feeding challenges

+ biting (bottles or boobs)

Yep, we hear you, it is blooming sore. Babies are most likely to partake in biting when they are teething, but sometimes they just bite down when they feel like it.... thanks minis! There isn't a lot you can do to stop an infant from biting you during a feed, but there are some things you can try if it happens. First thing, break the suction. Use your little finger and insert it into the mouth to break the seal and pop them off. Once off, try offering something cold for them to bite on. Some mums try this before breastfeeding as well, to get it out their system before! Keep a close eye on your baby during the feed, you might be able to anticipate and intercept the biting!

Sometimes biting might be a sign of frustration, that the breast is not producing enough, quickly enough. So if biting is happening regularly and your baby is fussing, then it might be worth asking a health visitor or lactation consultant to assess the latch and make sure your baby is gaining weight appropriately.

+ blocked milk duct

Blocked ducts are really common. They occur often when supply and demand changes leading to engorgement, that is to say when your milk is increasing but your baby might be dropping a feed. Your supply will even out over time, but in the interim, you are at risk of blocked ducts. Imagine your breast is like half a grapefruit, each segment represents a duct. All these ducts drain to the centre and out the nipple. Ducts can become blocked when the flow of milk is interrupted. So engorgement is a big offender, but so are ill fitting bras and tight tops. Once you identify a blocked duct, usually by a hard lump, pain, redness, then you want to unblock ASAP to avoid mastitis. Continuing to breastfeed will unblock the duct. It will be really sore. Another option is to run yourself a bath, or hop in the shower and take a flannel and a comb. Imagine the breast is like a clock face, each number is a duct that drains into the centre point. Using the comb and flannel to massage each number on the face from the outside towards the centre, the nipple. Some women use their knuckles. Any area of redness needs the most attention. Sometimes you might see as well as milk coming out, a thicker cheesier substance which can be a reassuring sign you are unblocking the duct.

If this doesn't work, you might be at risk of mastitis, see below

+ abscess

A breast abscess occurs when mastitis infection has led to a collection of pus in the breast tissue. Breast abscesses are extremely painful and require medical attention. They require surgical drainage, either by needle and syringe if small or a small cut made in the skin to drain the pus. The procedure requires local anaesthetic, which will not affect breastfeeding, or your milk. It is usually a day procedure and you will get home that day. Most abscesses will be uncomplicated and heal within the week. However, some have further complications such as reoccurrence, or milk collecting in the space left by the abscess. If this happens then seek help from your healthcare professional and a lactation consultant. Final bit of advice is to set an alarm on your phone to remind you to take pain relief and antibiotics if required. Also get as much help as you can, you are likely to be completely exhausted, so help with the baby will be key!

+ bottle refusal

Bottle refusal is when your baby point blank refuses to take milk from a bottle. Whilst the definition is simple, the experience can be traumatising for parents. It happens for a number of different reasons. Your baby may prefer

1. the flow of milk from a breast (compared to a teat)
2. the taste of breast milk (compared to formula milk)
3. the position, latch and hold (during a breastfeed compared to a formula feed)
4. the temperature of breast milk (compared to formula milk)

If this is a new refusal, when previously they had happily drank from a bottle then it is worth considering:

1. Is your baby unwell? Do they have oral thrush? Do they have colic?
2. Is your baby just not hungry?
3. is this a new teat, or bottle, or milk you are using?

More often than not it is a breastfed baby who is struggling with the transition to bottle feeding and we know just how stressful this can be for parents. So the first thing to remember is, it will be OK, you are doing a great job!

We cover some tips for transition here and also a blog post on stopping breastfeeding here

The top tips are:

1. Try different bottles. If your baby has refused one bottle, try another. Get advice what bottles have worked for others; teats matter! If they really are hating the bottle then, depending on their age and head control, you could try a cup or spoon feeding.

2. Try different temperatures. Some babies like warm milk (never heat over body temperature), some like cooler milk, and some like cold milk.

3. Try different milks. If they are over 12 months then you can mix it up with cow’s milk, oat or almond milk. Before 12 months you are restricted to infant formula milk, but different brands will taste differently. The readymade taste different to the powdered. A babies taste buds develop around 6 months, so they might start to show preference around then. If you are a pumping mum, try mixing breast milk with formula milk in decreasing volumes until they are eventually on a full formula feed.

4. Try different times. Try when they are hungry, try when they are full, try when they are sleepy and when they are wide awake.

5. Try different people. It might be sending your baby crazy to smell you and not be given the boob. So get partners, grandparents, friends - anyone who is willing - involved in offering a bottle. Make sure you leave the room. Not only may it help your baby to settle, but it will be much less stressful for you too.

