A guide to breastfeeding

Helpful tips and good advice to help get your baby feeding contentedly.

A guide to sterilising

When bottle feeding using formula or giving expressed breast milk, and when you start to introduce your baby to solids, you will need to wash and sterilise all of his or her feeding equipment, every time.

What you’ll need

• Bottle brush
• Sterilising unit. There are 3 types available
        - cold water, steam and microwave. Cold water units use chemical tablets made from bleach (sterilising takes about 30 minutes)
        - microwave and electrical use steam - (takes between 4 and 9 minutes)

How to sterilise
Please read your steriliser instruction leaflet carefully, and take the time to find out how to use it before you need it.

Always wash your hands thoroughly before sterilising equipment or making up a feed.

Wash all bottles, teats, soothers, bottle tops and washable breast pump parts in hot water with washing up liquid. Scrub bottles inside with a bottle brush. Wash teats inside out and remove all traces of milk. Sterilising will not be fully effective if you place even slightly unclean bottles or teats into your unit.

In an emergency, equipment can be sterilised by boiling. Items must be placed in a saucepan and boiled for ten minutes. This method makes teats spongy and swollen so they will need frequent checking and replacing.

How long do I need to sterilise feeding equipment for?

• Bottles, teats and soothers - sterilise for as long as used
• Plastic spoons and beaker tops - sterilise until around 8 months (thereafter need to be very clean but not sterile)
• Bowls and beaker bases - wash thoroughly in hot water and store in a clean cupboard

A few general points
Placing a dirty teat or soother in your mouth doesn’t clean it, it just adds your own germs. It is better to take spare teats and soothers out with you and secure in a clean container.

Bottle feeding your baby

There is revised information from the Department of Health and Food Standards Agency (February 2006). Click here to see updated advice from the Department of Health and the Food Standards Agency (13 February 2006).

How will you be feeding your baby? If you haven't started thinking about it, now is probably a good time. Breastfeeding is best for your baby's health, but every woman, and baby, is different and the decision how to feed your baby is yours and yours alone. It is far better, for you and your baby, to choose the method of feeding that you feel comfortable with.

You can always start breastfeeding and then change to bottle feeding if you would like to, but it is more difficult to make the switch the other way. You can express milk from your breasts for your baby to take from a bottle or use formula milk.

Formula milk
If you bottle-feed your baby, you must use formula milk, not cow's milk. Cow's milk is not suitable for babies. It can cause an allergic reaction, and babies also find it very hard to digest.

Only feed your baby milk that is formulated especially for babies. You can discuss with your midwife or GP the formula milk that will be best for your baby - the number of different brands on the market can be very confusing.

How do I prepare formula milk?
Formula milk comes in two different types:

• Ready to use - as the name suggests, this comes ready to pour straight into the bottle. It is very convenient, but it is also an expensive method of bottle feeding
• Powdered - dried formula that must be mixed with water. It is very important that when you prepare powdered formula milk you add the right amount of water. Adding too much water will mean that your baby is not getting enough nutrition from his feeds. Also, not adding enough water can cause digestive problems.

What equipment will I need to bottle feed my baby?
You will need 6 full size bottles and teats for a fully bottle-fed baby. The variety available is huge and the type of bottles and teats you choose really is up to you. The other thing to bear in mind is that newborn babies may need smaller bottles and a faster flowing teat - they can become tired very quickly if they have to suck very hard to make the milk flow.

It is very important to make sure your bottles and teats are sterilised. To do this, first rinse all the bottles and teats in cold water. Then wash all the equipment in warm, soapy water. Now you have a choice of sterilisation methods.

