BFI - Theme 2 (Supporting Infant feeding)

Why do you think breastfeeding rates in the UK are amongst the lowest in the world?

• Misconception → formula is almost as good as breast milk

• Breastfeeding can be difficult at first → women may switch to formula if support is limited

• Lack of positive role models (family/friends ) → are not encouraging breastfeeding

• Social norms → breastfeeding is not always seen as the “normal” way to feed

• Returning to work → not all workplaces support expressing or feeding

• Conflicting or inconsistent advice from different sources

Why is skin to skin contact important at birth and in the postnatal period?

• Keeps baby warm (helps regulate temperature)

• Regulates the baby’s heart rate and breathing

• Encourages early and effective breastfeeding

• Supports bonding and attachment between mother and baby

• Releases oxytocin → helps milk let-down and uterine contraction

• Calms both mother and baby → reduces stress and crying

A mother asks you how to hold her baby for breastfeeding. What is the key information you would share with her about how to position her baby at the breast?

CHINS

• C — Chin touching breast (and leading)

• H — Head free (not pushed, can tilt back)

• I — Inline (head, neck and spine)

• N — Nose to nipple (touching the soft palate)

• S — Sustainable feeding, with swallowing heard

Positions

• Cradle hold

• Cross-cradle

• Rugby

• Side-lying

• Laid-back (biological nurturing)

Whatever is comfortable and effective for mum and baby.

How do babies attach to the breast?

• Baby has a wide open mouth before latching

• Chin leads and touches the breast first

• Bottom lip attaches well away from the base of the nipple

• More areola is visible above than below the mouth

• Nipple drawn towards the soft palate at the back of the roof of the mouth

• Baby’s head should be free to tilt back to allow deep attachment

• A mother should not push the baby’s head onto the breast

What signs would tell you that a baby is well attached to the breast?

Looking for:

• Chin touching/indenting the breast

• Wide open mouth with lips flanged out

• More areola is visible above the top lip than below

• Round, full cheeks (not dimpled)

• Rhythmic pattern → rapid sucks at first, then slow, deep sucks with audible swallows

• Baby appears calm and satisfied during and after the feed

• No ongoing pain for the mother after the initial latch-on

Why is effective attachment important?

For baby

• Allows adequate milk transfer to the baby

For mother

• Prevents nipple pain and trauma (sore or cracked nipples)

• Reduces risk of engorgement

• Reduces the risk of blocked ducts and mastitis

• Helps maintain a good milk supply through effective breast drainage

• Makes feeding more comfortable and sustainable

Can you describe how you would support a mother with hand expressing?

• Ensure mother is comfortable, relaxed and has privacy

• Gently massage the breast and roll the nipple to stimulate milk flow

• Place finger and thumb in a C-shape 2 to 3 cm around the areola

• Gently compress and release

• Rotate finger and thumb positions around the areola to drain all the ducts

• It may take time for milk to flow → encourage patience and reassurance

• When flow slows, switch to the other breast, then return again if needed

What signs would you discuss with the mother to help her tell if her baby is getting enough breastmilk?

Feeding pattern

• At least 8–12 feeds in 24 hours

• Feeds can last around 5 to 40 minutes

Baby’s behaviour

• Baby appears content and settled after feeds

• Good skin colour and tone (well perfused, not lethargic)

Nappy output (D3 to W6)

• At least 5–6 wet nappies in 24 hours

• At least 2 yellow, soft stools per day

Mother’s breasts and comfort

• Breasts feel softer after feeds

• No ongoing pain, severe tenderness or signs of engorgement

Longer-term sign

• Baby shows steady weight gain over time

A mother asks you to explain to her how she will know when to put her baby to the breast. How would you explain responsive feeding to her?

Responding to the baby’s feeding cues and the mother’s own needs, rather than feeding to a strict schedule

Baby’s feeding cues

• Early cues

  • Stirring and waking

  • Turning head/rooting

• Mid cues

  • Hand-to-mouth movements / sucking fingers

  • Waving arms and wriggling

• Late cues

  • Crying or distress — the baby may need calming before feeding.