6. Try different environments and positions. Some babies like to be still, others to be rocked. Some like noise and familiarity, others like quiet, unstimulating environments.

7. Mix formula into EVERYTHING. If they are already on solids mix formula with food. It will become really sloppy and disgusting looking, but it will allow them to get used to the taste. Mix it with breakfast, lunch, dinner and snacks.

8. Things you have tried once before, revisit them.

9. Finally, and most importantly, try and relax. This is going to be the hardest one of all to do. It can be a very stressful time when you want to stop breastfeeding but don’t panic, they will eat when they want to. As long as they are hydrated (producing wet and dirty nappies) and getting plenty of cuddles they will be fine and, trust us, you will be too.

+ choking or spluttering

Choking happens when milk goes down the wrong tube and enters the baby’s airway, rather than the oesophagus and into the stomach, where it is meant to go. If your baby is choking during a feed it usually means the flow is too fast, this can happen for both breast and formula fed babies. If your baby is breastfed, you could try a different position, to allow your baby to pull away from the breast more easily and be more in control of the flow. These tend to be more upright positions. If you are able, then a laid back feeding position will help reduce the forceful letdown and allow your baby to take more control. See our blog on laid back feeding here. If you are bottle feeding, then consider the position you baby is in during a feed, hold them in a more upright position and allow them to control the flow using responsive feeding methods. You also might want to consider changing the size of the teat, to a smaller / slower flow.

+ cluster feeding

This is when your baby wants to feed ALL THE TIME. You have just finished feeding them, you try and put them down, but boom, they want more and you are there for another 45 minutes. The cycle continues until you realise you have been feeding your baby what feels like non-stop for 24 hours. For most of us this is mentally and physically exhausting and an exceptionally limiting period of time where you achieve very little, including bathroom breaks.

Babies are more likely to cluster feed at times of rapid growth, which is usually in the first couple of weeks and then again around 3 to 4 months (helpfully co-in siding with the sleep regression time - eye roll).

There isn't anything you can do to stop cluster feeding, it happens to breastfed and bottle fed babies alike. However, there are some things you can do to help you manage cluster feeding.

Firstly rally the troops. You will need help. Someone to bring you water, food, hold the baby whilst you have a shower, go to the bathroom etc. Your baby might cry whilst you are doing these vital activities, that is OK, you need to ensure you are looking after yourself. As they say, you can't pour from an empty jug.

Prepare your feeding zone. Ensure you have a comfortable chair, with easy reach to water, to the remote control, and with muslins to hand. Having a handy change station nearby is also helpful, as we all know milk in = poop out. Once you are in the zone, you might be highly reliant on a helper to bring you anything else you need, so don't forget your phone!

Prepare your feeds. If you are breastfeeding, make sure you look after the boobs. Use creams, pads, shields, whatever works for you to give your boobs the care they need. If you are bottle feeding, get ahead. Have your bottles sterile, organised and ready to go.

+ colic

The witching hour is often talked about, and for some, it is the witching 24 hours, where your baby cries and struggles to settle without any clear reason. Along with the crying, babies might also bring their legs up to their chest, clench their fists, go red in the face, generally look pretty furious. Colic is not well understood or researched. It is likely that when babies are little, their digestive systems are immature and they struggle to process milk, causing wind, which any adult who has experienced can tell you is pretty uncomfortable. There are lots of theories to what might help (listed below) but honestly, the best thing is time. Your baby will grow out of it as their tubes get bigger. As this is not entirely helpful here is a list of things that people have said help, although there is no evidence for or against.

1. Diet - if you are breastfeeding, then some mums have said what they eat can increase colic symptoms including foods such as broccoli, cabbage and cow's milk products. Keep a diary of your intake and see for yourself if there are any patterns.
2. Using a dummy - the sucking and swallowing might help soothe sore tummies
3. Rocking and bum patting - some positions that apply a little pressure to the tummy are also helpful such as tiger in a tree, where baby is held across the arm facing downwards
4. To swaddle or not to swaddle - a divisive area but some swear by it for making their baby feel safe and secure, and a sling can serve the same purpose too if you find the one that is right for you.
5. White noise – washing machines, vacuum cleaners, and smart speakers these days have a range of options
6. Give them a warm bath
7. Push them in their pram or take them for a drive – babies like movement

There are tonics that are sold to help babies settle, or special infant formula milks, again there is no evidence these work, and they are often more expensive. Colic may also be a symptom of an underlying medical condition, so if in doubt, talk to your health care provider. The witching hour can be really challenging for parents, pacing floors and streets at night time in desperation. So it is really important that you find the support you need, if you can, do it in shifts to allow you to rest.

