any mother experiencing
breastfeeding. difficulties with milk supply should
To find out what is available in talk to a midwife or health visitor.
your area, talk to your midwife The Breastfeeding Network’s With good support it is very
or health visitor, or contact the Drugs in Breastmilk Helpline possible to increase a mother’s
National Breastfeeding can provide information about milk supply to meet the needs of
Helpline on 0300 100 0212 breastfeeding and medicines. Call her baby.
(lines are open from 9.30am to 0844 412 4665.
39So give yourself plenty of time cuddling your baby in close
for the change, and cut out contact (skin-to-skin) as much
one feed at a time. Try the first as possible gives you and your
formula feed when your baby is baby the time and opportunity
happy and relaxed – not when for breastfeeding to happen as
they are very hungry. It may help easily as possible.
if someone other than you gives
the first feeds, so that your baby This stage can take some time,
is not near you and smelling with your baby building up feeds
your breastmilk. It may take your little and often. This boosts your
Different feeding baby a little time to get used to supply. When your baby comes
situations the new arrangements. So keep off the first breast, offer the
Some mothers breastfeed trying, stay calm and don’t force it. second. It doesn’t matter if they
whereas other mothers use are not interested or don’t feed
infant formula, and some If you are making these changes for long. This is fine – just start
mothers use a combination. because you are going back with that breast next time. Talk
There are several different ways to work, make sure you start a to your midwife, health visitor or
of doing this: few weeks before you are due peer supporter about ways to
to go back. However, don’t feel reduce the amount of formula or
• you can express breastmilk you have to stop breastfeeding expressed milk.
to be given by bottle; if you are returning to work.
Depending on what age your If you have been expressing
• you can introduce infant
baby is, they may take milk milk for most of your baby’s
formula but carry on
from a cup while being cared feeds, it is often helpful to carry
breastfeeding;
for by someone else and you on so you keep your supply high
• you can introduce can breastfeed when you are at during this transition period.
infant formula and stop home with your baby.
breastfeeding; Types of milk to avoid
Changing from breast to formula Cows’ milk should not be given
• depending on the age of feeding can be an emotional as a main drink to a child under
your baby, they may take the time for you. It’s best to do it the age of one year. Small
milk in a cup. gradually to give yourself time amounts of cows’ milk can
to adapt and your body time to be used in the preparation of
Introducing infant formula reduce the amount of milk it foods and for cooking after
Introducing infant formula will makes. six months of age. Condensed
reduce the amount of breastmilk milk, evaporated milk, dried milk,
you produce. This may make Increasing the amount of sheep’s milk, or any other type
breastfeeding more difficult. breastmilk you make of drinks (such as rice, oat or
If you have had a difficult start almond drinks, often known as
Most mothers find it easier, ‘milks’) should never be given
or have changed your mind and
more comfortable and less to a baby under the age of one
want to start breastfeeding,
likely to cause mastitis (painful, year. You should not use soya
talk to your midwife, health
inflamed breasts) if they formula unless it has been
visitor or peer supporter about
gradually stop breastfeeding. prescribed by your GP.
what you can do. Holding and
40Follow-on formula should never standards for what they contain.
be fed to babies under six months More expensive brands still have
old and there is no need to switch to meet the same standards
to these milks after six months. as cheaper brands. To find out
more about infant formula visit
Some follow-on formula has www.firststepsnutrition.org
cereal added to it, and is
2
described as a ‘night-time feed Infant formula milk usually
for babies’. This type of formula comes in powder form and is
is not necessary and there is no based on processed, skimmed
evidence that babies settle better cows’ milk and is treated so opened, the carton should be
Feeding your baby and young child
or sleep longer when fed this. babies can digest it. Vegetable stored in the fridge with the cut
oils, vitamins, minerals and fatty corner turned down or screw
Formula feeding acids are added to make sure cap replaced. Do not store it for
the milk contains the vitamins longer than 24 hours. You can
This new information is
and minerals that young babies continue giving your baby infant
based on guidance from the
need. This information will be formula when they are older
Department of Health and
on the contents list of the pack. than six months. If you have any
the Food Standards Agency. It
Infant formula powders are not worries about the infant formula
may differ from what you have
sterile, so it is important to follow milk you are giving your baby,
done before if you have older
the cleaning and sterilising ask your midwife, health visitor
children, but to minimise any
instructions on page 42. or GP for information.
risk it is recommended that you
follow this new information.
Formula is either ‘whey Using formula milk safely
Choosing a formula dominant’ or ‘casein dominant’, Powdered infant formula milk
depending on the balance of must be prepared as carefully
The different types of infant proteins it contains. It may also as possible. It is not a sterile
formula, and other infant milks be referred to as stage one or product, and even though tins
marketed for babies and young stage two milk. Whey-dominant and packets of milk powder
children, can seem confusing as milk is thought to be easier to are sealed, they can contain
there are lots of different brands digest than casein-dominant bacteria such as Cronobacter
and types available. The majority milk, so should always be the sakazakii (formerly known as
of infants who are formula fed first formula you give your Enterobacter sakazakii) and,
or mixed fed should be given baby. There is little nutritional more rarely, salmonella.
a first infant milk (sometimes difference in the two forms
called first stage or stage 1 of milk, so if whey-dominant If the feed is not prepared
milk) throughout the first year. formula milk suits your baby, safely, these bacteria can cause
they can stay on it for the first infections. Infections are very
All infant formula on the UK year or even longer. rare, but can be life-threatening.
market must meet required
Formula must therefore be
‘Ready-to-feed’ infant formula made up with water hot enough
milk in cartons is also available. to kill the bacteria – at least
This is generally more expensive 70ºC. In practice, this means
than powdered milk. Once boiling the kettle and leaving
41it to cool for no longer than 30 given vitamin D supplements equipment in cold, clean
minutes. from birth, see page 56 for running water before
more information. You can buy sterilising.
Vulnerable premature babies suitable drops at any pharmacy.
benefit from the use of ready- 2 Cold water sterilising.
to-feed formula rather than Ask your midwife or health Follow the manufacturer’s
powdered formula to reduce visitor where you can get vitamin instructions. Change the
the risk of contamination and drops. sterilising solution every 24
infection in hospital, however hours, and leave feeding
on discharge home a powdered Sterilising equipment in the solution for
formula can be used. If you are All the equipment used for at least 30 minutes. Make
using formula, mix the formula feeding your baby must be sure there is no air trapped
and water and cool quickly to sterilised. By sterilising your in the bottles or teats when
feeding temperature in cold water. feeding equipment, washing putting them in the sterilising
your hands and keeping the solution. Keep all the
It’s also essential to make up a preparation area clean, you will equipment under the solution
fresh bottle for each feed. Throw reduce the chance of your baby with a floating cover.
away unused formula within two getting sickness and diarrhoea.
hours. Bacteria multiply rapidly 3 Steam sterilising (electric
at room temperature and can The following cleaning and or microwave). Follow the
even survive and multiply slowly sterilising instructions apply manufacturer’s instructions.
in some fridges, so storing whether you are using Make sure the openings
formula milk for any length of expressed breastmilk or infant of the bottles and teats are
time increases the risk. formula milk. facing down in the steriliser.
Any equipment not used
Automatic formula straight away should be
1 Clean and rinse. Clean the
makers re-sterilised before use.
bottle and teat in hot soapy
The Food Safety Authority water as soon as possible
of Ireland (FSAI) does after a feed, using a clean Preparing a feed
not recommend the use bottle brush. Rinse all Step 1: Before making up a
of automatic formula feed, clean and disinfect the
preparation machines. surface you are going to use.
There is not enough Wash your hands carefully.
evidence to support the If you are using a cold water
safety of these machines. steriliser, shake off any excess
solution from the bottle and
the teat or rinse the bottle
Vitamin drops with cooled boiled water from
If your baby is formula fed, you the kettle (not the tap). Stand
should give them vitamin drops the bottle on a clean surface.
from the age of six months or Keep the teat and cap on the
if they are drinking less than upturned lid of the steriliser.
500ml of formula milk a day. Don’t put them on the work
Some babies may need to be surface.
42STEP 2 Step 3: Loosely fill the scoop Make sure you make up a
with milk powder and level it fresh bottle each time you
off using the flat edge of a feed your baby and throw away
clean, dry knife or the leveller unused feed after two hours.
provided. Do not pat it down. Using stored formula milk can
increase the chance of your
STEP 4
baby becoming ill.
Feeding your baby 2
Always cool your baby’s milk
Feeding your baby and young child
down before feeding. At 70°C,
it is still hot enough to scald.
Step 2: Use fresh tap water to To cool it, hold the bottle, with
boil a kettle with at least 1 litre the cap covering the teat, under
of water. After it has boiled, let cold running water. Test the
the water cool for no more than Step 4: Add the milk powder temperature of the feed by
30 minutes. Don’t use artificially to the water. Repeat, until dropping a little onto the inside
softened water or water that you have added the number of your wrist. It should just feel
has already been boiled. If you of scoops specified in the warm to the touch, not hot.
have to use bottled water, you manufacturer’s instructions. It is
will still need to boil it. The water important to use only the scoop If the milk is too cool, and your
must still be hot, otherwise any that is enclosed with that milk baby doesn’t like it that way, you
bacteria in the milk powder powder. Using too much powder can warm it up a little by putting
might not be destroyed. For can give your baby constipation the bottle upright in some hot
more information on bottled and lead to dehydration; too water, keeping the teat out of
water, go to www.eatwell.gov.uk little could mean that your baby the water. Never warm milk
is not getting the nutrients in a microwave oven. It will
Always put the partially they need. Don’t add sugar or continue to heat up for a time
cooled boiled water in the cereals to the feed in the bottle. after you take it out of the
bottle first. microwave, even though the
STEP 5
outside of the bottle may feel
Be careful – at 70°C, water is
cold. The milk inside may be
still hot enough to scald. Always
very hot and could scald your
check that the water level is
baby’s mouth.
correct. Failure to follow the
manufacturer’s instructions may
Responsive bottle feeding
make your baby ill.
Get everything you need ready
STEP 3
before you start feeding. Find
Step 5: Holding the edge of
a comfortable position to hold
the teat, put it on the bottle.
your baby while you are feeding.
Screw the retaining ring onto
Use this time to connect with
the bottle. Cover the teat with a
your baby, hold them close, talk
cap. Shake the bottle until the
to your baby and make eye
powder dissolves.
43You can also read
