Feeding Your Baby

How should I feed my baby?

One of the first decisions you will make, after your baby is born, is how to feed him or her. Most mums will have the choice of either breastfeeding or bottle-feeding from the start.

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Is breastfeeding for me? The pros and cons of breastmilk and formula

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• Breastfeeding: What is colostrum and what are the benefits?

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Should I breastfeed or bottle-feed?

The benefits of breastfeeding for you and your baby are so great that experts recommend that, in almost every circumstance, breastfeeding your baby for the first six months is the best option for both your health and your baby's health, even in countries where infant formula is easily obtained and water supplies are clean and safe. Nevertheless, deciding whether to do this is a personal decision and you need to consider both the pros and cons of both types of feeding for you and your baby. You don't have to choose completely between them - you can do both, for different periods of time and in different proportions. Each approach has advantages and disadvantages, and to help you think them through we have listed the main ones here:

Advantages of breastfeeding to your baby

• Breastfeeding provides your child with the perfect, tailor-made source of nutrition, the one that nature evolved for them. It is the easiest food for them to digest, so it possibly causes less gas and colic.
• Breast milk, particularly first milk, helps protect your baby from illness during infancy, particularly tummy bugs and ear infections. It also reduces the incidence of cot death (sudden infant death syndrome).
• Breastfeeding has lasting benefits for your baby's metabolism, reducing the chance of obesity and diabetes, and of allergies like eczema, later.
• Breastfeeding makes feeding simple: no other fluids (such as water) are needed for a breast-fed baby. In the hottest weather, the breast milk composition changes, to provide everything your baby needs.
• Breastfeeding enhances the bonding process between baby and mother. Being cuddled naked, against the mother's bare skin for as long as possible at birth, is important. This can of course be done even if you do not breastfeed.
• Babies generally 'take to' the taste of breast milk quickly, whereas not all babies like the taste of all bottled milks.
• A breast-fed baby's bowel movements are less smelly and are not irritating to a baby's skin. Breast-fed babies are less prone therefore to nappy rash.
• Breast-fed babies don't usually get diarrhoea or constipation.
• Breast-fed babies tend to be less fussy at weaning.
• Breast milk appears to help loosen a newborn baby's mucus and it acts as a laxative helping with the passage of the first poo (meconium).
• Breast-fed babies perform slightly better in intelligence tests in early childhood.
• Breastfeeding is comforting for you and your baby (although this can equally be true of bottle-feeding).

Advantages of breastfeeding to you

• Breastfeeding will help speed your recovery from childbirth, particularly the shrinking down of your womb after delivery.
• Breastfeeding helps you manage the initial breast 'engorgement' which often appears around day 3-4 and which can be very uncomfortable.
• Breastfeeding is convenient: you don't have to prepare bottles. It is also the cheapest option - it's free.
• Breastfeeding slightly reduces the chance of postnatal depression.
• Breastfeeding gives you later protection, to some degree, against ovarian and breast cancer. It also decreases your chances of developing 'thinning' of the bones (osteoporosis), diabetes and obesity as you age.
• Night-time feedings are easier and quicker when you breastfeed, meaning that you get more sleep.
• Breastfeeding usually delays the return of your period for three months or more. Whilst you are breastfeeding exclusively, your fertility is suppressed for up to six months - a natural birth control method which is up to 98% effective.
• Pumping or expressing your breast milk can give you some freedom, allowing you to spend time away from your baby yet continue to provide breast milk, and giving your partner the ability to participate in feedings.
• Exclusive breastfeeding for the first six months of life provides the maximum benefit. However, any breastfeeding that you do will bring you and your baby benefits.

Advantages of bottle-feeding

• You have more flexibility in being away from your baby if you have to work, for example. (Although you can express or supplement breastfeeding with bottle-feeding, in the first few days when your breast milk supply is just establishing this is not so easy to do, so you can't easily be away from your baby.)
• Breastfeeding can be tiring, especially during the first few weeks when you are feeding your baby on demand. Bottle-feeding is easier to delegate when you are tired, allowing you to rest properly and have more energy overall.
• Breastfeeding can be painful: common problems include breast engorgement, leaking, sore nipples and infection of the breast (mastitis). Bottle-feeding allows your breasts to settle down more quickly after pregnancy.
• Your partner can't breastfeed, and may feel a little left out (although you can express to allow them to bottle-feed).
• You may find breastfeeding in public awkward and embarrassing, making it difficult to go out with your baby. Bottle-feeding removes this worry (whether feeding expressed milk or formula).
• Bottle-feeding allows you to see how much milk your baby has taken, which you may find reassuring.
• Breastfeeding can be difficult at first. Not all babies latch on immediately and breastfeed well, and you may find breastfeeding stressful and be unsure whether your baby has fed properly.
• Breastfeeding can be particularly difficult if you have more than one baby to feed; partially or completely using bottles may help you manage.
• Women who have had surgery to their breasts, including cosmetic surgery, can have a decreased flow of breast milk - the effect depends on precisely what surgery they have had.
• Some women worry that they cannot produce enough milk to satisfy their baby, and bottle milk relieves this anxiety.
• Bottle-feeding may be safer for your baby if you need to be on medications which would enter your breast milk and be harmful for your baby, or if your baby needs a specially adapted milk because they have a medical condition.
• Women who are HIV positive are advised not to breastfeed unless in a country or situation where safe supplies of formula and water are not readily available.
• Other, practical reasons why your baby might need to bottle-feed include you not being with your baby (for example, because of adoption, prematurity, or sickness in you or your baby, or because you need to return to work early).
• If your baby is born before 32 weeks it can be harder to establish your breast milk supply, so some bottle-feeding may take the pressure off you as you try to establish your supply.
• Some women just prefer the idea of bottle-feeding (although they may be able to express for a while if they want to give their baby breast milk).