+ dysphoric milk ejection reflex (DMER)

DMER refers to the sudden onset of negative emotions triggered by the let down reflex when breastfeeding. It is usual for the emotions or sadness, anxiety, revulsion, restlessness, anxiety, to develop just prior to let down and last a couple of minutes after let down. It is not the same as breastfeeding aversion, which is described as negative emotions that last throughout the duration of the breastfeed, or towards the thought of breastfeeding. Unlike aversion, DMER is confined to the short, transient period during let down at the initiation of a feed only.

There is very little research on DMER, the pathophysiology is not well understood and thus treatments are more guess work and trial and error. Hypotheses include links with sudden changes in dopamine levels, or surges in oxytocin. However, theories are based on case studies, and more research is definitely needed.

As the mechanisms are not well understood, treatments are limited. Often women with DMER stop breastfeeding earlier than they would like to. Treatment focuses on coping strategies to help distract from and to make the symptoms more tolerable. Given the lack of evidence, we can't recommend a tried and tested measure, but reports of meditation, drinking cold water and connecting with others who suffer with DMER have been said to help.

+ engorgement

Engorgement is when the breasts are overly full and become hard and tight and can be very painful. Whilst this can happen at any time, it is most common in the first week after delivery and when your infant “drops a feed”. The breasts can become so firm that the wee one struggles to latch, which perpetuates the problem. There are some things you can do to help.

• Hand express to soften the breast, this will help your baby latch.
• The use of hot and cold. Warm flannels / showers will stimulate let down and flow – this will soften the breasts. However, remember that anything that triggers let down will stimulate milk production. Cold pads help ease pain and inflammation.
• Breast Pumps. Some people find lightly pumping softens the breast enough to enable your baby to latch. Again watch for over stimulating.
• Some swear by cabbage leaves, but the evidence is limited.
• Take regular pain relief. Paracetamol is a good pain killer and ibuprofen works as an anti-inflammatory. Read the labels before taking. Only take if medically fit to, and always seek advice if in doubt.
• Wear well fitting underwear.

Engorgement should ease over 2 to 3 days. If your breasts continue to be firm then perhaps you have a milk over supply issue (link to oversupply).

+ feeding strike

This is when your baby point blank refuses to feed. This can happen at any stage and can happen for many different reasons. The most important thing is that your baby is well hydrated. If they are showing signs of dehydration then you need to take them to be assessed by a medical professional. Signs include, dry nappies, crystals forming in the nappy, dry mouth, not crying with tears and sunken head spot.

The reasons for feeding strikes vary and can be related to changes in taste, changes in flow, feeling unwell, thrush, teething, distracted, or they are full on other food stuffs if weaned.

1. Speak to your health visitor or lactation consultant to try and assess feeding.
2. Don't panic. Easier said than done we know.
3. Keep offering the boob or the bottle, at different times, in different places etc, but never force it.
4. Your health care provider might suggest trying sippy cups or syringes of milk.
   Your health care provider will be there to guide you on next steps if needed.

+ inverted nipples

Flat or inverted nipples doesn't mean you can't breastfeed, but it is an extra hurdle. Evidence shows women with flat or inverted nipples are less likely to exclusively breastfeed. However, all is not lost, there is good evidence to show a number of techniques work in helping babies to latch to breasts with inverted or flat nipples to help sustain breastfeeding.

1. Hoffman's exercise - sounds fancy... well it isn't. It basically is placing your thumbs on either side of the nipple at the base, pressing firmly and pulling them away from each other. This is done all around the nipple in order to encourage it out.
2. The inverted syringe technique. This uses a syringe with the top cut. The end in placed over the nipple and the plunger is pulled back. It creates a vacuum and pulls the nipple out. It is said to be quite uncomfortable. Less barbaric tools are available and are called latch assists, and are designed to do the same job.

Other tools have less evidence but may work include:

1. Nipple shields - if anything they might protect your boobs from a bit of discomfort.
2. Nipple shells - if worn all day then they create a vacuum which may pull the nipple out.

+ jaundice

When your baby has a healthy glow, only for you to realise the glow is yellow. Jaundice is very common and occurs within 72 hours of birth, called newborn baby jaundice. It is caused by an accumulation of a compound called bilirubin due to your baby’s liver making a sluggish start, and not processing all the bilirubin fast enough. Your midwife during the first few days will be looking out for signs of jaundice which include a yellow colour to the skin, yellow eyes, dark urine and pale coloured poos. A little bit of jaundice is not a problem, but your midwife will do a small blood test, to check the levels of bilirubin. If it is too high, then your baby will need to go back to hospital for treatment. Treatment is either phototherapy, or if this is not effective and levels are very high, exchange transfusion where their blood is replaced with that of a matching donor.

