Infant feeding

Getting ready to welcome your new arrival, although one of the most exciting times of your life, may also be confusing. One of the many questions new parents may have, is often on feeding your baby. Just remember, you will know what is right for you and your baby and whether you decide to breastfeed or formula feed (or a bit of both), you will find there is lots of support available to help you.

This page provides lots of advice and you can also visit step by step guide to breastfeeding at Health for Under 5s and feeding your newborn baby advice from NHS Start for Life for more information.

Breastfeeding

Your milk is perfect and uniquely made for your growing baby’s needs. Giving your milk to your baby makes a big difference to both your baby’s health and yours.

Some of the benefits of breastfeeding are:

  • your breast milk meets all of your baby’s nutritional needs
  • breast milk protects your baby from infections and diseases
  • breastfeeding provides health benefits for you, including lowering your risk of some cancers and cardiovascular disease. 
  • breast milk is available for your baby whenever your baby needs it
  • breastfeeding can build a strong emotional bond between you and your baby

Formula milk does not provide the same protection from illness and does not give you any health benefits.

If you have any questions about breastfeeding, speak to your midwife or health visitor, or you can also visit Your breastfeeding questions answered - NHS, which provides answers to many common questions about breastfeeding. 

You can also visit Breastfeeding - NHS which gives you tips on how to breastfeed, express milk, eating healthy when breastfeeding as well as tips on feeding challenges and feeding in public. 

Attachment, bonding and feeding

Attachment is the bond that develops between you and your baby through touch and communication. This bond helps your baby’s brain grow, especially the parts important for communication and relationships, making your baby feel safe and loved.

Feeding and bonding

  • Feeding, whether breast or bottle, is crucial for bonding. It’s not just about nutrition but also about responding to your baby’s hunger cues, holding them close, making eye contact, and talking lovingly.
  • Understand your baby’s hunger and fullness signals. Sometimes they may want a quick feed, other times a longer one in the same way we sometimes just want a drink and a quick snack and at other times a three-course dinner!

A responsive approach to feeding helps your baby feel secure and loved, and fosters a strong bond. There are a few differences between responsive breast and bottle feeding:

Responsive breastfeeding

  • A baby will not breastfeed if they do not want to, so offer the breast whenever needed, including whern baby seems distressed. Breastfed babies are in control of their feeding and cannot be overfed or 'spoiled' by frequent feeding. A sit down and a cuddle, even if they do not take much milk, will help your baby develop trust and security.
  • Seek support from your midwife and health visitor to learn how to know your baby is feeding well by knowing, for example, how many wet & dirty nappies to expect. This short film will show how to help your baby latch Latching on - How to breastfeed - NHS

Responsive feeding of expressed and formula milk:

  • Hold your baby close and failry upright, look into their eyes and support their head comfortably. 
  • Invite baby to open their mouth by gently rubbing the teat against their upper lip.

  • Hold the bottle horizontally (slightly tipped) to prevent milk flowing too fast and enable baby to control the pace of the feed.

  • Rub the teat gently against your baby's lips to encourage them to open their mouth wide and draw the teat into their mouth. Do not force the teat into your baby's mouth.

  • Hold the bottle level, in line with the ground (horizontal), and then tilt the bottle upwards enough to ensure your baby is taking in milk and not air through the teat.

  • Be cautious of overfeeding as milk from a bottle flows quicker and easier than from the breast. Avoid fast flow teats.

  • Don’t force your baby to finish the bottle if they show signs of being full. If you don’t see bubbles during feeding, break the suction by moving the teat slightly to the side of your baby’s mouth.

  • Use “pacing” to let your baby pause and decide if they want more. Don’t force the teat if they turn away. Interrupting the feed from time to time gives your baby a chance to register how full they are and allows them to control what they want. It also gives them the chance to bring up any wind.

  • Try to limit the number of people feeding your baby to strengthen attachment. If another close family member gives an occasional feed, make sure they use the same technique as you so that your baby does not feel frightened or confused.​​​​​​

  • Your baby should always be held and never left unattended while feeding from a bottle.