Mother’s cues and needs

• Feeling breasts are full or uncomfortable

• Wanting to be close, comfort or bond with the baby

When else would it be appropriate for the mother to offer the breast?

• To comfort or soothe the baby (responsive feeding is not only about hunger)

• To support the emotional well-being and bonding for mother and baby

• To help the baby settle to sleep

• During skin-to-skin contact

• When the mother wants to feel close or reconnect with her baby

• If the mother feels her breasts are full or uncomfortable

• For convenience (breastfeeding is quick and accessible)

How could you support a breastfeeding mother who has begun to introduce formula feeds to continue to breastfeed?

• Listen without judgement and explore the mother’s reasons for introducing formula

• Acknowledge her feelings and support informed choice

• Reassure her that any amount of breast milk is beneficial

• Support her to find ways to continue breastfeeding, for example:

  • Offering the breast first and then offering formula milk

  • Hand expressing

• Support responsive feeding and skin-to-skin to maintain bonding and milk supply

• Signpost to community breastfeeding support, such as:

  • Infant feeding clinics

  • Peer support groups

  • Community midwives or health visitors

• Provide reliable information, such as the UNICEF Baby Friendly Initiative website

What information do formula feeding mothers need to do this safely as possible?

• How to clean and sterilise the equipment

• How to prepare the feeds as safe as possible

• How to store the milk

• Stage 1 formula milk until the baby is one year old. No need to buy the stage 2

How to prepare the feeds

1. Wash hands thoroughly

2. Boil at least 1 litre of fresh tap water in a kettle

3. Allow water to cool for no more than 30 minutes → so it remains at ≥70 °C

4. Pour the required amount of water into a sterilised bottle

5. Add the recommended number of level scoops of formula

   • Use the scoop provided

   • Level it off (do not pack or heap)

6. Secure the lid and shake well to dissolve the powder

7. Cool the feed by holding the bottle under cool running water

8. Check temperature on the inside of the wrist before feeding (it should feel warm, not hot)

How would you explain responsive bottle feeding to a mother?

• Feed the baby responsively, waiting for early feeding cues rather than feeding to a schedule

• Hold the baby close and upright, with eye contact during feeds

• Limit the number of people feeding the baby to support bonding

• Pace the feeds so the baby can pause and rest

• Allow the baby to control the flow and amount of milk

• Stop the feed when the baby shows signs of fullness, even if milk remains

How to bottle feed a baby?

1. Hold the baby semi-upright and close, supporting head and neck

2. Invite the baby to take the teat rather than pushing it into the mouth

3. Hold the bottle horizontally or slightly tilted to control milk flow

4. Watch and respond to the baby’s cues that they need a break, for example:

   • Splayed fingers or toes

   • Milk spilling from the mouth

   • Slowing or stopping suckling

5. Lower the bottle or teat so the milk flow stops, or remove the teat if the baby wants a pause

6. Resume feeding only when the baby shows cues again

7. Avoid forcing the baby to finish the bottle — stop when the baby shows signs of fullness

Why is the recommended age for starting solid foods six months?

• Before 6 months, milk meets the baby’s nutritional needs

• After around 6 months, milk alone may no longer meet all nutritional requirements

• Baby is usually developmentally ready, for example:

  • Able to sit up with support

  • Good head and neck control

  • Able to coordinate chewing and swallowing

• Swallowing skills are more developed, reducing the choking risk

• The gut has matured enough to digest and tolerate solid foods

• Starting solids at the right time supports safe feeding and healthy development

Why is it important to avoid allowing any advertising of formula milk in the healthcare system?

• Advertising can imply endorsement by healthcare professionals or organisations

• Formula marketing can be misleading and may exaggerate benefits

• Parents need unbiased, evidence-based information (eg First Steps Nutrition) to make informed choices

• Advertising can undermine breastfeeding, which has proven benefits for both mother and baby

• Supports the International Code of Marketing of Breastmilk Substitutes and UNICEF Baby Friendly standards

• Promotion of different stages can be confusing:

  • The Stage 1 formula is suitable until 1 year of age

  • Follow-on milks advertised from 6 months are not necessary

• Avoiding advertising supports consistent, ethical infant feeding advice