• A chemical steriliser is a sterilisation tank that you fill up with cold water and add a sterilisation tablet or liquid. Make sure you follow the instructions for how much steriliser to use. Never put metal items in your sterilising unit. As sterilising solution is a dilute bleach, all items should be rinsed in recently boiled water before immediate use.
• Steam sterilisation. This type of sterilising kills harmful bacteria using steam created in a specially designed electrical unit. Steam sterilisation is a very quick and easy method of sterilising, but make sure you fill the bottles with formula within 3 hours of sterilisation.
• Microwave sterilisation. This method works by creating steam in the microwave steriliser to destroy harmful bacteria. All cleaned equipment should be placed in the steriliser with the amount of water specified in the manufacturer's instructions, with bottles and caps upside down. The unit's lid should be securely fastened before placing in the centre of the oven.

Make sure your hands are absolutely clean when you take out the bottles and teats to make up the feeds.

How do I make up a bottle?
There are a few golden rules about making up formula milk:

• Make sure all your equipment is sterilised
• Follow the manufacturers guidelines to the letter regarding how much formula to use in one bottle - overfill each scoop and then scrape off the excess with a sterilised knife to make sure you have the right amount of formula
• Always add the water to the bottle first - not the powder - this will make sure that you are using the right amount of water
• The best way to warm your baby's bottle is by placing it in a jug of warm water. Warning: take great care if you heat your baby's feed in a microwave oven because of the risk of hot spot burning. Always shake or stir the bottle and test the temperature before serving.
• Always make sure the formula you are using is not out of date
• Always test the temperature of the bottle by dripping some of the milk onto the inside of your wrist

Storage of formula milk
The Department of Health and the Food Standards Agency advise that feeds are made up fresh for each feed. If you do need to prepare a feed for later, they suggest that water is kept in a sealed flask and fresh formula milk is made up when required. You should avoid making up enough feed for a whole day in advance, or warming up bottles of formula milk which has been made from powder.

How much should I feed my baby?
Your baby will let you know when he is hungry. A very small baby has a very small tummy so will probably require a lot of small feeds. Your baby will let you know when he is full - so take your lead from him and don't force him to finish a bottle. As a general guide, if your baby if putting on weight steadily, then he is eating enough.

How do I give the bottle?
Like anything new, giving a bottle might take a little time to get used to. Firstly, make yourself comfortable and hold your baby on your lap with his head resting in the crook of your arm. Make sure his head is higher than his tummy. Keep the bottle tilted to make sure there is always milk in the teat, and remember to give your baby the chance to burp during and after the feed. To wind your baby either sit him up and pat his back or hold him upright on your shoulder and pat his back.

If you have any questions about how to feed your baby, talk to your midwife or health visitor who will be able to give you all the help and information you need.

Making up formula milk

For this reason the UK Department of Health and the Food Standards Agency revised its advice in November 2005; they now advise that feeds are made up fresh for each feed. If you do need to prepare a feed for later, they suggest that water is kept in a sealed flask and fresh formula milk is made up when required. You should avoid making up enough feed for a whole day in advance, or warming up bottles of formula milk which has been made from powder.

Guidance on preparing infant formula - last updated Monday 13 February 2006

The Department of Health and Food Standards Agency have issued revised guidance on the preparation and storage of infant formula milk.

The European Food Safety Authority’s (EFSA) Scientific Panel on Biological Hazards has issued an opinion in relation to the microbiological risks in powdered infant and follow-on formulae.

The panel concluded that salmonella and Enterobacter sakazakii are the micro-organisms of greatest concern. Although infections with these micro-organisms from formula milk are rare, the risk can be reduced by following guidelines on preparation and storage. The Department of Health and the Food Standards Agency advise all health professionals, particularly nurses, midwives and health visitors, to change/revise/update their advice to mothers on the preparation and storage of infant formula milk in the home.

Health professionals should re-emphasise to parents:

• the importance of good hygiene practices in preparing and storing feeds made from powdered formula
• failure to follow the manufacturer’s guidelines may increase the chances of a baby becoming ill

Infant formula powder is not sterile; the risks associated with using powdered infant formula milk are reduced if:

• feeds are made up using boiled water that is greater than 70ºC; in practice, this means using water that has been left to cool for no more than half an hour
• feeds are made up fresh for each feed; storing made up formula milk may increase the chance of a baby becoming ill and should be avoided
• any left over milk is thrown away
• mothers, who require a feed for later, are advised to keep water they have just boiled in a sealed flask and make up fresh formula milk when needed or use a liquid ready-to-feed formula**
• the temperature of the feed should be tested and, if required, cooled by holding the bottle, with the cap covering the teat, under cold running water*

The NHS leaflet on bottle feeding has been updated and 'Birth to Five' and 'The Pregnancy Book' has been updated to reflect this advice before the next print run.