+ latch problems

Difficulties with latch are really common especially in the first few days and weeks. Latch is the attachment of your baby to your breast during feeding. You can tell straight away if it is really wrong, because it hurts. The difficulty comes with the grey area where the latch kind of looks OK, they feed OK, and there is some discomfort but is that normal?! Breastfeeding isn't easy and we don't all naturally know what is right and what isn't quite right.

Let's start with, what a good latch looks like:

• Big wide mouth, chin touching the breast with nose just clear.
• The breast should be in the mouth, not just nipple.
  It takes practice. Here is a good link to NHS step by step guide.

If the latch is not perfect then signs it can be improved include:

• wobbling head from your baby
• Pain that lasts throughout the feed
• white or discoloured nipples
• flat or lipstick shape nipples

Tips:

• Get an assessment from your midwife, health visitor, lactation consultant to assess latch, feeding position etc.
• Check out our pages on position and latch
• Don't be nervous to pop your baby off and try again, put your little finger in the side of their mouth to break the seal and then follow the step by step to reattach

Most health care providers say breastfeeding should never hurt. However, sometimes even if you have done everything right, there still might be discomfort and this is totally normal. This is true especially in the early days where your breasts and nipples are engorged and your baby has a tiny mouth. Sometimes no amount of repositioning is going to help to get breast into your baby’s mouth when it is already full to the brim with nipple. As you baby grows and your boobs deflate this will get easier. To help get through those first few days try different positions such as laid back feeding and if you need a break you could consider expressing or shells and bottle feed.

+ low milk supply

Arguably one of the most common feeding issues women report, low milk supply is an inability to produce enough milk to satisfy your baby. As our babies grow, they change their feeding demands, and whilst on paper, our supply is meant to follow this, there is usually nearly always a delay in matching a change. This is all down to the [hormones and physiology][10] that drive lactation. For a number of mums, even after the demand has settled, they are still unable to keep up with the feeding needs of their infants. Mums will report their baby is constantly hungry, feeding all the time, never satisfied, unsettled. Health care professionals tend to start getting a bit twitchy when your baby begins to show signs of dehydration and / or begin to lose weight.

However, up until these time points, the advice generally is "keep feeding - you have enough", despite that one of the leading causes of women stopping breastfeeding is them feeling they were not producing enough milk.

So we are changing the narrative. Please know that you are heard, and instead of dismissing your concerns we have pulled together a few tips

1. Breastfeeding is a physiological demanding activity. It requires plenty of calories, water and rest. You cannot pour from an empty jug.
2. The more the baby feeds, the more your breast will be stimulated to produce milk, it is the suckling that starts the hormone cascade telling the boobs to make milk. So if your baby has longer periods between feeds, they will be stimulating the breast less and your boobs will start to produce less milk. Feeding your baby regularly helps stimulate supply.
3. Check your latch. Breastfeeding is hard work for the baby too, so once they have had just enough to settle themselves, they will stop, because they are tried. So ensuring each feed is delivering the most amount of milk in the shortest space of time is ideal. So ensure the feeding position and latch are the best they can be. If in doubt, call in a trusty infant feeding specialist to check it out.
4. Check your medications. Whilst many medications are safe during breastfeeding, some do have an impact on supply, the most common being, hormonal contraception.
5. Being unwell can impact your supply. Mums who had a traumatic birth, who delivered prematurely, or who have had illness in the post partum period are more likely to have low milk supply. Our bodies will prioritise our own health over lactation. It comes down to - you can't pour from an empty jug!
6. Expressing between feeds also can stimulate the breasts, which eventually should increase supply. However, many mums find a strict regime of feeding and expressing exhausting, and also they have less milk when the time comes for a feed.
7. .... and here is the secret no one tells you.... topping up is completely OK. If you are totally stressed out, this will impact your supply, introducing a bottle is not the end of the world and might actually be the answer, it also doesn't have to be forever. But remember, most mums who breastfeed use formula as well, we are all [Flexible Feeders!][11]

[11]: /flexible feeding [10]: /physiology-of-breastfeeding

+ mastitis

Mastitis is caused when a blocked duct becomes infected with bacteria. It can result in local symptoms such as pain, swelling, redness and also systemic symptoms such as high temperature, vomiting and generally feeling very unwell. See our blog on mastitis here for an account of what it feels like.

Nipping a blocked duct in the bud early is the best thing to do. Continuing to breastfeed will unblock the duct. It will be really sore. Another option is to run yourself a bath, or hop in the shower and take a flannel and a comb. Imagine the breast is like a clock face, each number is a duct that drains into the centre point. Using the comb and flannel to massage each number on the face from the outside towards the centre, the nipple. Some women use their knuckles. Any area of redness needs the most attention. Sometimes you might see as well as milk coming out, a thicker cheesier substance which can be a reassuring sign you are unblocking the duct.