  • Look for signs like wriggling when waking up or sucking on their hands.
  • Crying is a late hunger cue. Soothe your baby before feeding if they are crying.
  • Remember crying doesn’t always mean hunger. Your baby might need a cuddle, a nappy change, or might feel uncomfortable or unwell.

How much should I feed my baby?

Your baby’s stomach is very small in the first few days, so they will only want small amounts of milk at each feed. This picture shows the approximate size of your baby's stomach as it grows in its first month after birth.

  • Day one - size of a cherry 5-7ml/0.2oz
  • Day three - size of a walnut 22-27ml/0.75-1oz
  • One week - size of an apricot 45-60ml/1.5-3oz
  • One month - size of a large egg 80-150ml/2.5-5oz

Breastfed Babies can control the amount of milk they take but if you’re not sure, your health professional can help you.

Bottle-fed Babies are at risk of being overfed and need you to control the amount of milk. This may mean providing smaller amounts of milk more frequently. Use pacing techniques mentioned in the section on responsive feeding to help.

It’s normal for babies to bring up small amounts of milk, indicating they have had enough. Consult a health professional if unsure.

Overfeeding Risks:

  • Overfeeding can cause sickness and excessive weight gain. It doesn’t help babies sleep longer and can make them uncomfortable.
  • NB: Overfeeding in early weeks can increase the risk of being overweight later in life.

First breast milk (colostrum)

 

The first breast milk, even before baby is born, is rich in antibodies, and a perfect source of nutrition for your baby. It is very concentrated and provides all the necessary nutrients in small amounts, to help protect your baby from infections and support their immune and digestive systems.

When born, colostrum encourages your baby to open their bowels and pass ‘meconium’ (your baby’s first black sticky poo) which reduces the risk of jaundice.

If you wish to Collect and freeze colostrum during the last weeks of pregnancy, speak to your midwife. She will help you to start hand expressing at 36-37 weeks of pregnancy. You can also visit collecting colostrum (first milk) for your baby for more information.

 

Useful links

www.nhs.uk/start4life/breastfeeding-more-help

Off to the best start.

 

We hope this information will be a useful introduction to colostrum harvesting. You can also talk to your midwife who will be able to answer any questions you may have.

Feeding your baby safely with a bottle

  • Always wash your hands before preparing any feed, expressed breast milk or formula.
  • Always follow the manufacturer's instructions for your chosen sterilising method.
  • Make up one bottle of formula feed at a time, and as described by the product guidelines. 
  • Do not add extra scoops of formula to a bottle.

If you are planning to continue breastfeeding as well as bottle feed, avoid giving your baby a teat until breastfeeding has been established, as sucking on a teat uses a different sucking action. This may cause confusion for your baby, who may then find it difficult to feed from the breast.

For more advice and information see:

Breastfeeding

Health for under 5s have advice on the easiest way to feed your baby when out and about.

You do not need to take any equipment with you, just yourself. Breast milk is the correct temperature, amount and no preparation is required. Your baby’s feed is ‘on tap’!

How do I re-heat my expressed breast milk?

From the fridge

  • Warm your milk gently by placing the container in some warm water.
  • Try not to overheat your milk.

From the freezer

  • Try to defrost your breast milk in the fridge and use it within 12 hours of removing from the freezer.
  • If you need to use your breast milk quickly, and it is still frozen, place the container under cool, then warm, running water.
  • Use your defrosted milk immediately

We do not recommend using a microwave to warm any of your baby's milk or food. Microwave cooking causes hot spots which can burn your baby's mouth.

Breastfeeding friendly spaces

Hertfordshire has a Breastfeeding Friendly scheme, encouraging businesses to support breastfeeding mothers to feel more confident to feed their baby in public. You can see who the businesses are on Hertfordshire County website breastfeeding page.  Some of Hertfordshire’s mums also share their experiences in this short film  short film.

Remember you are protected by law to breastfeed in public. Maternity Action provides information about your rights to feed your baby in public places. Here is a video which shows the experiences of women breastfeeding in public.

Bottle feeding

Pre-made formula

This is the easiest way to feed your baby formula when out and about.