Advantages of combination feeding

Breastfeeding or bottle-feeding doesn't have to be all or nothing. You can breastfeed fully or partly, and many mums combine breastfeeding and formula feeding, and breast-milk pumping, in differing proportions. It's easiest to begin combination feeding once you have breast-fed for six weeks so that your supply is fully established; however, you can try it sooner if you need or want to.

Combining breastfeeding with bottle-feeding offers the advantages and disadvantages of both options. It makes you more flexible, as you can move between the two, which might suit you if, for example:

• You want to breastfeed but would like your partner to share in the feeding routines
• You want to breastfeed but also to preserve your energy and offer the baby the best of both worlds
• You are breastfeeding but want to be able to give bottles of formula for one or more feeds so that you can get some rest
• You began by bottle-feeding your baby and have decided that you want to start breastfeeding
• You need to leave your baby and want to make sure they have some milk while you're away
• You have twins or more and feel this would be more manageable

Introducing formula feeds will tend to reduce the amount of breast milk you produce and this is more so if you do so in the first six weeks, whilst your breast-milk supply is adjusting to an 'even keel'. Your baby also has to learn to use a different kind of suck at the bottle than at the breast. However, with perseverance many mothers manage it successfully.

How do I express breast milk?

You might want to express milk because your breasts are engorged and you want to relieve the pressure, because your baby is very premature and not yet able to suck (see below), or because you need or want someone else to be able to feed your baby too. Expressing your own breast milk is a technique you can learn quite quickly, although it may take a little practice at first. Expressing breast milk is as it sounds: you 'milk' your breast for the supply it contains, and store the expressed milk so that you (or someone else) are able to give it to your baby from a bottle.

You can express milk using a pump (hand or electric) or by hand (often easiest at first). You can rent 'hospital-grade' breast pumps, which are the most effective. You can keep expressed milk in the fridge for up to five days, or freeze it for up to six months.

More detail on how to express breast milk is given in the separate leaflet called Breastfeeding Your Baby.

How should I feed my newborn baby?

You should offer your newborn baby a feed as soon as possible after birth. You can usually choose breastfeeding or bottle-feeding from the very start. Breastmilk, particularly early breast milk, is massively beneficial for your baby, and for this reason many mums who want to bottle-feed decide to breastfeed for the first couple of weeks. This means that they give their baby the important first milk (colostrum) before switching over to formula.

Your midwife will be there to help you establish feeding, until you can do it confidently without help, so you won't be doing this alone.

How often will my baby want to feed immediately after birth?

Straight after birth your baby will, like you, be tired and probably hungry. Some babies will want to feed straightaway; others may seem less keen to do so. Your midwife will encourage your baby to feed in the first hour after birth, as this helps both you and your baby recover from labour. It is particularly important for the babies of mums with diabetes to be encouraged to feed in the first half an hour or so after birth, as these babies can be particularly prone to developing low blood sugar otherwise.

Babies will vary greatly as to whether they will want to keep feeding in the first few hours after birth, or as to whether they seem to need a sleep. Newborn babies should be allowed to feed as often as they wish. If the baby is sucking actively they should be kept on the breast or bottle until they slow or stop. If you are breastfeeding you should offer the second breast before stopping (because it may be that the flow has slowed in the first breast but your baby is still hungry).

Will I have any milk in the first few hours?

When your baby is born your breasts will already be producing colostrum, which you may have noticed leaking from your breasts in late pregnancy. This yellowish 'milk' is a bit thicker than mature breast milk. Colostrum is only produced for the first few days of your baby's life, after which it gradually changes (and increases in quantity) to mature breast milk. Colostrum is very important to your baby. Even if you don't plan to breastfeed in the long term, any colostrum that you feed your baby will have long-term value to him or her.

What is colostrum?

Colostrum is a milky yellow 'first milk' which contains proteins, carbohydrates, fats, vitamins, minerals, antibodies and immune cells that fight disease-causing agents such as bacteria and viruses. It helps you pass on to your baby the immunity you have 'earned' through fighting infections yourself. This is hugely helpful to your baby, whose own immune defence system is not yet fully developed. Having their mother's colostrum reduces tummy and ear infections in babies in later childhood. Colostrum also helps prevent babies from developing early jaundice.

