73 baby feeding tips for NHS73 and World Breastfeeding Week | #TeamBartsHealth blogs

Monday 6 July marked the 73rd anniversary of the National Health Service founding. The NHS has been caring for women having babies since 1948 and we have continued to provide this service throughout the current pandemic 24hrs a day, 7 days a week.

Barts Health is implementing the standards of the UNICEF UK Baby Friendly Initiative, which is about infant feeding and relationship-building within new families - and to mark this, and as part of World Breastfeeding Week, we're sharing 73 baby feeding tips:

1. Responsive breastfeeding - Responsive breastfeeding involves a mother responding to her baby’s cues, as well as her own desire to feed her baby. Feeding responsively recognises that feeds are not just for nutrition, but also for love, comfort and reassurance between baby and mother.
    
2. Baby’s tummy sizes - Babies are born with small tummies. On the first day, the average size of a newborn baby’s stomach is like a cherry (5-7ml) turning into a size of a walnut (22-27ml) and size of an apricot in a week’s time holding (45-60ml). By feeding whenever the baby asks, a mother will be able to produce all the baby needs, and more.
    
3. Feeding pattern for a newborn - Each individual baby is different and they have their own pattern. Most of the time first 24 hours baby breast feeds only 3-4 times and from second 24 hours baby starts to breastfeed more frequently around 8-12 times in 24 hours.
    
4. Cluster feeding in the early days - There will be few hours in the 24 hours that baby will feed more frequently. Most of the time, babies show this kind of behaviour during the evenings and at night, and may feed on and off for 4-5 hours.
    
5. Building a relationship - Keeping your baby close during the early few days and weeks will encourage you to know when your baby is hungry and when they just need comfort. All of this is important for growing a happy baby and build a good relationship.
    
6. A growth spurt - There are some days and weeks the baby will breastfeed more frequently than other time to send the message to mother’s body to produce extra as they are growing bigger and older and this is very normal behaviour for a baby.
    
7. Paid/volunteer local support services for mothers - The Tower Hamlets Baby Feeding Service provides information and support for Tower Hamlets mothers and on the wards at the Royal London Hospital. They are a team of Baby Feeding Specialists who speak several languages including Bengali, Sylheti and Somali.
    
8. Colostrum harvesting - Antenatal Colostrum Harvesting means learning to express breast milk towards the end of pregnancy. It can be a useful way to find out how it all works, and the milk can be stored in case the baby doesn’t start feeding straight after birth.
    
9. Antenatal Workshops - Antenatal baby feeding workshops are a great way to find out all you need to know and have your questions answered.
    
10. Skin-to-skin - Skin-to-skin contact is when a baby is dried and laid directly on their mother’s bare chest after birth, both of them covered in a warm blanket and left for at least an hour or until after the first feed. Skin-to-skin contact can also take place any time a baby needs comforting or calming and to help boost a mother’s milk supply.
     
11. Kangaroo care - Skin-to-skin contact is also vital in neonatal units, where it is often known as ‘kangaroo care’ helping parents to bond with their baby, as well as supporting better physical and developmental outcomes for the baby.
     
12. Hand expressing - Hand expressing is very useful skill to deal with breast problem like blocked duct or mastitis or expressing colostrum antenatal / postnatal period.
     
13. Manual pump or electric? Some mother finds hand pumps are more effective than electrical and other finds the opposite. Come to one of our groups to talk things through
     
14. Cup feeding - Cup feeding can be used to feed a baby who is not yet taking the breast. It gives the baby a positive oral experience, the pleasure of taste and stimulates digestion. It allows the baby to control how quickly they feed and may be less disruptive than bottle feeding.
     
15. Positioning and Attachment - This is the basic skill for mothers to learn to help them establish and continue breatsfeeding. Please ask your midwife or health visitor or baby feeding specialist for help.
     
16. Biological nurturing/laid back nursing - Biological Nurturing is a neurobehavioral approach that encourages the mother to breastfeed in a relaxed, laidback position, with the baby lying prone on her chest and gravity ensuring the largest possible contact between the baby's body and the mother's chest and abdomen.
     
17. Night time feeding - Many people have strong beliefs and expectations about how babies should sleep. Baby Sleep Info presents research evidence about biologically normal sleep for human babies for both parents and health professionals.
     
18. SIDS and breastfeeding - Breastfeeding for at least 2 months halves the risk of SIDS but the longer you can continue the more protection it will give your baby.
     
19. Nappy and getting enough - The colour and frequency of your baby’s poo can help you tell whether they are getting enough to eat. This is one of several useful signs.
     
20. Tongue tie - Everyone has a frenulum under the tongue - sometime this is restricted and we call this tongue tie. Very few babies might have this and it can interfere with feeding. Please contact your local infant feeding team for feeding assessment and referral.
     
21. Expressing for baby in SCUBU - Breastmilk is very important for your baby especially if they are admitted to special care unit in neonatal department in the hospital. Please ask for more help while you are in the hospital from a breastfeeding specialist or midwives to help you with expressing.
     
22. Expressing and storing - You can store breastmilk in the fridge for up to 3 days where you don't know the exact temperature.
     
