Infant feeding is more than the transfer of milk. When you feed your baby you enjoy that wonderful closeness and intimacy that helps your baby’s brain to develop. In the Health Visiting service, we will support you to use a responsive approach to feeding. This is where you learn to know your baby’s feeding cues and respond to them timely and lovingly.
Breastfeeding gives your baby the best start in life. Breastfeeding exclusively for 6 months and then alongside other foods for at least the first two years of life is the World Health Organisation’s recommendation.
You may come across some challenges during your breastfeeding journey. There is support available to you from your Health Visitor to help you overcome these challenges so that you can continue to breastfeed for as long as you want to. Some of this support will be a combination of face to face and virtual/telephone contact. Other support may be in the form of signposting you to useful online resources.
How do I know if my baby is getting enough milk?
Questioning whether your baby is getting enough milk when breastfeeding is a real concern for many mothers. A breastfeeding assessment will be carried out by our team, to help assess how the breastfeeding is going, and you will be able access this yourself in the ‘red book’ (parent held records). This assessment will tell us and you if your baby is producing enough wet and dirty nappies as well as taking an adequate milk supply. If there are any concerns about your baby’s weight gain, these will be discussed with you by your health visitor.
Some mothers experience sore nipples, mastitis, engorgement, oral thrush and low milk supply. Baby can also have a tongue tie. This list of complications is not exhaustive, and there may be other issues that you are experiencing, however the Health Visiting team can support you with any concerns you have.
How can we help?
Health visiting team
Your health visiting team will review and monitor your baby’s wellbeing. The team is made up of health visitors and community nursery nurses who are trained to provide breastfeeding support. As an organisation we are accredited by the Unicef Baby Friendly Initiative having demonstrated a high standard of care in infant feeding.
In Wiltshire you will be offered an antenatal visit from your Health Visitor between 28 and 32 weeks of pregnancy. All pregnant women will be given the opportunity to discuss making a relationship with their unborn baby, keeping your new baby safe, and what their thoughts and feelings are about feeding their baby. This contact enables Health Visitors to give information about close and loving relationships and the importance of these for bonding and both mother and baby’s physical and emotional health and development, however you choose to feed your baby.
Your health visitor will also observe you feed when she visits you at the new birth visit and use the breastfeeding assessment tool to identify any concerns. This is a good opportunity for you to discuss with your health visitor any issues or difficulties you are facing with feeding. Your health visitor will work out a plan of care with you which may involve referrals to other specialists in infant feeding, ongoing monitoring or signposting to where you can get further information and help.
Many breastfeeding challenges can be linked to the position you are using to feed your baby. Adapting your position for feeding so that baby can attach to your breast more effectively can overcome some of the difficulties you may be facing with breastfeeding. Correcting your position ensures no damage to the nipples, the stimulation of an effective milk supply and the effective transfer of milk to baby.
Specialist infant feeding service
For mothers and carers experiencing complex infant feeding challenges including breast and bottle feeding, support can also be accessed via our specialist infant feeding service. If you feel that this is the service for you please don’t hesitate to contact the Single Point of Access 0300 247 0090. A trained health visitor will discuss your infant feeding concerns, offer support over the telephone as well as being able to contact your local health visitor to provide ongoing assessment and support or referral into the specialist infant feeding team. You should expect a telephone call within 2 working days of your referral being received.
Tongue tie services are also available and your health visitor can support you to access these if required.
What other support is available?
There are breastfeeding peer support groups all over Wiltshire. These peer groups can be found by going to the Wiltshire Council website.
National Breastfeeding Helpline – 0300 100 0212
La Leche League GB – 0345 120 2918
NCT Support Line – 0300 330 0700
Advice and support
Keeping mum and baby together
Wherever possible it is important for mother and baby to be kept together in hospital after birth as this allows mothers to recognise feeding cues, get to know her baby and their needs and for baby to recognise his/her mother. During the first hours after birth, it is ideal for mum and baby to be able to rest and bond in skin to skin contact.
Skin to skin contact
Skin to skin contact with your baby, wherever possible, and for as long as possible after birth helps to:
- Maintain baby’s temperature
- Calm and soothe both baby and mother
- Get breastfeeding off to a good start
- Calm and soothe a crying baby and relax mums at any time
Skin to skin triggers natural hormonal responses which helps contribute to calming and settling baby and puts the start of this precious new relationship on a good footing. If you have to have medical intervention during or straight after birth, don’t worry, you can catch up skin to skin time as soon as you are able; and in the meantime dad is the next best person. It’s a great opportunity for dads and partners to encourage their close bonds with the baby.
This is a relaxed and laid back approach to spending quality time with your baby while feeding. There is no right or wrong way, you simply sit back and allow mother and baby to find a comfortable position to feed. This also allows your baby to follow natural instinctive behaviour which makes initiating breastfeeding easier.
This was previously referred to as ‘demand’ or ‘baby led’ feeding and applies to both breastfeeding and formula feeding mothers and babies. This is holding your baby close and letting mother and baby feed in response to their needs, e.g. when baby shows signs of hunger or needs to be comforted, if the mother needs to feed or simply wants a rest.
Responsive bottle feeding is about trying to give your baby the same experience as a breastfed baby. This includes cuddling them close to you and ‘pacing’ feeds by allowing breaks and not rushing. Follow your baby’s signals that they are full, never try to push them into finishing every bottle just because that’s ‘how much they usually have’ or you are hoping they will ‘go for longer’ between feeds. The natural way for a young baby to want to be fed is little and often. It is also recommended that bottle fed babies are fed only by their main carers in the early days.
