What is breast engorgement

Breast engorgement is when your breasts become swollen and get too full of milk. Breast engorgement is a painful condition affecting large numbers of women in the early postpartum period. Your breasts may feel hard, tight and painful. It is normal for your breasts to become larger, heavier, and a little tender when they begin making milk. Sometimes, this fullness may turn into breast engorgement, when your breasts feel very hard and painful. Breast engorgement is the result of the milk building up. Breast engorgement usually happens during the third to fifth day after giving birth. But it can happen at any time, especially if you have an oversupply of milk or are not feeding your baby or expressing your milk often. Breast engorgement can happen in the early days when you and your baby are still getting used to breastfeeding. It can take a few days for your milk supply to match your baby’s needs. Breast engorgement can also happen when your baby is older and not feeding so frequently, perhaps when they start having solid foods.

Surgical enlargement of breasts (augmentation mammoplasty) may also predispose to breast engorgement ¹⁾. Breast engorgement should be differentiated from normal breast fullness, often called physiological breast engorgement ²⁾, occurring between day two to three postpartum, in which secretory activation of the breast is triggered by the delivery of the placenta (progesterone withdrawal) and subsequent rise in prolactin levels ³⁾. Increased milk production and interstitial tissue edema ensue resulting in visibly larger, warmer and slightly uncomfortable breasts. In women with normal breast fullness, milk flow from the breast is not hindered and with frequent, efficient breastfeeding, discomfort resolves within a few days.

Breast engorgement, on the other hand, is a distressing and debilitating condition affecting between 15% and 50% of women ⁴⁾. Breast engorgement may lead to premature weaning, cracked nipples, mastitis and breast abscess.

Breast engorgement can also cause:

• Breast swelling
• Breast tenderness
• Warmth
• Redness
• Throbbing
• Flattening of the nipple
• Low-grade fever

Breast engorgement can lead to plugged ducts or a breast infection, so it is important to try to prevent it before this happens.

When breast engorgement was described as part of an inflammatory process (any mixture of redness, pain, fever, breast tension and resistance in breast tissue), 75% of women in a Swedish study experienced symptoms within eight weeks postpartum ⁵⁾. Some level of breast tenderness during the first five days after birth was experienced by 72% of women in a study by Hill and Humenick ⁶⁾. Breast engorgement symptoms occur most commonly between the second and fifth days postpartum ⁷⁾, peaking at day five ⁸⁾, but may occur as late as day 14 ⁹⁾ and are usually diffuse, bilateral and may be associated with a low‐grade fever. Complications are common and include sore/damaged nipples, mastitis, abscess formation, decreased milk supply ¹⁰⁾, premature introduction of breast milk substitutes, and premature cessation of breastfeeding ¹¹⁾. Difficulty in feeding the baby occurs in up to 82% of mothers with breast engorgement ¹²⁾.

If your baby isn’t well attached to the breast it may be hard for them to take your milk when your breast is engorged. The nipple can become a little over-stretched and flattened, and possibly painful.

Breast engorgement can still happen once you have learnt the skill of positioning and attachment, usually when your baby hasn’t fed for a while.

Your baby usually knows when they need a feed, for how long and from which breast. Early signs (cues) that your baby is ready to feed can include:

• moving their eyes rapidly
• putting their fingers into their mouth
• rooting (turning to one side with their mouth open as if seeking the breast)
• becoming restless

Crying is the very last sign that your baby needs feeding. Feeding them before they cry often leads to a much calmer feed. Keeping your baby close so you can watch and learn their early feeding cues will help.

Most of the time the discomfort goes away once you start breastfeeding regularly. Here are some ways to help with breast engorgement:

• Try not to miss or go a long time between feedings. Don’t skip night feedings.
• Express a small amount of milk with a breast pump or by hand before breastfeeding.
• Take a warm shower or put warm towels on your breasts. If your engorgement is really painful, put cold packs on your breasts.
• Tell your provider if your breasts stay swollen.
• Ask your midwife, doctor or a breastfeeding specialist for help immediately to help your baby drain your breasts more effectively.

Milk ejection reflex

Each time you express milk or sit down to breastfeed your baby, you may notice a sensation in your breasts called the ‘milk ejection’ reflex. In the early days, this takes a few minutes to appear, but later on it will occur within a few seconds. Milk ejection feels different to different women. You may have tingling or prickling in your breasts and nipples, or a feeling as if the milk is rushing in to fill them. Some mothers describe a slight pain and some mums have no sensations at all, but notice that milk starts to drip from both breasts.

