Feeding Some mums are determined to breastfeed their babies, some opt to combine breast and bottle, while others bottlefeed exclusively. Find out more about your options.

In this article

Breast or bottle? Breastfeeding Bottlefeeding

Problems Feeding at night Help and support

Switching to formula Going back to breastfeeding

Feeding your baby can be very rewarding and a time to enjoy a real feeling of closeness. Babies get far more than just nutrition from a feed - they enjoy the cuddle, the comfort and the satisfaction of a full tummy.

In addition, feeding your baby has an impact on his health, not just in infancy but in the long term, too.

In the UK, most mums start off breastfeeding. Breastmilk supplies all the nutrients your baby needs for about first six months and it's the normal, physiological way to feed a human baby. Take the opportunity in pregnancy to talk about your feeding preferences and get the most up-to-date information you can.

Research shows that babies who aren't breastfed have a higher risk of infection, and are more likely to spend time in hospital during their first year. This difference does not depend on the social or economic status of the baby's family - the gaps in health persist even when these factors are taken into account.

But it's not enough to know that breastfeeding gives your baby a better start. Many mothers need help and support to breastfeed, and access to good information to overcome problems.

If you don't breastfeed, for whatever reason, then your baby will need infant formula milk.

Mixed feeding - giving your baby formula milk as well as breastfeeding - can be a way to maintain some breastfeeding if you return to work, or if breastfeeding alone isn't working out for you.

Because you need to breastfeed often to keep up a supply of milk, mixed feeding can lead to breastmilk production dwindling sooner than you wish. Talk to a breastfeeding counsellor, or other knowledgeable person, to help you work out a plan that suits you.

If everything's OK, your baby can start to breastfeed straight after birth.

It can take a little while for the two of you to feel you have your act together but, once you do, it's convenient and easy.

• All mothers produce breastmilk
• It's all your baby needs for the first six months
• It contains antibodies that help protect against infections
• Breastfed babies are at lower risk of conditions such as eczema, asthma and diabetes
• Breastmilk is convenient - it needs no preparation, and it's free
• Breastmilk is always the right temperature

If you're unable to feed your baby (you may be going back to work or having a night out with friends) but want your baby still to have breastmilk you could express it and have a bottle prepared. This is a technique you can learn to do by hand or with a pump.

It can be stored in the fridge for between three and eight days, depending on the temperature of the fridge, or in the freezer for up to three months, see Expressing and Storing.

Breastfeeding needs no equipment but you might want to think about buying some of the following:

1. Nursing bras - to make 'access' easier, and to improve comfort and support
2. Breastpads - to absorb leaks in the early days/weeks; folded up cotton hankies do the job just as well

If you're going to offer breastmilk from a bottle you may consider the following:

1. A breastpump for expressing, although hand expressing only needs an ordinary sterilised household bowl
2. A bottle and teat to give expressed breastmilk
3. Sterilising equipment
4. At least six bottles and teats

Technique

Early feeds are a learning process for you and your baby. You may need guidance from a midwife or breastfeeding counsellor, and an experienced eye to help you avoid becoming sore. Well-positioned and attached babies shouldn't damage your nipples. There's no single right way to hold your baby, as long as you remember:

• Your baby shouldn't have to twist his body, turn or flex his head to come on to your breast
• Your baby needs to take your nipple far back into the top third of his mouth (otherwise his tongue will get in the way)
• His mouth needs to be wide open, with his tongue coming over the bottom gum and lip
• Pushing his head on to your breast can make him uncomfortable and resistant. Instead, bring him on when his mouth is at its widest point
• He has powerful instincts to get it 'right', and you can work with these

Follow what your baby wants to do. You'll get better and better at following his cues. He may want both breasts every time, and you can offer the second when it seems right - maybe when he wants to take a natural break.

Holding your baby so he can attach himself can be a comfortable and easy way to get things going. Lie back with your baby lengthwise down your body, just cuddling him gently. Newborn babies, with their powerful instincts and reflexes, can get themselves on to the breast with very little help.

It's also a good way to 'get back to basics' with a baby who's had a difficult birth, or who has been handled a lot.

Making milk

You already have colostrum (the first milk that your breasts produce) and some time between days two and five after the birth, your milk changes and becomes more copious. This is because prolactin, the milk-making hormone, has worked on your breasts as soon as the placenta was delivered.

If you don't breastfeed, production slows down and then stops.

You continue producing milk only if it's removed from your breasts - that's how your body knows your baby wants it.

There's no need to time breastfeeds, or schedule them

There's no need to time breastfeeds, or schedule them. In fact, if you do, you may end up with problems.