Expressing breast milk
The technique of expressing breast milk is a valuable skill for all breastfeeding mothers. Sometimes it is necessary to maximise your milk supply or you may be separated from your baby and need to store some milk in your fridge. There are a variety of ways to express and your health visiting team can advise you on all them. Hand expressing is a skill that your health visitor will show you at your antenatal or new birth contact. Hand expressing can reduce engorgement and help you manage much of the discomfort related to mastitis or sore nipples.
Going back to work or study
Going back to study or work may be the first time you have been separated from your baby for long periods. Continuing to breastfeed helps to keep the close relationship you’ve built up, providing your baby with extra comfort and security for as long as you both want.
You don’t need to stop breastfeeding just because you’re returning to study or work. Many women find ways to continue breastfeeding their baby – and employers have certain obligations towards breastfeeding women.
What milk to use?
First infant formula is suitable for your newborn baby through to 1 year of age. ‘hungry baby milks’ or ‘follow on milks’ contain more of the protein casein than first infant formula and this is thought to make your baby feel more full. However, there is no evidence that babies settle better or sleep longer when fed this formula. At 1 year old you can now introduce pasteurised full fat cows milk.
However you decide to feed your baby parents can build a loving relationship with their baby by and feed responsively:
- Having regular skin to skin contact
- Holding baby close when feeding and looking into their eyes.
- Limiting the number of people who feed the baby
- Understanding that cuddles cannot spoil your baby
By implementing these strategies you are encouraging optimal brain development by allowing your baby to release high levels of oxytocin and low levels of stress hormones.
Whether you are giving your baby expressed breast milk or formula it is really important that you follow the guidance on sterilising bottles and teats and safe preparation of feeds to ensure safe feeding.
How to prepare a powdered formula feed
Good hygiene is essential when making up a feed as a baby’s immune system is not as strong as an adult’s. All equipment used to feed your baby must be sterilised before each feed to reduce the chances of your baby becoming unwell.
- Fill the kettle with at least 1 litre of fresh tap water from the cold tap (do not use water that has been previously boiled or artificially softened water because the balance of minerals may not be suitable for making up formula feeds.)
- Boil the water. Leave the water to cool in the kettle for no more than 30 minutes so that it remains at a temperature of at least 70°C.
- Clean and disinfect the surface you are going to use & WASH YOUR HANDS.
- If you are using a cold-water steriliser, shake off any excess solution from the bottle and the teat, or rinse the bottle with cooled boiled water from the kettle (not the tap).
- Stand the bottle on a clean surface.
- Keep the teat and cap on the upturned lid of the steriliser. Avoid putting them on the work surface.
- Follow the manufacturer’s instructions and pour the correct amount of water into the bottle. Double check that the water level is correct.
- Fill the scoop loosely, level off with either the flat edge of a clean, dry knife or a leveler if provided and add to the bottle.
- Holding the edge of the teat, put it on the bottle. Then screw the retaining ring onto the bottle.
- Cover the teat with the cap.
- Shake the bottle until the powder is dissolved.
- Cool the formula so it is not too hot to drink – hold the bottom half of the bottle under cold running water. Move the bottle about under the tap to ensure even cooling. Make sure that the water does not touch the cap covering the teat.
- Test the temperature of the infant formula on the inside of your wrist before giving it to your baby. It should be body temperature, which means it should feel warm or cool, but not hot.
- If there is any made-up infant formula left after a feed, throw it away.
How your Health Visitor can help with bottle feeding
Your health visitor will also advise you how you can feed your baby responsively with bottles using a paced-feeding approach that enables baby to enjoy feeding and be close to you.
Prep machines for formula feeding are not recommended as they do not meet the safety requirements. Water must be boiled to 70 degrees before the formula powder is added to minimise bacteria living in the milk. Further information on safe formula feeding can be found on First Steps Nutrition Trust website .
You may also wish to use the UNICEF Bottle Feeding Assessment Tool.
Introducing solid foods
As your baby approaches six months, this is the time to start thinking about introducing solid foods alongside breast milk or infant formula.
Your baby is ready for solid foods at around six months. Initially the amount of milk your baby drinks will remain very similar until weaning is established.
Breast milk, infant formula and water should be the only drinks offered after 6 months of age. The introduction of solid foods before 6 months reduces the amount of breast milk drunk and is associated with greater risk of infectious illness in infants.
It is best to wait until 6 months before introducing solid foods, but if you choose to start before, talk to your health visitor.
Never give any solid foods before 17 weeks.
Why wait until 6 months when the shop sells jar food for 4 month olds? At 6 months old your baby can:
- Sit up without support. It will be easier and safer to feed your baby once they are sitting up.
- Pick up objects and put them to their mouth!
- Chew objects. They don’t need teeth to chew.
- Swallow rather than suck. They use their tongue to move food from front to back of mouth
Babies move through this stage at different rates, if you have any queries please call our Single Point of Access and speak to one of our duty health visitors 0300 247 0900 (Monday – Friday 9am-5pm). You can also sign up to attend our live online group sessions with other parents on Introducing Solid Foods.
You can also download our our Introducing Solid Foods presentation.
Visit our advice and support page on introducing solid foods for more information.