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How to tell if breastfeeding is going well

This is a very common question. Especially when you first start breastfeeding or if you are a first time parent. It's impossible to tell you how much milk your baby is drinking. Every baby is different and they feed at different rates. Some will be full in 10 minutes and others may take 30 minutes. There are signs to look out for which can reassure you all is well. 

Does your baby seem happy and healthy? Are they active and alert? Are they developing well? Do they seem content after a feed? Trust your instincts and if you are worried seek help.

 

Feeding less can be a sign that something is wrong. Use the checklist below to see if you should be worried.

When should you worry?

If your baby has any of the following:

  • Unable to wake them for feeds
  • Breathing too fast to feed
  • Pale, mottled and feel abnormally cold to touch
  • Blue around the lips
  • Has a fit (seizure)
  • Becomes extremely agitated (crying inconsolably despite distraction)
  • Is under 3 months of age with a temperature of 38°C (100.4°F) or above (unless fever in the 48 hours following vaccinations and no other red or amber features)

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your baby has any of the following:

  • Not returned to their birth weight by 2 weeks old
  • You feel your baby is not growing well
  • Under 1 month old and pooing less than twice a day 
  • Appears yellow (jaundice) and feeding less
  • Fewer wet nappies than before 
  • Under 6 months old and breastfeeding less than 8 times in 24 hours
  • More sleepy or unsettled than normal 
  • Feeding all the time but never seems full or happy afterwards

You need to contact a doctor, midwife, health visitor or nurse today.

Please ring your GP surgery or call NHS 111

If you think it is a breastfeeding problem contact your local breastfeeding support service (see details below) 

 

  • Alert, content and normal skin colour
  • Wakes regularly for feeds and feeds 8 to 12 times in 24 hours
  • Feeds take between 5 and 40 minutes
  • Cluster feeds in the evening
  • Back to their birth weight by 2 weeks old (weight loss usually stops by day 4)
  • Growing well
  • In the first 48 hours has 2 to 3 wet nappies
  • After 5 days old has at least 6 wet nappies in 24 hours
  • Lots of wet and dirty nappies. See the NCT poo guide for more information
  • Baby has a good strong suck, feeds calmly and can be seen or heard swallowing. They are content and comes off the breast on their own
  • At the end of the feed your breasts feel softer and nipples should not be sore
  • Get advice on coping with crying

Self care

Continue providing your child’s care at home. If you are still concerned about your child contact your Health Visitor or call NHS 111

If you are struggling with breastfeeding contact your local breastfeeding support service (see details below) 

This guidance has been reviewed and adapted by healthcare professionals across West Yorkshire with consent from the Hampshire development groups.

Baby's latch

Breastfeeding is a tricky skill that both mum and baby need to learn together. It doesn't always come naturally. It can feel really difficult and uncomfortable at the beginning. Once you are past the first 6 weeks, for most mums and babies it gets easier. Hang in there, get help if needed, it should get better! 

Breastfeeding is not supposed to hurt but for some women it does at first. This is often due to your baby sucking on the nipple (shallow latch) rather than getting a large mouthful of the breast (deep latch). Babies feed many times a day so it doesn't take long for your nipples to become sore. If breastfeeding does hurt then try these tips on the breastfeeding support website. If things do not improve quickly speak to a breast feeding advisor or your midwife or health visitor. 

If you and your baby are comfortable with breastfeeding, then you are doing fine.

Signs that your baby is well attached to the breast:

  • baby takes a large mouthful of the breast
  • baby takes long sucks with pauses from time to time
  • baby comes off the breast feeling content at the end of a feed
  • your breasts or nipples should not feel sore afterwards

Visit the start4life website for more information about breast feeding positions and latching on.

Sometimes, a baby can't open their mouth wide enough to latch onto the breast.  This might be because they have a tongue tie. Please speak to your midwife or health visitor if you are worried about tongue tie. 

 

When will your milk come in?

The first milk is called colostrum. Your baby can feed on this as soon as they are born. Colostrum is a thick milk full of nutrients and antibodies for your baby. Your milk should 'come in' (change from colostrum to mature milk) 2 to 5 days after birth. 

Signs that your milk is 'coming in':

  • breasts feel full, heavy and swollen (engorged)
  • leaking milk
  • change in your baby’s feeding pattern and behaviour at the breast
  • you may notice the milk changing from a golden colostrum to a thinner, whiter milk

If your breasts feel overly full (engorged) and are getting painful then read these breastfeeding support tips on what to do and how to prevent mastitis. 

 

Do you feel like your baby isn't getting enough?

There will be times when your baby wants to feed all the time and your breasts feel empty. This is your baby's way of telling your body that they are growing and need more milk. When your breasts are empty they send a signal to your body to make more milk. When your breasts feel very full for a few days then this tells your body to make less milk. 

If your baby is growing and has none of the signs in the red or amber boxes above then you can relax. Trust your body and trust your baby. Your milk supply can take a few days to increase. Feed your baby as often as they want to be fed, this is called responsive feeding. In a couple of days things should settle down again. 

In the early months, babies can be fussy in the evenings and seem to want to feed all the time. This is called cluster feeding. It can be exhausting but it is normal. Some babies cluster feed at other times in the day. If your baby is fine in between and this only happens at their fussy time then don't worry. It has nothing to do with your milk supply and it doesn't mean you are doing something wrong. It will get better by around 3 or 4 months old.

 

Your milk supply

The more often you breast feed, the more milk your body will make. However, if you're worried that your baby isn't getting enough milk, talk to your midwife, health visitor or a breast feeding specialist as soon as possible. With their help you should be able to identify the problem and find a solution.