If things don’t get better, and you start to become unwell, then it is likely the blocked duct has become infected. You need to be assessed and it is likely you will be given antibiotics. Keep massaging the breast and breastfeeding (or pumping) to break up the blockage and let the antibiotics help rid the infection.

Remember (set a reminder on your phone for every 4-6 hours) to take pain killers and take the antibiotics. It is easy to forget when you are juggling everything.

+ nipple pain

Nipple pain in the early days is very common and this is often due to latch. Sometimes despite our best efforts, your baby’s mouth is just too small for the giant nipples you are trying to feed with, but don't worry, your baby will grown and your engorged nipples will shrink. However, if the latch remains not ideal, then babies will feed off nipples and not breasts - see position and latch. You can recognise this through pain but also the nipples will sometimes be misshapen after feeding (flattened or lipstick shape), or else look white in colour. The nipples can also develop lacerations and bleed. When the nips get this bad, feeding can be horrendously painful. Our top tips are:

1. Nipple cream. Lather it on like it is going out of fashion. It will stop the ulcerated nipples sticking to pads etc which is equally painful to remove.
2. Invest in nipple shells - they keep material from sticking to the nips and gives them a chance to heal.
3. Nipples shields - give the nips a break and protect them during a feed. They don't work for everyone but they can provide light relief.
4. Take a break - try expressing and feeding to allow your nipples to heal.
5. Get help. Health visitors and midwives have some fancy dressings they can turn to that help healing.

Other reasons for nipple pain are less common but worth thinking about if the pain persists despite the latch being grand.

1. Has your baby got a tongue tie? The evidence around this is equivocal to suggest having a tongue tie treated will help, so do your research first, but it is worth asking the question to your midwife / health visitor.
2. Infections: mastitis, subclinical mastitis and yeast infections are all reasons for nipple pain. Ask a health care professional to assess and treat if required. Word of caution - sometimes in treating mastitis we make way for a yeast infection to take hold. So even if you manage to treat one infection, another may well be waiting.
3. Circulatory issues such as vasospasm or Raynaulds. This is when blood vessels supplying the nipples constrict and the blood supply is reduced causing pain. You can help avoid this with keeping the breasts warm, avoiding nicotine and caffeine.
4. Milk blebs are when cheesy milk blocks a duct in the nipple and causes a white spot. Heat and compression can usually help unblock the blebs, but be warned it is not a pleasant process.

+ oversupply

Whilst you may hear about supply issues, often this refers to low milk supply and the less common issue of oversupply isn’t mentioned. However, oversupply can be just as damaging to your infant feeding goals! Most women who experience oversupply will do so in the first few weeks after delivery. This is when your milk supply “comes in” and starts to regulate. For some of us, the excess milk continues and can be a challenge to manage. Oversupply can result in problems for the mum, problems with the act of feeding and problems for the baby. Issues include leaking, blocked ducts, mastitis, engorgement, difficult latch, spraying, and fussing or choking when feeding. Often it is accompanied by people passing comment such as “wow you’re so lucky” and “well he won’t go hungry”.

If you feel your over supply is an issue, then it’s an issue and one which can be addressed to make your life easier.

1. Skin to Skin: There is evidence that skin to skin helps promote milk supply and some theory that it helps regulate supply. Certainly, skin to skin has been proven to promote the release of oxytocin (love hormone) and reduces the release of ACTH and cortisol. So even if skin to skin has limited effect on your supply, you might feel pretty happy about it.

2. Try and establish feeding as early as possible and get as much help as you can before being discharged. Make sure your position and latch and assessed and you have a position you feel comfortable with sorted.

3. By far the best thing you can do is to Block-Feed. Put simply, a full breast, or engorged breast, triggers stretch receptors that tell the brain to turn off the milk production. Suckling, latch and let down, all send messages to the brain to make more milk. So block feeding ensures maximum under stimulation and stretch! Basically you only feed off one breast for a set period of time, no matter how many times your baby wants to feed in that time, you only offer the one breast. This allows the other boob to become fully engorged and switch off those milk supply signals. Then when the time is up, you switch to the other breast for the same period of time. Be warned, you might need to switch it up a bit if you feel a blocked duct coming as initially block feeding can increase the risk of this. However, after a couple of days, things will settle.

4. Laid Back Feeding can also help supply. It can help if your let-down is particularly forceful and allow your baby to latch and take things at their own pace.

