Breastfeeding Your Baby
When should you worry?
Newborn
NEWBORN
Contact your health visitor or GP if your baby is newborn and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
- Are often startling and you cannot understand why
- Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other
6-8 weeks
6-8 WEEKS
Contact your health visitor or GP if your baby is 6-8 weeks and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
2-3 months
2-3 MONTHS
Contact your health visitor or GP if your baby is 2-3 months and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
3-4 months
3-4 MONTHS
Contact your health visitor or GP if your baby is 3-4 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
- Move their arms or legs in repetitive, jerky, or strange ways
- Still need you to support their head, or can’t lift their head when lying on their tummy
- Have very tight fists and it’s hard to open their hand
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
4-6 months
4-6 MONTHS
Contact your health visitor or GP if your baby is 4-6 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
- Are unable to roll, or can roll in one direction but not the other
- Find it difficult to reach their arms out. For example, they do not reach for toys
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
- Still need you to support their head
6-9 months
6-9 MONTHS
Contact your health visitor or GP if your baby is 6-9 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
- Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
- Still need you to support their head
- Still need you to help turn their head when lying on their back
- Can’t crawl, or find it hard, for example, drags one of their legs behind them
- Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
- Can’t move a toy from one hand to the other
- Doesn’t use both hands to hold larger things
9-12 months
9-12 MONTHS
Contact your health visitor or GP if your baby is 9-12 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms and legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
- Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
- Can’t move a toy from one hand to the other
- Don’t use both hands to hold larger things
- Don’t point to objects
- Can’t crawl, or find it hard, for example, drags one leg behind them
- Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support
2 months
Your Baby By Two Months
Social/Emotional Milestones
- Calms down when spoken to or picked up
- Looks at your face
- Seems happy to see you when you walk up to her
- Smiles when you talk to or smile at her
Language/Communication Milestones
- Makes sounds other than crying
- Reacts to loud sounds
Cognitive Milestones (learning, thinking, problem-solving)
- Watches you as you move
- Looks at a toy for several seconds
Movement/Physical Development Milestones
- Holds head up when on tummy
- Moves both arms and both legs
- Opens hands briefly
4 months
Your Baby By Four Months
Social/Emotional Milestones
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make him laugh
- Looks at you, moves, or makes sounds to get or keep your attention
Language/Communication Milestones
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving
- If hungry, opens mouth when he sees breast or bottle
- Looks at her hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding him
- Holds a toy when you put it in his hand
- Uses his arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
6 months
Your Baby By Six Months
Social/Emotional Milestones
- Knows familiar people
- Likes to look at self in a mirror
- Laughs
Language/Communication Milestones
- Takes turns making sounds with you
- Blows “raspberries” (sticks tongue out and blows)
- Makes squealing noises
Cognitive Milestones (learning, thinking, problem-solving)
- Puts things in her mouth to explore them
- Reaches to grab a toy she wants
- Closes lips to show she doesn’t want more food
Movement/Physical Development Milestones
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support herself when sitting
9 months
Your Baby By Nine Months
Social/Emotional Milestones
- Is shy, clingy, or fearful around strangers
- Shows several facial expressions, like happy, sad, angry, and surprised
- Looks when you call her name
- Reacts when you leave (looks, reaches for you, or cries)
- Smiles or laughs when you play peek-a-boo
Language/Communication Milestones
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Lifts arms up to be picked up
Cognitive Milestones (learning, thinking, problem-solving)
- Looks for objects when dropped out of sight (like his spoon or toy)
- Bangs two things together
Movement/Physical Development Milestones
- Gets to a sitting position by herself
- Moves things from one hand to her other hand
- Uses fingers to “rake” food towards himself
- Sits without support
1 year
Your Baby By One Year
Social/Emotional Milestones
- Plays games with you, like pat-a-cake
Language/Communication Milestones
- Waves “bye-bye”
- Calls a parent “mama” or “dada” or another special name
- Understands “no” (pauses briefly or stops when you say it)
Cognitive Milestones (learning, thinking, problem-solving)
- Puts something in a container, like a block in a cup
- Looks for things he sees you hide, like a toy under a blanket
Movement/Physical Development Milestones
- Pulls up to stand
- Walks, holding on to furniture
- Drinks from a cup without a lid, as you hold it
- Picks things up between thumb and pointer finger, like small bits of food
Advice and Guidance
Responsive breastfeeding involves recognising and responding to your baby’s feeding cues, as well as your own desire to feed your baby. It is important to remember that feeds are not just for nutrition, they also provide your baby with protection, love, comfort, and reassurance.
Responsive breastfeeding also involves feeding your baby to meet your own needs. For example, you may wish to offer your baby a feed before you have a shower, tend to the needs of other children, or complete a household task. Alternatively, you may want to sit down, rest, have a cuddle and feed your baby.
The timing and length of a feed will vary, depending on the reason for the feed.
Please watch the video on Responsive Breastfeeding for more information.