Babies don't need to be on the breast for a minimum or maximum time, either. Babies have individual needs, and mothers have individual milk storage capacity and responses. So responding to your baby is the best way of ensuring breastfeeding works out.

Breastfeeding after the early days

At first, you'll find your baby asks for feeds a lot and you may not be able to predict when he's likely to sleep. Sometimes you won't know when one feed flows into the next. Your baby may have ten to 15 feeds over 24 hours. This is the way your body adapts to producing the amount of milk your baby needs.

As time goes on, feeds are likely to become more predictable, though there may be occasional days when he enjoys a 'feed in' - that's normal.

It's fine for your breasts to feel softer after a few weeks - as though there's less milk there - it shows your breasts are producing what your baby needs.

How do I know it's going well?

• Your baby takes the breast without fighting or coming off and on
• He shows you he's contented after most feeds
• He's developing well and gaining weight
• He has several wet nappies a day, and does soft yellow poos
• Your breasts and nipples aren't sore

At first, most breastfed babies poo at least twice a day. Then, after a few weeks, they may go several days between each poo - that's normal, as is frequent pooing, too. Long gaps in between poos doesn't mean your baby has constipation.

Your baby's weight

Your baby's weight is normally plotted on a chart that's held in your parent-held child health record. In the UK, these charts are based on data collected from various studies and they show infant growth described on lines known as centiles.

A baby on the 95th centile is heavier than 94 per cent of babies of his age; a baby on the 3rd centile is heavier than 2 per cent of babies of this age.

It's not correct that these charts are based on bottle-fed babies, or that they come from the US. UK charts are based on UK babies, and the babies in the studies did not have their feeding differentiated.

But UK charts are different from the most recent World Health Organisation (WHO) charts, which are based on studies that tracked exclusively or predominantly breastfed babies in a number of centres across the world.

The WHO charts start to look different from the UK charts from when the babies are a few months old. Before then, they're pretty close. By the time the babies are a year old, the WHO chart babies are lighter, on every centile.

It may be that the UK will adopt the WHO charts in time, as they're certainly closer to a physiological norm than the current charts. But it's not clear how useful they'll be for babies on bottle or mixed feeding.

Focusing on weight alone can be very misleading

Whatever chart is used, an individual baby's weight is only one part of the picture. Focusing on weight alone can be very misleading. Perfectly healthy babies can move across centiles as they grow, and they can grow faster, or slower, than the charts indicate without there being a problem.

Help with breastfeeding issues

Breastfeeding isn't always easy.

Research on problems shows they are often resolvable.

• Sore nipples mean you need help with positioning your baby on your breasts
• Not having enough milk might mean you need to check your baby's feeding position (so your baby removes milk effectively) and/or the need to feed more often

Most mothers need support and encouragement as well as practical help. There are a lot of myths and misinformation about breastfeeding and they can be very misleading. For example, some mothers worry that their baby won't get a full feed if they're only the breast for a short time, because they've read the baby needs a certain amount of time to get the creamier hindmilk, after the foremilk.

In fact, the breast doesn't make two different sorts of milk. The more watery components (foremilk) may collect at the front of the breasts between feeds, that's all. When there's a lot of milk, there's proportionately more water in it; when there's less milk, there's proportionately more cream.

You don't need to 'engineer' your baby's intake of milk, responding to his cues allows you to be certain he'll get everything he needs.

• Formula milk is usually based on cow's milk.
• You reconstitute dried formula with water, although 'ready-to-feed' formula is also available in cartons.
• It's important to keep all feeding equipment clean - you must sterilise between uses for the first six months. This is because formula-fed babies don't get the same protection from infection as breastfed babies, and milk can be a breeding ground for bacteria.
• Make up each bottle as you need it and throw away any leftover milk. The Food Standards Agency has full guidance on preparing and storing formula milk.
• Follow instructions - you should always reconstitute the formula according to directions on the pack, so you get the right proportion of water to formula.

Bottlefeeding needs more equipment, especially if you plan to give more than the occasional bottle. You should consider the following:

1. At least six bottles and teats
2. Sterilising equipment
3. A brush/scrubber for cleaning the bottles

If you're using formula (as opposed to expressed breastmilk) you need to choose a recognised, infant formula. It's illegal in the UK to sell anything for your baby that's not a recognised formula, fulfilling government regulations on its nutritional content.