23. Brain development for a newborn - Breastfeeding responsively and building a good relationship with your baby from pregnancy to postnatal helps your baby’s brain to grow.
     
24. Microbiome - Skin to skin contact and breastfeeding helps your baby to colonise with your friendly bacteria which we call microbiome to help them grow healthier gut.

25. Newborn jaundice - This is very normal for you your baby to develop newborn jaundice in early days - you will receive a leaflet in your discharge pack with this information. Please ask your midwife or baby feeding team for further support on this.

26. Premature babies and breastmilk - Breastmilk special colostrum is valuable for your baby if they are born premature (before 37 weeks pregnancy). Breastmilk gives a strong immunity to your baby

27. Donor breastmilk - If your baby is in a neonatal unit and you want to use donor breastmilk please ask your breastfeeding specialist. It's recommended you do not buy donor milk over the internet. This is because the source cannot be confirmed and you cannot be sure whether the donor or the milk has been screened for infections. See the United Kingdom Association for Milk Banking (UKAMB) website for more about donor breast milk.

28. Flat or inverted nipple - Remember your baby latches on to a mouthful of breast, not only the nipple itself, when feeding effectively. Read supportive tips here, and to find out more about support in Tower Hamlets please call 07961 609 626 or 0203 594 2591.

29. Breastfeeding from one breast - You can breastfeed from only one breast if you have problems breastfeeding from both.

30. Breastfeeding while pregnant - It is absolutely fine to continue brestfeeding while you are pregnant.

31. Tandem breastfeeding - Do not be put off feeding an older baby and a newborn (tandem nursing). The more milk your babies take, the more your breasts produce, so it's possible to feed more than 1 baby.

32. Diet and eating well - You don't need to eat anything special while you're breastfeeding. But it's a good idea for you, just like everyone else, to eat a healthy diet.

33. Covid-19 - If you test positive for Covid-19, the WHO and UNICEF baby friendly initiative have recommended to continue breastfeeding.

34. Have a babymoon - A babymoon isn't only for expectant mothers - if you have had a long exhausting or complicated labour, or you did not have a good start of breastfeeding, a babymoon with a newborn is a wonderful way to focus on ongoing skin-to-skin contact, and staying close together with your baby, releasing love hormones and milk-making hormones to you that helps establish breastfeeding and bonding.

35. Baby massage - Many parents find baby massage a great way of bonding with their baby and getting to know them better.

36. Coping with crying - It is very normal that your baby will cry for certain times. Please look for NSPCC leaflet in your discharge pack to read more on this. You can ask your health visitors and midwife for further information.

37. Non-feeding parent baby bonding - Non-feeding parents can bond with the baby by doing baby massage, bathing together or going for walks. No bottles are needed!

38. Travelling and breastfeeding - It is very easy to breastfeed when you are travelling - you just need your baby with you. Wearing breastfeeding friendly clothing might help, and if you want privacy you can use a shawl or any clothes to cover yourself.

39. Breastfeeding out and about - There are a lot of places such as children centres, Gp surgeries, and libraries in your community that are breastfeeding-welcome places. Please look for this sign or ask the staff they will help you to breastfeed out and about. By law you can breastfeed anywhere in the UK.

40. Hot weather - In hot weather, babies are likely to ask to feed more frequently than usual, as milk provides hydration as well as food. Breastfed babies under six months old should not be given water to drink. Babies who are fed formula may need a little cooled, boiled water in very hot weather.

41. Unwell baby and breastfeeding - If your baby is not well and is not able to breastfeed effectively, there are alternative feeding methods to feed baby other than a bottle. At our trust we provide support to mothers with alternative feeding method such as cup and finger feeding - please ask help from your hospital staff or infantfeeding team.

42. Feeding cues - Feed your baby when they show signs of being hungry. Look out for cues (moving head and mouth around, sucking on fingers). Crying is the last sign of wanting to feed, so try and feed your baby before they cry.

43. Weaning and breastfeeding - Weaning is the process of stopping feeding your baby with breast milk. Ideally, the first step towards weaning your baby is introducing complementary foods alongside your breast milk around the age of six months. The weaning process continues until breast milk is completely replaced by other foods and drinks.

44. Feeding is a social activity - Feeding is a social activity for a baby. Singing, talking and eye contact when breast feeding or bottle feeding promote engaging with the baby!

45. Feeding twins/mutliples - Breastfeeding more than one baby is challenging, but it is definitely possible and a lot of mums go on to have a really enjoyable experience.

46. Feeding premature babies - Breastmilk special colostrum is valuable for your baby if they born as premature (born before 37 weeks pregnancy). Breastmilk gives a strong immunity to your baby.

47. Feeding medically complex babies - Please contact with your neonatal breastfeeding specialist or infant feeding team for support on your situation. At BartsHealth we have support available.

48. Exclusive pumping - There are some mothers who only choose to express and give breastmilk to their baby. It is possible to exclusively pump, but you need to be committed toward this, as this will not be as pleasant as breastfeeding your baby. Please contact your infant feeding team or neonatal breastfeeding specialist for more information and support.