5. Reduce Night Feeds. WARNING: this is likely to be very effective! There are plenty of old wives tales about why babies need to feed more at night. Milk-production is regulated by Prolactin, a hormone that’s highest at night. If you really want to quash your supply then not breastfeeding between 2am and 5am will certainly do that. You can collect milk in shells throughout the day (no need to pump) and feed this in a bottle at night. This reduces supply by reducing prolactin levels.

6. Avoid expressing. As mentioned early, any kind of stimulation will tell the body to produce more milk, this includes pumping. Get yourself some shells to use for a few hours a day to collect the milk and then use that. Wearing shells for long periods stops the breast from becoming engorged and switching off supply, so try not to do it all the time.

7. Avoid galactagogues: medicines or foods that increase milk supply. these include domperidone (Motilium) which is often taken off-label to boost milk supply. Note: taking domperidone is not without risk and we strongly advise against it. It’s also said that oats, chickpeas, garlic, ginger, fenugreek, fennel and red raspberry leaf are galactagogues, although there is no evidence to back up these claims.

8. Cold packs: Muslin cloths soaked in water, moulded into a bra shape and frozen work a treat.

9. Hot showers: bliss when engorged as you don’t feel like a big sticky mess. Your boobs can flow freely, giving a bit of light relief. But don’t stay too long, as heat and free flow can stimulate supply.

+ nipple confusion

Nipple confusion? Confused... we are!

Nipple confusion is a greatly debated topic and one with no conclusive evidence. The difficulty is in defining nipple confusion and then studying it. Nipple confusion is essentially when an infant forgets how to feed from the breast allegedly because they have been given a teat or pacifier / dummy. Hmm. Genuinely this has been studied and currently the consensus in the research world is that nipple confusion is unlikely to be the reason your baby is feeding from a bottle and not the boob. Certainly use of a dummy has no impact on breastfeeding and there is still debate as to whether using a teated bottle does. It is much more likely the reason for breastfeeding cessation is related to other factors like supply and latch. Furthermore it is recommended to use a dummy / pacifier in order to reduce the risk of SIDS.

+ reflux

Puking, vomiting, throwing up, being sick.... this is what babies do on and off. Traditionally it was called posseting, and is defined as small amounts of puke just after a feed but now more commonly called reflux. Reflux is on a spectrum of severity. For most infants, it will cause them no harm, for others, they might find it painful and show signs of discomfort.

Reflux is very common, affecting nearly half of all infants. It normally starts in the first few months of life and resolves around the age of 1 year. For most babies, it gets better on its own and doesn’t need any treatment. Some babies have associate underlying conditions that need further investigation, such as cow’s milk protein allergy. Some babies may benefit from treatment, such as heartburn medications. If you are worried about your baby, you should ask your midwife, health visitor or GP for a further assessment.

Signs of further investigation needed include

• Projectile vomiting – a more forceful vomit
• Vomit that is either greeny yellow or blood stained
• If your baby is very distressed and will not settle
• If your baby is not weeing or pooing
• If your baby is not drinking

Things that help:

• Try feeding in a more upright position, so the babies head is above the babies stomach.
• If bottle feeding, ensure you are doing responsive feeding, and allowing gaps in the feeds
• Keep the baby upright after a feed for 20 minutes or so
• There are some over the counter and prescription remedies that might also help.

There is no evidence that special milks will help such as comfort milks.

+ sleepy baby

A sleepy baby who won’t feed always needs checking over by a healthcare professional. Most babies within the first few days of life are pretty sleepy. Everything is just a bit overwhelming going from the womb to the world.
But your baby needs to feed in those first few days often. This helps establish your milk supply and it ensures your baby has enough hydration and energy. It is recommended to feed every 2 to 3 hours in those first few days. If your baby goes on strike and refuses to wake, firstly, don’t panic.

1. Call your midwife and inform them of the situation, they may just ask you to keep trying, if it has only been a couple of hours.
2. Skin to Skin. The smell of milk can help stimulate the need to feed.
3. Protect your supply, you might want to think about hand expressing to stimulate production.

If you are still getting nowhere, then we suggest taking your baby to be assessed.

+ thrush

Thrush is a yeast or fungal infection that can sometimes affect the nipples in breastfeeding women. Fungal infections like warm, damp environments, rich in sugar, so sadly new mothers boobs are a perfect breading ground.
How do I know if I have nipple thrush? Pain in nipples – thrush usually effects both breasts, to have just one affected is unusual and there maybe another cause for the pain. Pain during feeding – this is new pain – if you have always had pain then it is more likely to be a latch issue rather than an infection.
Your baby may have signs of oral thrush – a white mouth, this is more than just a milky tongue, it is a coating around the mouth. They may also be in pain on swallowing and find feeding difficult. Thrush doesn’t usually cause you to feel unwell, or give you a fever, these symptoms are more likely related to a bacterial infection, also known as mastitis.
If you are recently had antibiotics then thrush is more likely. If you suspect you have thrush then see your doctor. They can take samples of your milk, swab your nipples and offer you and your baby treatment to clear it up. It is perfectly safe to continue breastfeeding whilst you are both being treated.