Figure 1. Normal breast (female)

What to do when you have oversupply of breast milk?

An overfull breast can make breastfeeding stressful and uncomfortable for you and your baby.

What you can do:

• Breastfeed on one side for each feeding. Continue to offer that same breast for at least two hours until the next full feeding, gradually increasing the length of time per feeding.
• If the other breast feels unbearably full before you are ready to breastfeed on it, hand express for a few moments to relieve some of the pressure. You can also use a cold compress or washcloth to reduce discomfort and swelling.
• Feed your baby before he or she becomes overly hungry to prevent aggressive sucking.
• Burp your baby often if he or she is gassy so there is more room in baby’s tummy for milk.

How can I prevent engorgement?

• Feed your baby often from birth.
• Don’t limit baby’s time at the breast.
• Wake your baby for a feed if your breasts become full and uncomfortable (especially at night time).
• Ensure your baby is positioned and attached correctly, to maximize the amount of milk she is getting.

How to breastfeed

Breastfeeding positioning and attachment

If breastfeeding feels a bit awkward at first, don’t worry. Breastfeeding is a skill that you and your baby learn together, and it can take time to get used to.

There are lots of different positions you can use to breastfeed. You just need to check the following points:

• Are you comfortable? It’s worth getting comfortable before a feed. Use pillows or cushions if necessary. Your shoulders and arms should be relaxed.
• Are your baby’s head and body in a straight line? (It’s hard for your baby to swallow if their head and neck are twisted.)
• Are you holding your baby close to you, facing your breast? Supporting their neck, shoulders and back should allow them to tilt their head back and swallow easily.
• Always bring your baby to the breast rather than leaning forward to ‘post’ your breast into your baby’s mouth, as this can lead to poor attachment.
• Your baby needs to get a big mouthful of breast. Placing your baby with their nose level with your nipple will encourage them to open their mouth wide and attach to the breast well.
• Avoid holding the back of your baby’s head, so that they can tip their head back. This way your nipple goes past the hard roof of their mouth and ends up at the back of their mouth against the soft palate.

Breastfeeding positions

Some moms find that the following positions are helpful ways to get comfortable and support their babies while breastfeeding. You can also use pillows under your arms, elbows, neck, or back to give you added comfort and support. Keep trying different positions until you are comfortable. What works for one feeding may not work for the next feeding.

Clutch or “football” hold: useful if you had a C-section, or if you have large breasts, flat or inverted nipples, or a strong let-down reflex. This hold is also helpful for babies who like to be in a more upright position when they feed. Hold your baby at your side with the baby lying on his or her back and with his or her head at the level of your nipple. Support your baby’s head by placing the palm of your hand at the base of his or her head.

Cross-cradle or transitional hold: useful for premature babies or babies with a weak suck because this hold gives extra head support and may help the baby stay latched. Hold your baby along the area opposite from the breast you are using. Support your baby’s head at the base of his or her neck with the palm of your hand.

Cradle hold: an easy, common hold that is comfortable for most mothers and babies. Hold your baby with his or her head on your forearm and his or her body facing yours.

Laid-back hold (straddle hold): a more relaxed, baby-led approach. Lie back on a pillow. Lay your baby against your body with your baby’s head just above and between your breasts. Gravity and an instinct to nurse will guide your baby to your breast. As your baby searches for your breast, support your baby’s head and shoulders but don’t force the latch.

Side-lying position: useful if you had a C-section, but also allows you to rest while the baby breastfeeds. Lie on your side with your baby facing you. Pull your baby close so your baby faces your body.

How to breastfeed twins, triplets or more

How to latch your baby on to your breast

1. Hold your baby close to you with their nose level with the nipple.
2. Wait until your baby opens their mouth really wide with their tongue down. You can encourage them to do this by gently stroking their top lip.
3. Bring your baby on to your breast.
4. Your baby will tilt their head back and come to your breast chin first. Remember to support your baby’s neck but not hold the back of their head. They should then be able to take a large mouthful of breast. Your nipple should go towards the roof of their mouth.

Getting a good latch

Getting your baby to “latch on” properly can take some practice. You can try different breastfeeding holds to help your baby get a good latch.

The steps below can help your newborn latch on to the breast to start sucking when he or she is ready. Letting your baby begin the process of searching for the breast may take some of the pressure off you and keeps the baby calm and relaxed. This approach to learning to breastfeeding is a more relaxed, baby-led latch. Sometimes called biological nurturing, laid-back breastfeeding, or baby-led breastfeeding, this style of breastfeeding allows your baby to lead and follow his or her instincts to suck.