Many mothers who don't want to go on to breastfeed decide to give their baby that vital, initial colostrum. After this, over the first two weeks the milk gradually changes from colostrum through a 'transitional milk' to 'mature' breast milk. In the first 24 hours after the birth you will produce about 40 ml of colostrum, and your baby will take about a fifth of this during a feed.

How does feeding my baby the colostrum help my body?

Breastfeeding in the minutes and hours just after your baby is delivered helps your womb expel the afterbirth (placenta) more efficiently and then helps it contract firmly down towards its pre-pregnant size. This helps kick-start the process of your own return to normal shape and can also help relieve the breast engorgement that usually arrives around day 3-4 after birth (whether or not you breastfeed).

How do I feed my premature baby?

Premature babies are ideally given breast milk from birth, although before 32 weeks of gestation they may not yet be strong enough to feed directly. If you are making milk and your baby is strong enough to suckle, you will usually be encouraged to breastfeed, as breastfeeding is particularly helpful for premature babies. If you are unable to breastfeed initially, or decide not to, your premature baby may be given formula milk or, occasionally after discussion with you, expressed donor milk.

• If your baby is extremely premature, his or her digestive system may not yet be mature enough to have food in the stomach, so feeding may need to be into a vein using a special nutrient rich solution called TPN (this stands for total parenteral nutrition).
• Premature babies who are ready to digest milk but not yet strong enough to suckle, may be given breast or formula milk through a tiny tube which goes to the stomach. Ideally your own breast milk will be used, if you can express it. Premature babies may also need food supplements, or special premature baby formula, to make up for the time in the womb that they have missed.
• If your baby is very early it may take a little while for you to produce milk. However, if you keep expressing regularly, eight times a day, the milk is likely to come in. Whilst your milk supply isn't fully established then the team may talk consider using donated human breast milk or formula, until you can replace it with your own breast milk.
• Your baby may continue tube feeding while they are learning to feed from the breast, from a cup or from a bottle, to make sure they get enough food.

How do I express breast milk for my premature baby?

To express milk for your premature baby, you should start hand expressing within six hours of delivering your baby. You'll need to do this eight to ten times a day, including once during the night. In the first few days you may make only a few drops of milk each time, which can seem like very little, but every single drop counts.

How many calories are there in colostrum and breast and formula milk?

Colostrum has around 50 calories per oz and mature breast milk has 60-75 calories, as does infant formula. When producing mature milk, each breast will produce 'richer' milk with a higher fat content towards the end of a feed when it is nearly empty, so it is important that breastfeeding babies get the opportunity to empty one breast before feeding from the other, so that they can access this richer milk.

How do I breastfeed my baby?

See the separate leaflet called Breastfeeding Your Baby.

How do I bottle-feed my baby?

See the separate leaflet called Bottle-feeding Your Baby.

Can I go back to breastfeeding after bottle-feeding?

You can restart breastfeeding for weeks or even months after you have stopped, if you want to do so. It can take a little perseverance, but there are a few things which may help your milk to come back in:

• Hold your baby as much as possible, skin to skin.
• Express your breast milk around eight times a day - this releases the hormone prolactin, which stimulates your breasts to make milk. It may be easier to express by hand to begin with, although pumps are also available.
• If your baby is latching on but you don't yet have much milk, feed little and often, when your baby is relaxed and not too hungry.
• Decrease the number of bottles gradually, as your milk supply increases.
• Consider using a lactation aid. This is a tiny tube which is taped next to your nipple and goes to your baby's mouth, so that when your baby suckles on your nipple he or she can get milk via the tube as well as from your breast. This helps keep your baby suckling, giving your breasts the stimulation they need to keep producing milk.

Can I breastfeed if I adopt?

It can be possible to breastfeed even if you have not just had a baby - it is called adoptive nursing. The principle is that repeated stimulation of the nipples triggers milk production. It is more difficult to trigger milk production if you have not been pregnant recently. This is because although the milk production itself is triggered by nipple stimulation, you won't have the high levels of pregnancy hormones that also prepare your body for breastfeeding by enlarging and sensitising the milk-producing apparatus. But it is possible.

It can take considerable perseverance to get a good supply of milk, but a lactational aid (as those described above) can be very helpful in persuading the baby to keep suckling, delivering the stimulation needed to create a milk supply.

How do I wean my baby?

Weaning is the gradual introduction of additional food to your baby, on top of infant formula or breast milk. See the separate leaflet called Baby-led Weaning.

What is the best way to help my baby eat a balanced diet after he or she is fully weaned?

Feeding children over the age of 12 months is both an art and a science. Your aim is to encourage healthy tastes and eating habits, which will set your child up for life.

See the separate leaflet called Feeding Your Toddler.

Dr Mary Lowth is an author or the original author of this leaflet.