Things that could affect your milk supply include:

  • sore nipples
  • feeding at fixed times (better to feed responsively whenever your baby appears hungry)
  • topping up with formula milk
  • tongue tie
  • dummies
  • being apart from your baby
  • medication

 

Tips to increase your milk supply
  • Breastfeed often, at least 8 to 12 times in 24 hours. Wake your baby if needed. Crying is a late sign of hunger
  • Offer both breasts at every feed, alternate which breast you offer first
  • Night feeds are important until breast feeding is well established (the first 6 weeks)
  • Keep your baby close, lots of skin to skin contact
  • Try not to give your baby anything other than breast milk
  • If you want to give your baby a dummy, try to wait a few weeks until you are both comfortable and confident with breastfeeding
  • Look for your baby's feeding cues. Let your baby feed when they want to and for as long as they need. Don't clock watch

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Expressing and storing breast milk

You can express milk using a breast pump or by hand. You can feed it to baby straight away or store it in a fridge or freezer. It can then be used to feed your baby at another time.

There are some good reasons why you might need to feed your baby expressed breast milk:

  • Your baby is premature. They may not be able to feed at the breast but can still get the goodness
  • Returning to work or study. Someone else can feed your baby your expressed milk
  • If your breasts feel uncomfortably full (engorged)
  • Your baby can't latch on or suck properly for some reason
  • You want to boost your milk supply

Make sure you follow advice about expressing breast milk and storing it.

 

What you should eat and drink if you're breast feeding:

Anything you eat and drink whilst breast feeding can find its way into your breastmilk in small amounts. You don't need to eat a special diet when breast feeding. A balanced diet will provide most of the vitamins you need. However, you and your baby should take a vitamin D supplement due to the lack of sunshine most of the year in the UK.

You may notice your baby becomes restless if you drink too much caffeine.

If you think something you are eating is affecting your baby then speak to your GP, health visitor or a breast feeding advisor. 

 

Alcohol and breast feeding

It is safer not to drink any alcohol whilst breast feeding. Alcohol does pass into your breast milk. An occasional alcoholic drink (1 or 2 units once or twice a week) is unlikely to harm your baby.

Drinking alcohol will not help your baby sleep better. This is a myth! In fact, it might even make your baby's sleep worse.

If you do choose to drink alcohol then try to wait 2 to 3 hours before breastfeeding your baby. If you are going to a special event then plan ahead. You could give your baby milk that you expressed on a different day instead.

Never share a bed or sofa with your baby if you have drunk alcohol or taken drugs which make you feel sleepy.

This is very dangerous and linked to sudden infant death syndrome.

 

Breastfeeding support

You can talk to your midwife, health visitor or contact any of the breastfeeding support services listed below.

Local

National 

Further information

Leeds teaching hospitals website has a selection of helpful videos about a variety of breastfeeding issues. 

NCT The reality of feeding 10 things you need to know

New baby what's normal and what's not

You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

All community pharmacies across England are required to be Healthy Living Pharmacies. This means that they are able to offer advice on a range of healthy living matters which includes eating a healthy diet. They can provide information leaflets and give parents, carers and young people more information about other organisations that might also be able to help.

Pharmacists are experts in many aspects of healthcare, and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment, and many have private consultation areas. Your pharmacist will say if you need further medical attention.

Sound advice

  1. Visit a pharmacy if your child is ill, but does not need to see a GP.
  2. Remember that if your child's condition gets worse, you should seek further medical advice immediately.
  3. Help your child to understand. Watch this video with them about going to the pharmacy.

For information on common childhood illnesses go to What is wrong with my child?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns, or to the Community Paediatricians, or the child and adolescent mental health services.

 

Contact your local Health Visiting Team:

Bradford Health Visitors or call - 01274 221223

Wakefield Health Visitors or call - 0300 373 0944

Craven Health Visitors or call - 01423 544265

Leeds Health Visitors or call - 0113 843 5683

Calderdale Health Visitors or call - 030 0304 5555 (local rate number)

Kirklees Health Visitors or call - 030 0304 5555 (local rate number)

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

For more information about what Health Visitors do: What does a health visitor do?

School nurses care for children and young people, aged 5 to19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and, or emotional health needs.

 

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse. Phone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Contact your local school nursing team:

Bradford School Nurses 01274 221203

Wakefield School Nurses (0 to 19 service) 0300 373 0944 (local rate number)

Leeds School Nurses 0113 843 5683

Calderdale School Nurses 030 3330 9974 (local rate number)

Kirklees School Nurses 0300 304 5555 (local rate number)

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

All children should be registered with a GP. Anyone in England can register for free with a GP surgery. You do not need proof of address or immigration status, ID or an NHS number.

How to find your local GP.

Sound advice

You have a choice of service:

  1. Doctors/GPs can treat many illnesses that do not warrant a visit to A&E.
  2. Help your child to understand. Watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Please note, the online version of NHS 111 is only recommended for children over the age of 5. If your child is under 5 years old, please phone 111.

NHS 111 can also direct you to your nearest urgent treatment centre (minor injuries unit or walk-in centre).

Find your local urgent treatment centre.

When to visit an urgent treatment centre.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as:

  • loss of consciousness
  • breathing difficulties
  • severe bleeding that cannot be stopped
  • major trauma such as road traffic collisions

If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  1. Many visits to A&E and calls to 999 could be resolved by any other NHS services.
  2. If your child's condition is not critical, choose another service to get them the best possible treatment.
  3. Help your child to understand. Watch this video with them about going to A&E or riding in an ambulance

This guidance has been reviewed and adapted by healthcare professionals across WY with consent from the Hampshire development groups. 

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