*This last point has been added since this article was originally published.

** The advice about using a liquid ready-to-feed formula was added on 13 February 2006 as a result of the Department of Health updating their advice.

Breastfeeding Q and A

Breastfeeding helps you give your baby the best possible start in life. It may take a little bit of practice to get it right, but once you do, you will find it one of the most rewarding things about being a new mother. Don't be afraid to ask for advice - your midwife or health visitor can offer practical advice on how to make breastfeeding successful and enjoyable.

What are the benefits of breastfeeding?
Breastfeeding not only has health advantages, but also helps create a close bond between mother and baby.

Breast milk contains all the vital nutrients your baby needs to develop and grow into a healthy child. The vitamins, minerals, protein and fat content of breast milk are ideally balanced in a form that your baby can easily digest.

By breastfeeding you are also passing on your antibodies to your baby. This helps strengthen the baby's immune system and promotes resistance to coughs, colds and stomach upsets.

It also has advantages for you: breastfeeding helps the uterus shrink back its normal size, postpones ovulation and periods. There is evidence that longer-term breastfeeding may help to reduce postnatal weight and women who have breastfed may have a reduced risk of premenopausal breast cancer, ovarian cancer and hip fractures due to osteoporosis.

Recent evidence from the World Health Organisation has shown that breastfeeding is more than 98% effective as a birth control method if the mother is a full-time breastfeeder and feeding on demand day and night. However, most GPs would recommend that you also use a barrier method (such as a condom) to be on the safe side.

The closeness and comfort of breastfeeding is enjoyable for both mothers and baby. It is a great way to get to know your new baby, and makes the baby feel secure and contented. Mothers can feel relaxed, peaceful and calm during and after breastfeeding.

It is also convenient - breast milk can't spoil, it is always the right temperature, it needs no preparation, there are no bottles to wash, and it's free!

Are there any reasons not to breastfeed?
Mothers with serious illnesses or infections, or those taking certain medications, may be recommended not to breastfeed. If in doubt, ask your GP, midwife or health visitor.

How long should I breastfeed?
There is no 'correct' answer to this question. You should breastfeed as long as you want to. Most mothers breastfeed anywhere from 3 months to 12 months and some for longer. It is up to you to decide. La Leche League suggests that breastfeeding for the first 6 months gives your baby the best start in life, and that it is up to you and your baby to decide when you should stop breastfeeding. It is, however, possible to begin introducing solids to your baby's diet at 4 months. UNICEF and the World Health Organisation recommend breastfeeding for at least the first 2 years, in industrialised countries as well as poorer parts of the world.

It is a good idea to begin breastfeeding as soon as possible after birth. However, if you can't breastfeed immediately, for instance if you have had a Caesarean, don't worry. The process will be just as successful if you start as soon as you can.

Just after birth, your breasts will produce a rich fluid called colostrum. Although it may seem to come in only tiny amounts it contains just the right nutrients and antibodies for your baby's needs in the days just after birth. This will begin to flow when your baby starts suckling. This suckling will also stimulate the production of milk after a couple of days.

How often should I feed?
Your baby will let you know when she is hungry and when she is full! Feeding on demand helps ensure your baby is getting adequate nutrition without overfeeding. It is more important for your baby to gain weight at the right rate than to stick to a rigid schedule. There is no advantage to making a tiny baby wait for a feed, they have very small stomachs. As you gain confidence and get to know your baby's moods, you will be able to settle into a reasonable schedule.