  • Take an empty sterilised bottle with you and transfer the pre-made formula.
  • Pre-made formula cartons/bottles can be stored in a cool bag with an ice pack and used within four hours once opened.
  • To warm the milk, place the bottle in a container of warm water. Always test the milk on the inside of your wrist to make sure it is not too hot for your baby.

Powdered formula

  • The best way is to take a good quality vacuum flask of boiling water with you.
  • A full flask of 17.5oz (525mls) of boiling water should stay at 70 degrees Celsius for three hours. There is evidence that smaller amounts of water might not stay at the required 70 degrees Celsius and therefore not kill any bacteria in the powder.
  • Add the correct amount of water to the pre sterilised bottle and add the correct amount of powdered formula.
  • Cool the feed before giving it to your baby.

Formula Preparation Machines

At present there is no published research and insufficient evidence that these machines are safe in preparing infant formula. The Department of Health recommend that powdered infant formula is made up with freshly boiled water and left for no more than 30 minutes so that it remains at a temperature of at least 70 degrees.

Personal Child Helth Record

In your Personal Child Health Record (PCHR/Red book) you will find growth charts. Take some time to read the information pages that come with them.

The charts describe the growth patterns of thousands of normal, healthy, breastfed babies and toddlers from around the world and older children from the UK. Healthy bottle-fed babies should follow the same growth patterns as breastfed babies.

The lines on the charts are called 'centiles' and they simply describe how your baby's weight, length and head circumference compares with other children of the same age and sex. For example - if your baby's weight is on the 25th centile, this means that if you weighed 100 babies of the same age and sex and ranked them from light to heavy, 75 babies would be heavier than yours and 24 lighter. For more information about healhty growth and weight gain, visit Your baby's weight and height - NHS. 

Weight Problems

Weight is fantastic for assessing the health of a baby. Crossing the centiles up and down may be a cause for concern. Historically most emphasis has been on monitoring babies who appear to be gaining weight too slowly - and your midwife and health visitor will watch out for this. It is likely to become apparent quite early on and the most common cause is difficulties with feeding. It is normal - and healthy - for a baby to lose some weight in the first few days of life, and only if this exceeds 10% will your midwife be concerned. There is some evidence that this early weight loss helps 'set' appetite and feeding patterns for the rest of the child's life.

These days, poor weight gain is pretty rare and for this generation we are much more worried about babies who cross the centiles upwards across the chart because this is very unlikely to be healthy. 

To learn about how you can weigh your baby please visit:

Babies can become overweight

This is never an easy topic to broach, but it is, without doubt, the most worrying risk to the future health and happiness of your baby. The research evidence is absolutely clear:

  • Eating, activity habits and food preferences start to develop early in life - in the first few days and weeks.
  • Overweight and obesity impair normal childhood development.
  • Overweight babies and toddlers are at least five times more likely to be overweight at the age of 12 than those who were a healthy weight in infancy.
  • Childhood obesity tracks into adulthood - at least 70% of obese children, even those as young as 5 years, will go on to become obese adults.
  • Obese children are at greater risk of serious long-term health problems, including heart problems, Type 2 diabetes and various cancers. We are now seeing conditions that were previously unheard of in children and teenagers such as Type 2 diabetes, early signs of fatty liver disease (the commonest cause of irreversible liver disease) and clogging of the arteries.
  • The emotional consequences of obesity in childhood can be severe and long-lasting, including bullying, low self-esteem and social exclusiong.
  • Rather than trying to manage children and teenagers who already have weight problems, we want to help you to prevent your baby becoming one of the 25% (1 in 4) who are overweight or obese when they start school.