The main types of formula for babies under six months are:

• Whey-based milks - normally marketed for babies from birth. The protein content has more whey in it than casein, which reflects breastmilk's balance of these ingredients
• Casein-based milk - suitable for babies from birth, though usually marketed as being for 'hungrier' babies as the casein is less easily digestible, and is supposed to keep the baby feeling fuller for longer
• Soya formula - used with babies who can't tolerate cow's milk formula (some other specialist formulas are used for babies who have other special needs, for instance pre-term babies

Is there any milk my baby can't drink?

Ordinary cow's milk, goat's milk, condensed milk, dried milk, evaporated milk or any other type of milk should never be given to a baby under 12 months old.

Specialist formula milks include formulas for pre-term babies and formula for babies who are not breastfed and who are unable to tolerate regular cow's milk formula. The protein in these formulas is hydrolised, which means it's partially broken down, and this makes them easier to digest. Your doctor can prescribe them if they're needed.

Talk over your choice of formula with your midwife or health visitor if you have any concerns.

When you bottlefeed, hold your baby close and tip the bottle up so the teat fills with milk, and not air. Follow your baby's cues when you feed, and take the bottle out if he starts to wriggle as he may need to burp.

Some babies have very strong preferences for warm milk - and some are fine with it straight from the fridge.

The guidelines on the packet of formula will tell you how much an 'average' baby can be expected to drink at any one feed, but don't be concerned if your baby doesn't stick to these. His weight and progress are a good guide as to whether you're giving him the right amount.

Your formula-fed baby will need night feeds at first. If he always has warm milk you can make the night feeds easier by having the boiled water in vacuum flask ready to mix - don't forget to check the temperature first by shaking a few drops on to your hand, to check it's not too hot or cold. It should feel warm.

Sometimes, a breastfed baby will refuse to take a bottle. This can be problematic, especially if he has to begin bottlefeeding because you're going back to work.

• Someone else - not you - should try offering the bottle when your baby's not hungry, so he doesn't get cross that it's not what he's used to
• Try offering the bottle when you're face to face with your baby - for instance, when he's in a car seat looking up at you - that way he doesn't expect to be breastfed and, again, doesn't get so cross
• If attempts to bottlefeed end in a battle, leave it for a few days and then try again

Combining breast and bottle feeding

Many mothers do manage to combine feeding by breast and bottle - this is also known as 'mixed feeding'. Women who return to work, or know they're going to be separated from their baby for a length of time, may choose to use a combination of breastmilk and formula.

Some women express breastmilk so their baby can continue having breastmilk when they're not together. Breastmilk is made in direct response to your baby feeding - giving formula alongside breastfeeding could affect your breastmilk supply, but it's possible to combine successfully.

Speak to your health visitor or a breastfeeding counsellor about how best to manage this, so you can maintain breastfeeding.

• Wait until breastfeeding is well established, so formula has less of an effect on your breastfeeding - for most mothers a good time to do this is after five to six weeks
• Waiting also reduces the chance your baby ends up preferring the bottle - babies who are happy breastfeeders seem less likely to end up being confused between the different sucking methods at breast and bottle
• If you're giving formula at the same feed as breastfeeding, breastfeed first to keep up your supply, if that's what you want

It's normal for babies to wake in the night and need feeding. Breastfeeding makes night feeds easier. See our feature on Sleeping.

In hospital, midwives should help you. Hospitals that have Baby Friendly status, or are working towards it, should be especially good at this.

At home, you'll get a number of visits from a community midwife. Part of her job is to give breastfeeding support and information. Your health visitor should also be able to help you with any feeding questions - breast or bottle.

You could also contact a breastfeeding counsellor from a volunteer organisation. Ask your midwife or health visitor about local groups for breastfeeding mothers.

Most mother who switch to formula in the early weeks do so with regret - 90 per cent of women who switch before six weeks would like to continue. This means they can feel guilty and defensive about switching.

If this applies to you, think about giving yourself a break. Feed your baby closely and responsively, just as you would with breastfeeding. Often, it's the intimacy that mothers miss when breastfeeding stops, for whatever reason. It needn't disappear. In fact, there's nothing to stop you holding your baby to your breast whenever you want to, even if you're no longer breastfeeding.

Guilt is the emotion we feel when we know we've done something deliberately wrong - this just doesn't apply to infant feeding, when parents work out what's likely to be best for them and their baby in their own particular circumstances.

If breastfeeding didn't work out well, understanding what happened can help, as can considering where you might get support if there's a next time with another baby.

This is called 'relactation' and if you're very unhappy about your switch to formula, you might want to think about exploring this option. It isn't easy and you have to be fairly sure you want to do it. Ask a breastfeeding counsellor how it's done.

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