Breastfeeding is a skill that you and your baby learn together. It takes time and practise. There are several different positions you can adopt when you are feeding your baby, these include sitting, laying back and lying down. Allow yourself time to try them all, so you can find the positions that suit you and your baby. The positions you choose may change throughout the day and night and whether you are at home or out and about.
Positioning is also about how you hold your baby while you are feeding. The acronym ‘CHINS’ explained in the table below, describes the principles of good positioning which are important for effective attachment.
Close - Keep your baby close to you, ensuring their hands and clothing are not in the way, so they can scoop enough breast into their mouth.
Head free - Support your baby’s neck, shoulders and back, so they can tilt their head back and allow their chin to come to your breast first, making it more comfortable for them to swallow. Even a finger on the back of your baby’s head will prevent this important movement.
In line - Your baby’s head and body should be in a straight line so they aren’t twisting their neck, which would make feeding and swallowing difficult.
Nose to nipple - Hold your baby close to you with their nose level with your nipple. Let your baby’s head tip back a little so that their upper lip can brush against your nipple. This will make your baby root and open their mouth wide. As they open their mouth, they will tilt their head back further and your nipple will slip under your baby’s upper lip and rest at the back of their mouth (at the junction between their hard and soft palate).
Sustainable - Ensure you are in a comfortable position before you start the feed, as you may be there for a little while. Bring your baby to your breast and let them attach themselves. Avoid putting your breast into your baby's mouth, as this can lead to poor attachment.
When your baby is in the right position, they will be able to effectively attach to your breast. Whichever position you choose, it is important to make sure your baby is able to attach effectively to your breast. Effective attachment is the key to successful breastfeeding.to enable them to attach well to your breast and feed
For more information about breastfeeding positions, please visit:
www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/how-to-breastfeed/breastfeeding-positions
www.globalhealthmedia.org/videos/positions-for-breastfeeding
Attachment is the term used to describe how your baby takes your breast into their mouth. Effective attachment is the key to successful breastfeeding.
Your baby is well attached to your breast if:
- their chin touches your breast.
- their mouth is wide open, and their tongue is down.
- their lower lip is curled back.
- their cheeks are full and rounded.
- more areola (the area of dark skin around the nipple) is visible above your baby’s upper lip.
- they have a co-ordinated suck and swallow sequence with pauses. At the start of a feed, your baby will suck rapidly to encourage your milk to flow or ‘let down.’ This will then change as your milk flows to a slower and more rhythmic suck and then little sucks or flutters as the feed finishes.
- it is a pain-free feed for you (at the end of a feed or if your baby comes off during a feed, your nipple should look rounded and not flattened or lipstick-shaped. If your nipple is misshapen, you need to adjust your baby’s position to improve their attachment.
For more information about attachment, please visit:
www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/off-to-the-best-start
www.globalhealthmedia.org/videos/attaching-your-baby-at-the-breast
For further UNICEF resources, please visit:
www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources
A baby’s stomach is very small when they are born (approximately the size of a cherry), so they need to feed little and often.
All parents and babies are different, and you and your baby will work out your own feeding pattern together. Both the length of time between feeds and the length of an individual feed can vary. However, breastfed babies normally feed 8 to 12 times in 24 hours, with each feed lasting between 5 and 40 minutes.
When your baby comes off the breast, offer your other breast. If your baby has had enough milk and is content, they may not want to feed from the other breast during this feed. This is normal. If this is the case, remember to start with this breast at the next feed.
It is important to feed your baby during the night as this is when levels of your milk-making hormone prolactin are higher which supports your milk supply.
If your baby ‘cluster feeds’ (feeds very frequently), at certain times of the day and goes longer between feeds at other times this is normal.
It is important to note that you cannot overfeed a breastfed baby or spoil your baby with cuddles, so do not worry about feeding your baby whenever you want to or whenever your baby is hungry or in need of comfort. If your baby feeds all the time and you are worried, speak to a midwife, health visitor or breastfeeding specialist. You may need some help with positioning and attachment.
During the first few days after giving birth, the volume of milk (colostrum) you make will be small to match your baby’s small tummy size. After the first few days, your milk will come in and the volume of milk you produce will increase. Your baby will also develop a more rhythmic suck-swallow pattern.
When your baby breastfeeds, the hormone oxytocin is released, this causes the muscles in your breasts to squeeze milk towards your nipples. This action is called the ‘let-down reflex’. You may feel the let-down reflex as a mild to strong tingling feeling or feel nothing at all.
At the beginning of a feed, your baby will make quick, shallow sucks to stimulate your let-down reflex and encourage your milk to flow. Once your milk starts to flow, your baby will take one or two deeper sucks before swallowing. If you listen carefully, you may be able to hear your baby swallowing or breathing out after they have swallowed. After breathing out, your baby will breathe in and swallow again, repeating the feeding cycle.