How do I know my baby's getting enough milk?
Most babies will regulate themselves, and take as much milk as they need at each feed. You will know your baby is getting enough if:
    * They are steadily putting on weight.
    * The urine is pale or clear.
    * They have at least 6 wet nappies a day.
    * They have regular, soft, mustard-coloured stools.
    * They are breastfeeding contentedly.

How do I express milk?
Expressing will probably take some trial and error. You can express before, during or after a feed, but most women find that they have more milk in the morning so it may be easier then. You can express milk by hand into a sterilised container. You could also buy a drip catcher, which collects milk that drips from one breast while you are feeding with the other, or a hand or battery-operated breast pump.

What can I do about engorged breasts?
Engorged breasts feel swollen, tight and painful. Your breasts will become enlarged when you start producing milk after the birth, and the engorgement might last a couple of days. Although it might seem painful at first, you should keep breastfeeding - the more your baby feeds, the less engorged you will become. Try nursing more often, or lie in a warm bath and gently milk your breasts to relieve some of the pain. Cool compresses or placing cabbage leaves in your bra can also help.

You may also want to check with your midwife, health visitor, or a breastfeeding counsellor from the National Childbirth Trust or La Leche to ensure your baby is latching onto your nipple properly.

What can I do about sore nipples?
Your nipples might feel sore or tender when you first start breastfeeding. You might need to adjust the baby's position when you are feeding - ask your midwife for advice. It may be that your baby is only sucking on your nipple and needs to open his mouth wider to actually take in more of the breast.

If your nipples become cracked, try using absorbent breast pads in your bra, changing them frequently, and try wearing cotton bras. Avoid using soap because this can dry out the skin on your nipples even more. You can try using petroleum jelly between feeds, or squeeze out some milk at the end of the feed and gently rub it into your nipples. If breastfeeding hurts, do ask for help straight away to put it right. If you know your baby is in a comfortable position and is latched onto your breast properly, it may be thrush causing the problem. In the meantime, try and be patient with breastfeeding and persevere. Many women get sore nipples, and in the majority of cases it is because the baby's position at your breast needs to be changed. With help from your midwife it should clear up within a few days.

What if I have a blocked duct?
Milk ducts can sometimes become clogged with solidified milk. This will show up as a red bump on your breast or a white spot on your nipple. Blocked ducts usually occur when feeding is stopped before the baby is finished, and the breast is not emptied completely. You should let your GP or midwife know if you have blocked ducts, especially if it becomes very painful.

If you have a blocked duct, feed from the affected breast first. If the baby doesn't empty the breast completely, try expressing the rest of the milk. Make sure there is no dried milk on the nipple after nursing; if necessary, wipe it with sterile cotton dipped in water that has been boiled and then cooled. A warm bath or shower before feeding may also help the milk flow smoothly.

A painful red spot on your breast, accompanied by a fever and swelling, may be a sign of mastitis. This occurs when the breast is not efficiently emptied of milk and is almost always caused by incorrect attachment. Ensure that your baby is positioned correctly at your breast and is latched onto your nipple properly. The inflammation that accompanies mastitis is difficult to distinguish from an infection, so you may be offered antibiotics. If you suspect you have mastitis, contact your GP immediately. It is best not to stop nursing while you are being treated for mastitis.

How does what I eat and drink affect breastfeeding?
Most foods and drink won't affect the quality or composition of your breastmilk. If you don't eat enough protein and calories it is your body that suffers rather than your breastmilk. Be sure to drink plenty of liquids (but limit your intake of high-caffeine drinks such as tea and coffee), and try drinking milk to boost your calcium intake. At first many women feel thirsty when they sit down to breastfeed, so it is a good idea to have a drink handy. You may also be hungry in the middle of the night or the afternoon - don't forget that you are still producing all your baby needs to keep growing. Useful snacks include breakfast cereals, dried fruit and nuts, sandwiches and yoghurts. Some women take special vitamin supplements formulated for pregnant or breastfeeding mothers as an insurance policy against any deficiencies.