+ tongue tie

A tongue tie or ankyloglossia is where the lingual frenulum is shorter or tighter than normal.... what is the lingual frenulum I hear you ask? This is a band of connective tissue that holds the base of the tongue down. If you open your mouth and lift up your tongue – then you will see it just under your own tongue in the middle.
It is a relatively common condition affecting around 1-2 in every 10 babies born. For most babies, having a tongue tie doesn’t cause them much issue. For others it may impact on your baby’s ability to develop a good latch during breastfeeding. This might lead to pain and discomfort for you and also to unsatisfactory feeds for your baby, fussing during feeds and cluster feeding.
The research in this area is limited. NICE, the UK governing body on medical conditions and interventions state: “Current evidence suggests that there are no major safety concerns about division of ankyloglossia (tongue-tie) and limited evidence suggests that this procedure can improve breastfeeding. This evidence is adequate to support the use of the procedure provided that normal arrangements are in place for consent, audit and clinical governance. Division of ankyloglossia (tongue-tie) for breastfeeding should only be performed by registered healthcare professionals who are properly trained.” In essence – having your babies tongue tie snipped may or may not help with infant feeding, we don’t know for sure but it is likely it won’t cause harm. If you do decide to go ahead with the procedure, it is really important it is carried out by a health care professional who is properly trained.

We know this is something that affects many of you, from our research and sharing your stories. You can read Hayley's experience of tongue tie here and if you would like to share your story, then please get in touch.

+ unhappy Mum

Baby Blues Nearly all new mums (85%) experience some degree of baby blues. It usually starts around day 2 to 3 after delivery. It is defined as low mood, mild depressive symptoms (including apathy, lack of enjoyment, guilt). The cause is multifactorial, you have gone through a lot in the last 9 months, and even more so in the last 3 days both physically and psychologically.
There is a strong link between baby blues and hormonal changes, after delivery, there are dramatic peaks and troughs in progesterone, oestradiol and prolactin, all of which affect mood. Women who are more prone to menstrual related mood changes, or have previously had mood related illnesses, are more likely to have post-partum mood related disorders.
The baby blues can last up to 2 weeks, is usually self limiting and doesn’t require any specific medical treatments. Things that can help are talking about it, giving it a name, and speaking to others who have experienced it, to know that this too shall pass. This also allows loved ones in, so that if things aren’t getting better, then they can support you with getting an assessment and treatment you need.
Postnatal Depression
This is a recognised mental health condition affecting 15-20% of women after the birth of their baby. There is some data to suggest it is more wide spread than this, and largely goes undiagnosed, especially in women from ethnic minority groups.
The symptoms are similar to baby blues but they are more severe and longer lasting. These include, very low mood, anxiety, disturbed sleep, loss of appetite, low self esteem, worthlessness, guilt, low energy, loss of libido, a feeling of apathy towards your baby or your partner, and suicidal thoughts.
Many new mums will experience these symptoms without a diagnosis of PND, so it is really important to ensure you are talking about how you are feeling, and seek out help when necessary. There are standard mental health checks that take place throughout pregnancy and after delivery. They will use two screening questions: 1. During the past month, have you often been bothered by feeling down, depressed or hopeless? 2. During the past month, have you often been bothered by having little interest or pleasure in doing things? If you answer yes to either of these – then you need further assessment, it is that simple. You may feel you don’t need to bother anyone, or that people are making a fuss, or that you don’t deserve their time. This is just not true. You are the most important person right now.
Following an assessment you may be offered treatment options. Part of this will be ensuring you have space to talk, you feel safe and supported and that your network around you knows how to help. Depending on how severe the depression is, they may offer a range of interventions, from self guided mindfulness therapy, to antidepressants, to a course of cognitive behavioural therapy.
Choosing a path of wellness is empowering and not a failure.
Little things that will help to complement professional treatments: 1. Exercise. Even a brisk 20 minute walk once a day will help clear the mind 2. Down the socials. Step away from your phone, especially for the hour before bed 3. Avoid caffeine and alcohol, these can affect your sleep, when let’s face it, it will already be pretty disturbed! 4. Practice mindfulness, being in the moment. You can find out more about PND at the PANDAS charity How we can support you – PANDAS Foundation UK
Postpartum Psychosis
Postpartum psychosis is a severe mental health condition affecting mums after the delivery of their baby, usually within the first month. It is seen as a psychiatric emergency and effects 0.1% of mums – this is 1 in 1000 births. Some women will be assessed during pregnancy and flagged as being high risk, they will be monitored closely and will have plans in place. It is less common but can happen that this is the first presentation of mental health illness.
Women who experience post partum psychosis tend to fit into two presentations. They can be seriously depressed and in the most severe cases, catatonic, or they may be more manic with symptoms of agitation and elation. Psychotic symptoms include delusional beliefs, paranoia, jealousy, grandiosity and there maybe hallucinations – seeing things that aren’t there, hearing voices that aren’t there.
This can be extremely frightening and lonely for mums. It is an emergency situation that needs urgent assessment and treatment. Most mums will be admitted to hospital and treated in special mother and baby units. Most of the mediations are secreted in breast milk, and some of them can be harmful to babies, such as lithium. If you are taking Lithium, you will not be able to breastfeed. Sometimes an alternative of Electroconvulsive Therapy may be offered.
The best course of treatment is prevention, so if you have a family history of post partum psychosis, or you have a personal history of severe mental illness, then it is important to get a plan in place during pregnancy. This may include a medication regime and a discussion about your feeding options.
You can read more about postpartum psychosis on the PANDAS website Postpartum Psychosis – PANDAS Foundation UK

+ unsettled during feed

If your baby is crying, or fussing, pulling away during a feed then there are a number of things that could be causing this. There are some red flags that might indicate a serious infection and to be aware of: 1. Fever, a high temperature over 38 degrees Celsius, indicates an infection 2. Dry nappies. If your baby is not wetting or soiling their nappy as often as they normally do, this may indicate dehydration and needs assessing. 3. Rash: this may indicate an infection and needs urgent assessment.
4. Floppy or less responsive: this may indicate an infection and requires urgent assessment. That said, healthy babies also fuss during feeding, so here are some alternative explanations:

1. Growth spurts:
   Fussing that happens around times of growth – most commonly anytime in the first 6 weeks, 3 months, 4 months, 6 months and 9 months. They will be feeding more often.
2. New skills: there are certain times when your baby will be less interested in feeding and more interested in what is happening around them constantly popping off to have a look.
3. Fast let down: forceful let down can lead to choking, spluttering and a bit of anger from your baby, they might just need a few more breaks in feeding whilst your supply and let down settle.
4. Slow let down: when the milk doesn’t come out quickly enough, this can really frustrate a hungry baby, it might be your supply is low, try feeding more often to stimulate production.
5. Gassy / reflux: they might be swallowing air during feeds or having sore regurgitation. Check out our reflux section for tips.
6. Teething: this will be apparent when they chew on the nipple and then 5 days later have a pearly white. Quite often they will get a bright red cheek as an early indication this will happen!
7. Blocked nose; if your baby has a cold and their nose is blocked, it makes breathing challenging during a feed, so they pop on and off to breath properly. You can get little pipettes to suck the bogie out if it is becoming a real challenge, but hopefully shouldn’t last more than a couple of days.
8. Allergy: cows milk protein allergy can cause discomfort during feed, you may also see a red mouth, or rash around the mouth. Check out our Allergy section for more details.
9. Tongue tie: Having a tongue tie can make latching difficult, this can affect milk flow leading to a frustrated fussy baby. Check out our section on tongue tie for more details.

Wind In the first few months of life, when your baby is learning how to feed and yawn and cry, they are likely to swallow a lot of air. This is why new born babies are farty and burpy and squirmy with all that trapped wind. This can present as colic or as a fussy feeder. There are some things to help with a windy baby. Feeding: try and feed in a more upright position, the head should be above the level of their stomach. If bottle feeding, use the methods of responsive feeding, keep the bottle at a horizontal level and make sure the teat has milk in it, not air. There is no evidence that specialist milks will help, but trying different milks will not harm your baby. All first infant formula milks are nutritionally the same, so they will all provide your baby with the nutrients they need.
Carrying: windy babies like to be held. You could try carrying them in a sling to keep them upright and tucked in, giving a little pressure to their tummys that feels nice. You could also try the tiger in a tree hold. This is where your baby lies face down across your forearm, again it gives a little pressure to the tummy and allows you to pat the bum, or bob about that helps with wind.
Massage: baby massage helps relieve wind. There are many online videos of how to do this, or you can ask your midwife / health visitor about local classes, some of which you might need to pay for, others might be free. They are a good way to meet other mums and also get a cuppa! The NCT have a page on baby massage, you can see here: Baby massage: tips and benefits | NCT