If your baby seems to be falling asleep before the ‘deep swallowing’ stage of a feed, or is sucking three or four times before swallowing, ask your midwife or health visitor to check your baby’s positioning and attachment. Your baby may not be effectively attaching to your breast. You may also wish to ask for help and support if your let-down reflex is too strong and causes your baby to cough or splutter.
Your ‘let-down reflex’ may also be triggered at other times, for example when your baby cries, when you are thinking about your baby or when you are having a warm bath or shower.
When you first start breastfeeding, you may wonder if you are producing enough milk for your baby. This is normal and it can take a while to feel confident that your baby is getting what they need.
You can use the guide below to see if breastfeeding is going well or if you would benefit from some support from your midwifery or health visiting service.
Signs that breastfeeding is going well:
- Your baby is alert, has good muscle tone and is a normal skin colour.
- Your baby has at least 8 to 12 feeds in 24 hours.
- Your baby’s suck and swallow pattern is rhythmic, with deep sucks and audible swallows.
- During most feeds, your baby feeds for between 5 and 40 minutes.
- Your baby spontaneously comes off your breast at the end of a feed (or does so when you lift your breast).
- Your baby is calm and relaxed during a feed and content after most feeds.
- Your breasts and nipples are comfortable during and after a feed.
- The shape of your nipple remains the same rounded shape at the end of a feed as it was at the start.
- Your baby has the expected number of wet and dirty nappies according to their age.
- There are no concerns about your baby’s weight gain and/or growth.
- Your baby is not using a dummy or a teat. You are not using formula milk.
Signs that breastfeeding may not be going well.
- Talk to a member of your midwifery or health visiting service.
- Your baby is sleepy, floppy or appears jaundiced (a yellow discolouration of the skin, whites of the eyes, gums, or roof of the mouth).
- Your baby has less than 8 feeds in 24 hours.
- Your baby is not sucking frequently during a feed, and you can only hear a few swallows.
- At each feed, your baby consistently feeds for: less than 5 minutes or longer than 40 minutes
- Your baby always falls asleep on your breast and/or never finishes a feed.
- Your baby comes on and off your breast frequently during a feed, and/or is not content after a feed or may refuse your breast.
- Your breasts or nipples are painful, and the pain doesn’t disappear after your baby’s first few sucks.
- Your nipple looks flattened or lipstick-shaped after a feed.
- Your baby does not have the expected number of wet and dirty nappies according to their age.
- There is a concern that your baby is not gaining enough weight or is slow to gain weight.
- You feel you need to give your baby formula milk and/or a dummy.
Your baby’s nappies are a good guide to the amount of milk they are drinking.
Day 1
A minimum of 1 wet nappy in 24 hours.
Your baby’s nappy may contain rust (orange-brown) coloured spots of concentrated urine. These are known as urates. At this age, they are not a problem, but if they continue beyond the first couple of days, you should tell your midwife as they can be a sign that your baby is not getting enough milk.
A minimum of 1 dirty nappy in 24 hours.
Your baby’s poo will be a dark green or black colour and tar-like. This is known as ‘meconium.’
Day 2
A minimum of 2 wet nappies in 24 hours.
Your baby’s nappy may contain rust (orange-brown) coloured spots of concentrated urine. These are known as urates. At this age, they are not a problem, but if they continue beyond the first couple of days, you should tell your midwife as they can be a sign that your baby is not getting enough milk.
A minimum of 1 dirty nappy in 24 hours.
Your baby’s poo will be a dark green or black colour and tar-like. This is known as ‘meconium.’
Day 3
A minimum of 3 wet nappies in 24 hours.
Your baby’s nappies should feel heavier.
A minimum of 2 dirty nappies in 24 hours.
Your baby’s poo will change to a brown, green, or yellow colour and be looser in consistency. This is known as a ‘changing stool’.
Day 4
A minimum of 4 wet nappies in 24 hours.
Your baby’s nappies should feel heavier.
A minimum of 2 dirty nappies in 24 hours.
Your baby’s poo will change to a brown, green, or yellow colour and be looser in consistency. This is known as a ‘changing stool’.
Day 5
A minimum of 5 wet, heavy nappies in 24 hours.
A minimum of 2 dirty nappies in 24 hours.
Your baby’s poo will change to a yellow colour and should be at least the size of a £2 coin and runny.
By day 6
A minimum of 6 wet, heavy nappies in 24 hours.
A minimum of 2 dirty nappies in 24 hours.
Your baby’s poo will be a yellow colour and should be at least the size of a £2 coin and runny.
4 to 6 weeks
A minimum of 6 wet, heavy nappies in 24 hours.
After 4 to 6 weeks, when breastfeeding is more established, some babies may go a few days or more without opening their bowels. This is normal.
A breastfed baby is unlikely to become constipated, and when they do poo, it will still be soft, yellow, and plentiful. If you are concerned your baby is constipated, please discuss this with your midwife, health visitor or GP.
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