You may find that your baby reacts to certain foods you have eaten. Strong seasonings may flavour your breast milk but some babies seem to like this so keep an open mind. Garlic, onions and cabbage may cause your baby to have wind. If you have any questions about your diet while breastfeeding, talk to your GP or midwife.

Alcohol and smoking should be avoided as they can affect your breast milk. Alcohol will make your baby drowsy, and large amounts can affect development. Cigarette smoke contains toxic substances that can enter the breast milk.

Some medications can affect breastmilk, so be sure to check with your health visitor or GP if you need to take any medication while breastfeeding. This includes aspirin, cold remedies and other over-the-counter medicines as well as prescription drugs.

A guide to weaning

From birth to 6 months
Breast or formula milk provides all your baby's needs. Your baby's gut is not ready for other foods. You will be giving around 6-8 breast/bottle feeds per day.

From 6 months
Introduce baby rice, pureed fruit and vegetables. Your baby is learning to take food from a spoon rather than the breast or bottle. Start once a day with one to a few teaspoons - let your baby's interest and appetite guide you. You will be giving around 5-8 breast/bottle feeds per day. Your baby may want less milk after solids.

From 7 months
Widen the range of foods, e.g. pureed meat, fish, chicken, pulses, whole fat yoghurt and custard. Increase the number of meals to two then three a day as your baby gets used to food from a spoon. Your baby will close her mouth or turn her head away when she has had enough. Never force your baby to have more than she wants to. Start to introduce finger foods such as toast fingers, cooked vegetables and soft fruit. You may be giving around 5-8 breast/bottle feeds per day. Your baby may want less milk after solids.

From 8 to 9 months
Your baby should now be having three meals a day - including a range of sweet and savoury foods. Your baby will probably be managing 1/2-1 small bowl/jar of food at each meal. Iron rich foods such as meat and fortified cereals are particularly important because the stores your baby was born with will now be used up. You will be giving about 4-6 breast/bottle feeds per day. You can offer water or well-diluted juice at mealtimes from a lidded cup if desired. At around 9 months start mashing food rather than pureeing. Introduce more finger foods such as fruit, cooked vegetables and bread sticks.

From 9 to 12 months
Encourage self-feeding - with fingers and a spoon. Start chopping food rather than mashing at around 10 months. You may be giving about 3-4 breast/bottle feeds per day.

From 12 to 15 months
Your baby should be eating the same food as the rest of the family - chopped into small pieces to make it easier to manage. Your baby may also need 2-3 small snacks each day, for example fruit, toast, yoghurt, breadsticks or plain biscuits.

You can now start to give about 500mls (1 pint) of full cream cow's milk at this age - or you can continue breastfeeding. Try to give all drinks from a cup rather than a bottle. You can give up to 3-4 small cups of water per day - any more may put your baby off their food.

How to clean your baby's teeth
Avoid battles at tooth-brushing time by starting a routine as soon as your baby's first tooth appears (usually at around six months). Use a toothbrush designed for babies and a low-fluoride children's toothpaste.

At this age the easiest way to brush is with your baby sitting on your lap, with their head cradled in the crook of your arm. Twice a day gently ease the toothbrush into their mouth and give their teeth a quick once-over. Let your baby chew the brush and investigate if they want to, but then gently take it back and brush some more. Gently brush in circular movements around each tooth, with the bristles aimed where the tooth and gum meet. Work right around the mouth so you don't miss any.

Turning the whole experience into a game like 'here comes the aeroplane' may help, but you want them to like the idea of brushing so don't force them to open up. As your child gets older, sit them on your knee. Use only a smear of children's toothpaste on the brush, as too much toothpaste can lead to fluorosis (white patches or mottling on the teeth).

As they grow, let them have a go at doing their own teeth, and you do yours at the same time. Make it a positive, fun routine. When you've both finished brushing, make a game of checking each other's teeth - this will give you the opportunity to brush their teeth yourself. Remember that young children love to copy.

Don't give up it will be worth it! Weeks of 'having a go' morning and night, which will eventually develop into a healthy daily routine.

Weaning

Highchairs

Last Modified: 08/03/2010