49. Extended feeding/natural term weaning - It is very important to continue breastfeeding alongside with solid food.

50. Returning to work - You should be given a reasonable break for pumping or to breastfeed your baby when you come back to work. Please discuss this with your employer when you are returning to work. At Barts Health we provide support for breastfeeding staff when they come back from maternity leave.

51. Your employer's breastfeeding policy - Returning to work does not have to mean the end of breastfeeding. You should let your employer know that you are breastfeeding. They have a duty to keep you safe and support you to continue to make milk for your baby.

52. Environmental benefits - Breastfeeding is one of the best ways to protect both our planet’s ecosystems and our health. It helps to ensure food security, has a positive effect on maternal and child health and wellbeing, and is vastly important to our carbon footprint.

53. Keeping your baby close - During the early few days and weeks, keep your baby close as much as possible. This will help you to know when they are hungry and to learn the different ways you can comfort them.

54. Routines for your baby - It’s unlikely that a baby will follow a predictable feeding routine. Trying to make your baby feed in a strict pattern can disrupt your breast milk supply and will not be much fun for your baby.

55. Using the red book and child health eRedbook app - Shortly before or after your baby is born, you'll be given a personal child health record (PCHR). This usually has a red cover and is known as the "red book"; there is also an eRedbook app available to use. Please discuss with your health visitors to best understand the charts and what this means for your baby.You can also contact your local infant feeding group to discuss further regarding your baby’s weight and the red book growth chart.

56. Knowing when to ask for support - It is very important to get help as soon as possible if you are experiencing any pain on your nipple. Please contact your local infant feeding or baby feeding team or your midwife to signpost you.

57. Teats, dummies and nipple shields - Any intervention during establishing breastfeeding, especially for the first 4 weeks, risks interfering with milk supply . Please contact your midwife, health visitor and infant feeding team for extra support.

58. Using formula milk - Please follow the FIRSTSTEP Nutrition trust link and other links to get more information on formula milk.

59. Responsive bottle feeding - there are resources available to cover a range of issues around bottle feeding, including making up feeds and responsive bottle feeding.

60. Safe preparation of formula milk - Good hygiene is very important when making up a formula feed. Your baby's immune system is not as strong as an adult's. That's why bottles, teats and any other feeding equipment need to be washed and sterilised before each feed. Follow the step-by-step guide to safe preparation of formula milk here.

61. Bottle feeding while out and about - You'll need several bottles, teats and a bottle brush, as well as sterilising equipment, such as a cold-water steriliser, microwave or steam steriliser. There's no evidence that one type of teat or bottle is better than any other. Simple bottles that are easy to wash and sterilise are probably best.

62. Medication and breastmilk - Taking medication does not usually mean that a mother has to stop breastfeeding temporarily or permanently. Make sure you read these resources related to medication and breastmilk.

63. Breastfeeding and alcohol - Anything you eat or drink while you’re breastfeeding can find its way into your breast milk, and that includes alcohol. Drinking alcohol also reduces the ability of the mother to be aware of her baby’s needs, whether she is breastfeeding or not.

64. Anxiety and breastfeeding - Anxiety is a normal and healthy emotion which helps to tell us that something in our environment may be threatening, either physically or emotionally to either ourselves or the people we care about. Concerns about breastfeeding or perceived lack of support may add to anxiety. There are several simple things we can do to balance our life and manage anxiety.

65. Perinatal mental health and breastfeeding - the NHS Long Term Plan is further ramping up specialist perinatal care for every part of the country, offering tailored support and extending care to cover the first two years of your child’s life.

66. Diabetes and breastfeeding - Having diabetes should not stop you from breastfeeding your baby. However, there are a few points worth thinking about if you are going to make sure that you combine good blood sugar control whilst coping with the demands of a new baby.

67. Breastfeeding and oral health - Since 2001 the WHO has recommended that mothers worldwide exclusively breastfeed infants for the first 6 months to achieve optimal growth, development and health, including for oral health.

68. Obesity and breastfeeding - Healthy mothers with a BMI higher than 35 may struggle to produce as much milk as other healthy mothers, but with the right support by health professionals this is easily overcome.

69. Blocked milk duct, mastitis or engorgement - Please contact your local infant feeding team or midwife or health visitor to get help to resolve this problem.

70. Epigenetics and breastfeeding - Epigenetic changes to our DNA can be made by environmental and lifestyle factors such as nutrition, chemicals, stress, and emotional experiences - there is emerging and growing evidence that genetics, prenatal environments, delivery modes and early postnatal environments including breastfeeding method can affect the infant microbiome, with significant implications for the infant immune system and both short and long term health outcomes.

71. Health benefits for your baby long into adulthood - Any amount of breastmilk has a positive effect. The longer you breastfeed, the longer the protection lasts and the greater the benefits.

72. Health benefits for mothers - Breastfeeding and making breast milk also has health benefits for you. The more you breastfeed, the greater the benefits. Breastfeeding lowers your risk of breast cancer, ovarian cancer, osteoporosis (weak bones), cardiovascular disease, and obesity.

73. Benefits worldwide - breastfeeding saves lives, improves health and cuts costs in every country worldwide.

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