Do' and don'ts to help prevent your baby becoming overweight or obese:

Do:

  • Breastfeed
  • Remember responsive feeding
  • Understand your baby's feeding cues
  • Only give your baby milk to drink
  • Understand the growth charts
  • Let us help with your efforts to prevent your baby becoming overweight

Don't:

  • Give your baby more milk if they drain their bottle. When you finish your dinner it doesn't mean you want another one!
  • Give your baby plenty of milk during the day hoping that they will sleep through the night sooner - they won't
  • Start solids before six months
  • Reward with sweets and treats
  • Forget activity - this is a really important factor and the earlier you can get your baby active the better. However it is very difficult to control weight simply by increasing activity.
  • Feel guilty if your baby becomes overweight - we know that the earlier it is spotted the better the chances of success in helping your baby return to a healthy weight
  • Think we think this is easy! Being a parent is rarely straightforward but your are responsible for what your child is allowed to eat and drink - by you or other carers

Myths about weight:

'Obesity is inherited' - No it isn't. The obesity 'epidemic' has developed over the past 20 years but our genes haven't changed in that short time - they have generations to alter. Instead our lifestyles have altered and eating behaviour tends to run in families. Try to make your family healthier - it's worth it.

'Breastfed babies cannot becomes overweight' - Yes they can. It is much rarer but happens. The longer you breastfeed the lower the risk. Breastfeeding is only partly protective and the choices you make about starting solids, the portion sizes, the foods you offer and swapping to bottle feeding will all have an impact.

'My baby is always hungry' - No, they aren't. Many families describe this and are tempted to either give up breastfeeding, try milks for hungrier babies (which are unnecessary) or to introduce solids too early. Remember that babies cry for all sorts of reasons and it is important to recognise the difference between hunger cues and a baby who is crying about something else. Provided your baby is growing and gaining weight along their centiles they do not need any extra calories.

'My baby will slim down when they start exercising' - This is unlikely. Feeding habits start to develop in the first days and weeks of life. Not only are babies who are overweight at a year of age highly likely to be overweight when they start school, but they also have higher blood pressure. Yes - health differences even at a year!

'A big baby is a healthy baby' - Only if designed to be. We come in all shapes and sizes. It does not matter where your baby is on the growth charts provided they are not crossing the centiles up or down and their weight is within one major centile of their length. There is no 'best' centile. Encouraging your baby to cross the centiles upwards is rarely healthy even for a baby born small.

'We are a big-boned family' - Body Mass Index (BMI) allows for this. BMI is a simple index of weight-for-height that is commonly used in classifying overweight and obesity. A healthy BMI for adults is somewhere between 19-25, a range which allows for some people having a larger frame or being 'big-boned'. This is not a reason for having a higher than healthy BMI. In growing children, the healthy range varies with age and there are BMI charts for children over two. Your health visitor can show you these.

Starting solid foods

  • Babies need only breastmilk or appropriate formula at least for the first 6 months.
  • At 6 months babies show readiness for solids alongside milk, and their gut is matured to be able to accept & digest solid food.
  • Night waking, extra feeds, and fist chewing are normal growth behaviours, not hunger signs.
  • NB: Bigger babies don’t need solids earlier than six months.
  • Talk to your health visitor if you are considering solids before six months.

Learning eating behaviours and trying new foods

  • Include babies in family meals without special foods.
  • Babies learn eating behaviours by watching family members.
  • Set a good example with healthy foods.
  • Babies may need several tries to accept new foods.
  • Never force feeding; let babies recognise their own fullness to avoid overeating.

Baby is ready for solids if:

  • They are sitting up and holding their head steady.
  • They can Co-ordinate eyes, hands, and mouth to self-feed and swallow food without pushing it out.

For further information about starting your baby on solid foods see:

Returning to work

When the time comes for you to return to work, it is beneficial for both you and your baby if you are able to carry on breastfeeding, even some of the time. You will both continue to get the health benefits from breastfeeding as well as being able to to enjoy that special closeness that it brings - it is a lovely way to be reunited when you are together again at the end of your working day.

It is worth thinking about how you will manage this several weeks before you go back to work, and you can get help with this from your health visitor or from the following links:

Breastfeeding when returning to work/study - Hertfordshire | Health for Under5s

UNICEF

Remember to speak to your place of work before you return, about a room for expressing your milk, where a fridge should be available.

Just ask...

Don’t be afraid to ask for support and information to help you with feeding. No problem is too small – if something is worrying you, the chances are that other parents/carers will have felt the same.

Ask your midwife, health visitor or a breastfeeding counsellor to help you position your baby. This may help boost your confidence and improve feeding for you and your child.

For more information on how to get support in Hertfordshire:

For more advice and information see: