Information about Infant Feeding

You may already have some thoughts about how you will feed your baby, based on previous experience or what other have told you. However, you do not have to decide until after your baby is born. Breastfeeding provides everything your baby needs to grow and develop. It also helps protect and comfort your baby. Your Midwife will be happy to talk to you about this. Further information can be found at: www.bestbeginning.org.uk. If you decide to use formula milk to feed your baby, your Midwife will give you information about how to hold your baby for feeding and how to make up feeds safely.

Taking time out to being to develop a relationship with your unborn baby will have a positive impact on your baby’s wellbeing and help their brain to grow. You can begin to connect through talking or singing to your baby bump and noticing when your baby has a pattern of movements. It is lovely to include your partner and/or other children too.

New babies have a strong desire to be close to their parents as this will help them to feel secure and loved. When babies feel secure they release a hormone called oxytocin which helps their brain to grow and develop. If you are breastfeeding you can offer your baby your breast when he/she shows sign of wanting to feed, when they just want a cuddle, if you need to fit in a quick feed or if you want to sit down and have a rest. If you choose to bottle feed, your baby will enjoy being held close, and fed by you and your partner rather than by lots of different people.

Holding your baby in skin-to-skin contact soon after birth is the perfect way to say hello. Skin contact will help you both to feel calm, give you time to rest, keep warm and get to know each other. As your baby recognises your voice and smell, they will begin to feel safe and secure. Take time to notice the different stages your baby goes through to get ready for their first feed.

We would like to remind our Maternity Service Users that in line with the Baby Friendly Initiative, our Maternity Infant Feeding Guideline has been updated and we have made changes to our policy in relation to providing formula to Maternity Service Users. If you choose to formula feed your baby, you will need to bring in small pre-packed bottles of a ready-made newborn formula into hospital with you. Please do not bring in powdered formula or the larger bottles/cartons of ready-made formula, as MKUH does not have a milk preparation area, storage for larger bottles or a safe place for you to wash and sterilise reusable bottles. Thank you for your support.

Holding your baby naked against your bare chest straight after birth is very important because it helps calm your baby, keeps them warm, steadies their breathing and gives you time to bond. It also helps get breastfeeding off to a good start. A blanket over both of you will help keep your baby warm. Your midwife will check you and your baby regularly while you are having skin to skin contact and will explain the signs for you and your partner to look out for to ensure your baby remains safe and well. If you have a caesarean section or are separated from the baby after the birth, you can still both benefit from skin to skin as soon as possible. If you choose to bottle feed your baby, you can still give your baby’s first feed whilst in skin contact.

The value of breastfeeding

Breastfeeding provides everything your baby needs to grow and develop. Your milk is perfect and uniquely made for your growing baby’s needs. Giving your milk to your baby makes a big difference to both you and your baby’s health now and in the future.

Babies who are not breastfed have an increased chance of:

• diarrhoea and vomiting
• chest, ear and urine infections
• allergies such as asthma and eczema
• diabetes and other illnesses later in life
• obesity

Breastfeeding helps mothers to: 

• reduce the risk of breast and ovarian cancer
• have stronger bones for later life
• lose weight faster after giving birth
• save money and time

If your baby was born prematurely, breastmilk is the ideal means of providing nutrients to help your baby grow whilst protecting them against potentially serious infections.

Protecting your baby on a daily basis: a mother will use her own immune system to protect herself from infections and viruses within her immediate environment. When breastfeeding, she transfers this immunity into the milk she gives to her baby, thereby protecting them on a continuous basis.

Getting breastfeeding off to a good start

Holding your baby in skin to skin contact after birth and allowing them to spend time licking and nuzzling at your breast will help your baby instinctively ‘learn’ how to breastfeed. Your midwife will help you hold your baby in a way that will make it easier for them to feed effectively. This is important for both you and your baby as it will prevent you getting sore and will make sure your baby gets enough milk to help them grow. The more feeds your baby has, the more milk you will make. In the early days, your baby may feed very often, particularly in the evening time. Although this can be challenging for you, it is normal for babies to do this as it sets up your milk supply for the future.

Responsive breastfeeding

Because breastfeeding is about much more than just providing food for your baby, the term ‘responsive feeding’ is used to describe how you can feed your baby in response to early cues (sucking fingers, mouthing or general restlessness), to comfort them if they seem lonely or upset, or if either of you just wants a cuddle and to spend some time together. Try to think about breastfeeding as an opportunity for you to take time out and rest. You can’t overfeed or spoil a breastfed baby.

Expressing your milk

Your midwife will show you how to express your milk by hand. Although you may never need to do this, it is useful to know how as it can help you to soften your breasts if they become full, or if you get any red lumpy areas (a sign that one of your milk ducts may have become blocked). The milk can be expressed into a sterile bottle, covered securely and kept in the back of the fridge (never in the door) at four degrees or lower for up to five days. You can freeze breast milk for two weeks in the freezer compartment of the fridge or for up to six months in a freezer. Defrost frozen milk in a fridge, once thawed use straight away. Never refreeze. If your baby prefers, you can warm the milk up to body temperature before feeding. Never heat the milk in the microwave as it can cause hot spots which can burn your baby’s mouth.

Winding and posseting

Babies who are breastfed do not usually need to be winded. Sometimes babies will bring up a mouthful of milk during or just after a feed. This is called posseting and is not unusual. If you are concerned that your baby is vomiting an excessive amount please contact your midwife or doctor.

Weaning

Exclusive breastfeeding is recommended for the first six months of an infant’s life, as it provides all the nutrients a baby needs. Six months is the recommended age for introducing solids. When weaning your baby, carry on breastfeeding beyond the six months.

General principles of breastfeeding

• Hold your baby in skin to skin contact
• Feed your baby as soon as possible after the birth
• Give only breastmilk
• Keep your baby close so you can pick up on early cues
• Breastfeed responsively
• Seek help if breastfeeding is painful
• Allow your baby to come off the breast by themselves and always offer your other breast although your baby may not always take this
• Avoid introducing a teat or dummy while your baby is learning to breastfeed
• Consider joining a local breastfeeding support group

Helping your baby to breastfeed (positioning)

• Cuddle your baby as much as possible in skin contact
• Keep your baby calm by talking and stroking them gently
• Hold your baby with head and body in a straight line so that they aren’t twisted
• Look out for feeding cues
• Position your baby’s nose to your nipple
• Encourage your baby to open their mouth by gently stroking your nipple above their top lip
• Make sure your baby’s head is free so that they can tilt their head back as they take your breast into their mouth
• Their bottom lip should make contact with your breast about 2.5cm away from the nipple
• Express a little milk to tempt your baby

Close – baby has easy access to your breast
Head free – they can tilt their head back as they take your breast
In line – they aren’t twisted which would make feeding difficult
Nose to nipple – as they tilt their head your nipple will go to the back of their mouth

You will know your baby is ‘attached’ when:

• It doesn’t hurt although the first few sucks may feel strong or uncomfortable
• Their chin will be firmly touching your breast
• Their cheeks stay rounded during sucking
• If you can see dark skin around your nipple you should see more above your baby’s top lip
• Your baby will take long sucks and swallows with the occasional pause

We would like to remind our Maternity Service Users that in line with the Baby Friendly Initiative, our Maternity Infant Feeding Guideline has been updated and we have made changes to our policy in relation to providing formula to Maternity Service Users. If you choose to formula feed your baby, you will need to bring in small pre-packed bottles of a ready-made newborn formula into hospital with you. Please do not bring in powdered formula or the larger bottles/cartons of ready-made formula, as MKUH does not have a milk preparation area, storage for larger bottles or a safe place for you to wash and sterilise reusable bottles. Thank you for your support.

First stage milk is suitable for the first 12 months of your baby’s life. If you are considering formula milk, please discuss this with your midwife or health visitor who can give you advice. When using formula milk to feed your baby, please discuss this with your midwife or health visitor who can give you advice. When using formula milk to feed your baby, it is important that you prepare it in the safest way possible. Tins and packets of milk powder are not sterile even when sealed and can contain harmful bacteria, which, if the feed is prepared incorrectly can cause infections that can be life threatening.

Cleaning and sterilising – this apples if you are breast or formula feeding.

• Wash your hands and work surfaces
• Clean all feeding equipment in hot soapy water then rinse under running water before sterilising. Remove all traces of milk.
• For cold water sterilising units, follow the manufacturers instructions. Change the sterilising solution every 24 hours. Completely immerse the bottles and teats in the solution, ensuring no air is trapped in them. Keep all the equipment under the solution by using the floating cover. It will take at least 30 minutes to sterilise the equipment.
• For steam sterilisers follow the manufacturer’s instructions. Ensure the openings of the bottles and teats are facing down in the unit. Any equipment not used immediately should be resterilised before use.

Making up feeds – always make up bottles fresh at each feed. 

Never store milk in the fridge for later.

• Use fresh tap water to fill the kettle.
• After it has boiled, let it cool for no more than 30 minutes. The optimal temperature to prepare the feed is 70°C. Do not use artificially softened water, or kettle water that has been repeatedly boiled. If you have to use bottled water (if you are on holiday), it will still have to be boiled.
• Shake off any excess water from the bottle and stand on a clean surface. Always pour the cooling boiled water first. Check the bottle is filled to the required level.
• Follow the formula manufacturer’s instructions. Loosely fill the scoop with milk powder and level it off with the flat side of a clean knife or leveller.
• Never add extra scoops, sugar or cereals to the bottle as this can make your baby ill or choke.
• Carefully attach the teat, retaining ring and cap on the bottle and shake until all the powder is dissolved.
• Make sure the feed is not too hot; 70°C can cause scalds. You may need to cool the bottle in cool water before giving it to your baby. Always test a small amount on the inside of your wrist to check it is cool enough to give to your baby.

Feeding your baby

• Sit comfortably and cuddle your baby close looking into their eyes.
• Tilt the bottle slightly so milk reaches the end of the teat.
• Invite your baby to take the teat by gently rubbing it against their top lip.
• When your baby opens their mouth and pokes their tongue out, place the teat in their mouth and your baby will draw it in.
• Allow your baby to pace the feed by removing the teat at various times to give them a break.
• Never force your baby to take a full feed and throw away any unused milk left in the bottle.
• Limit the number of people who feed your baby to you and your partner, particularly in the early weeks, as this will help them feel safe and secure.

Responsive feeding: your baby will let you know when they are hungry by becoming restless, sucking their fingers or making mouthing movements. Offerings a breast or bottle feed before they begin to get upset and cry will make feeding easier. If you are breastfeeding you can offer your baby your breast when you want a cuddle, or fit in a quick feed when you want to sit down and rest. If you choose to bottle feed, your baby will enjoy being held close and being fed by you and your partner rather than by lots of different people.

Skin to skin contact: holding your baby naked against your bare chest straight after birth is very important because it helps calm your baby, keeps them warm, steadies their breathing and gives you time to bond. It also helps get breastfeeding off to a good start. A blanket over both of you will help keep your baby warm. Your midwife will check you and your baby regularly while you are having skin to skin contact and will explain the signs for you and your partner to look out for to ensure your baby remains safe and well. If you have a caesarean section or are separated from the baby after the birth, you can still both benefit from skin to skin as soon as possible. If you choose to bottle feed your baby, you can still give your baby’s first feed whilst in skin contact.

Later skin contact: skin contact at any time will help calm and settle your baby. It can also encourage your baby to feed and help you and your partner to feel close to your baby.

Keeping baby close to you: newborn babies have a strong need to be close to their parents as this will help them to feel secure and loved. When babies feel secure, they release a hormone called oxytocin which helps their brain to grow and develop. In hospital, providing you and your baby are well, your baby will stay in a cot next to your bed at all times so that you can get to know each other and you can respond to their needs for feeding and comfort. When you go home, your baby will benefit from being close by you during the day and at night.

Safe sleep for your baby: your baby should have a clear, safe space e.g. in a separate cot or Moses basket with a firm flat mattress, without any raised or cushioned areas, no pillows, bumpers, quilts or duvets. Place your baby on their back with their feet against the foot of the cot. This is to ensure that your baby’s head does not become covered by bedding, leading to overheating. This is commonly referred to as the ‘feet to foot’ position. Babies should always be in the same room as you day and night for the first six months of your baby’s life. This means you can hear your baby and respond to their needs before they start crying or become distressed. You can also reach them easily without having to get up.

Some parents choose to share a bed with their baby – but be aware you should not take your baby into bed if you or your partner are smokers, have recently drunk alcohol, taken drugs which may cause drowsiness (legal or illegal), if your baby was born prematurely or is a low birth weight. Ask your midwife or health visitor if you need any advice about bedsharing. For further information visit www.lullabytrust.org.uk. Never fall asleep with your baby on a sofa or armchair. Move somewhere safer if you might fall asleep. 

Keep your baby in a smoke free area at all times, day and night. Babies exposed to cigarette smoke before and after birth are at an increased risk of Sudden Infant Death Syndrome (SIDS) sometimes known as cot death. It is important to not let your baby get too hot. An ideal room temperature is between 16-20°C.

Ways to wake a sleepy baby: if you feel worries about how long your baby has slept you can:

• gently wake your baby by picking them up and talking to them
• changing their nappy
• rubbing their hands and feet
• undressing them and holding them in skin to skin contact

Soothing and settling a crying baby: all babies cry at some time as a means of communicating with you and will generally settle when they are picked up and cuddled. Here are some things you can try that may help:

Ask your midwife, health visitor or GP for help if you feel the crying is making you feel anxious, agitated, or feel unable to cope. If your baby is crying for long periods, they may be ill and require an urgent medical check.

Taking your baby out safely

Your baby is ready to go out as soon as you feel fit enough to go out yourself. Walking is good for both of you. If you use a buggy, make sure your baby can lie flat on their back. A parent-facing buggy is best so that your baby can see you and feel secure.

In a car: it is illegal for anyone to hold a baby while sitting in the front or back seat of a car. The recommended way of your baby to travel in a car is in a properly secured, backward-facing, baby seat in the back of the car. Ideally a second adult should travel in the back of the car with the baby. If you have a car with air bags fitted in the front, your baby should not travel in the front seat (even facing backwards) because of the danger of suffocation if the bag inflates. Avoid travelling for long periods of time and take regular breaks to give you a chance to take the baby out of their car seat. If your baby changes position and slumps forward, stop the car as soon as it is safe to do so and take the baby out of the car seat.

In cold weather: make sure your baby is wrapped up warm in cold weather because babies chill very easily. Take the extra clothing off when you get into a warm place, including the car, so that your baby does not overheat, even if he or she is asleep.

In hot weather: babies and children are particularly vulnerable to the effects of the sun, as their skin is thinner, and they may not be able to produce enough pigment called melanin to protect them from sunburn. The amount of sun your child is exposed to may increase their risk of skin cancer in later life. Keep babies under six months old out of the sun altogether.

Safety in the home: Children most at risk of a home accident are in the 0-4 age group. Speak to your midwife or health visitor for information on practical issues e.g. fitting smoke detectors and how to keep your baby safe generally. More information on preventing accidents relating to choking, suffocation, burns and scalds, poisons and emergency first aid is available at www.rospa.com. A safe sleeping discussion/assessment will be carried out by your midwife and health visitor to ensure that where your baby sleeps is a safe environment. Never leave your baby alone with any pets. Infant behaviour e.g. crying can irritate a pet. For further information visit: www.rspca.org.uk/safeandhappy.

Sudden Infant Death Syndrome (SIDS) sometimes known as cot death is the sudden, unexpected and unexplained death of an apparently healthy baby. Whilst it is rare, it can still happen and there are steps you can take to help reduce the risk for your baby:

• Place your baby to sleep in a clear, safe sleep space e.g. separate cot or Moses basket in the same room with you for the first six months, day and night.
• Use a firm, flat mattress with no raised cushioned areas, no pillows, quilts or duvets, or bumpers.
• Don’t use any pods, nests or sleep positioners.
• Always place your baby on their back for every sleep.
• Don’t cover your baby’s head or face while sleeping and place him or her in the ‘feet to foot’ position.
• Keep your baby in a smoke free area at all times, day and night.
• Don’t let your baby get too hot or too cold. The ideal room temperature should be between 16 and 20°C.
• Do not share a bed with your baby if you or your partner smoke, drink alcohol, take drugs or are very tired. It is advised not to share a bed with your baby if they were born prematurely (before 37 weeks) or has a low birth weight under 2.5kg.
• Never sleep with your baby on a sofa or armchair.
• Breastfeeding your baby reduces the risk.
• Ensuring your baby receives their course of vaccinations in their first year of life reduces the risk.

If you think your baby is showing any signs of being unwell, always seek urgent medical advice.