Keep in mind that there is no one way to start breastfeeding. As long as the baby is latched on well, how you get there is up to you.

• Create a calm environment first. Recline on pillows or other comfortable area. Be in a place where you can be relaxed and calm.
• Hold your baby skin-to-skin. Hold your baby, wearing only a diaper, against your bare chest. Hold the baby upright between your breasts and just enjoy your baby for a while with no thoughts of breastfeeding yet.
• Let your baby lead. If your baby is not hungry, she will stay curled up against your chest. If your baby is hungry, she will bob her head against you, try to make eye contact, and squirm around. Learn how to read your baby’s hunger signs.
• Support your baby, but don’t force the latch. Support her head and shoulders as she searches for your breast. Avoid the temptation to help her latch on.
• Allow your breast to hang naturally. When your baby’s chin hits your breast, the firm pressure makes her open her mouth wide and reach up and over the nipple. As she presses her chin into the breast and opens her mouth, she should get a deep latch. Keep in mind that your baby can breathe at the breast. The nostrils flare to allow air in.

If you have tried the “baby-led” approach and your baby is still having problems latching on, try these tips:

• Tickle the baby’s lips with your nipple to encourage him or her to open wide.
• Pull your baby close so that the baby’s chin and lower jaw moves in to your breast.
• Watch the baby’s lower lip and aim it as far from the base of the nipple as possible so that the baby takes a large mouthful of breast.

Step by Step Guide in Getting your baby into position

Breastfeeding – Step 1. Hold your baby’s whole body close with their nose level with your nipple.

Breastfeeding – Step 2. Let your baby’s head tip back a little so that their top lip can brush against your nipple. This should help your baby to make a wide open mouth.

Breastfeeding – Step 3. When your baby’s mouth opens wide, their chin should be able to touch your breast first, with their head tipped back so that their tongue can reach as much breast as possible.

Breastfeeding – Step 4. With your baby’s chin firmly touching your breast and their nose clear, their mouth should be wide open. You should see much more of the darker nipple skin above your baby’s top lip than below their bottom lip. Your baby’s cheeks will look full and rounded as they feed.

What are signs of a good latch?

Signs your baby is well attached to your breast

• The latch feels comfortable to you and does not hurt or pinch.
• Your baby’s chest rests against your body. Your baby does not have to turn his or her head while drinking.
• Your baby has a wide mouth and a large mouthful of breast.
• The baby’s tongue is cupped under the breast, so you might not see the baby’s tongue.
• You hear or see your baby swallow. Some babies swallow so quietly that a pause in their breathing may be the only sign of swallowing.
• You see the baby’s ears “wiggle” slightly.
• Your baby’s lips turn outward like fish lips, not inward. You may not even be able to see the baby’s bottom lip.
• Your baby’s chin is touching your breast, their lower lip is rolled down (you can’t always see this) and their nose isn’t squashed against your breast.
• You don’t feel any pain in your breasts or nipples when your baby is feeding, although the first few sucks may feel strong.
• You can see more of the dark skin around your nipple (areola) above your baby’s top lip than below their bottom lip, depending on the size of your areola and the size of your baby’s mouth.

What are some common breastfeeding latch problems?

Below are some common latch problems and how to deal with them.

• You’re in pain. Many moms say their breasts feel tender when they first start breastfeeding. A mother and her baby need time to find comfortable breastfeeding positions and a good latch. If breastfeeding hurts, your baby may be sucking on only the nipple, and not also on the areola (the darker skin around the nipple). Gently break your baby’s suction to your breast by placing a clean finger in the corner of your baby’s mouth. Then try again to get your baby to latch on. To find out if your baby is sucking only on your nipple, check what your nipple looks like when it comes out of your baby’s mouth. Your nipple should not look flat or compressed. It should look round and long or the same shape as it was before the feeding.
• You or your baby feels frustrated. Take a short break and hold your baby in an upright position. Try holding your baby between your breasts with your skin touching his or her skin (called skin-to-skin). Talk or sing to your baby, or give your baby one of your fingers to suck on for comfort. Try to breastfeed again in a little while.
• Your baby has a weak suck or makes tiny sucking movements. Your baby may not have a deep enough latch to suck the milk from your breast. Gently break your baby’s suction to your breast by placing a clean finger in the corner of your baby’s mouth. Then try to get your baby to latch on again. Talk with a lactation consultant or pediatrician if you are not sure if your baby is getting enough milk. But don’t worry. A weak suck is rarely caused by a health problem.
• Your baby may be tongue-tied. Babies with a tight or short lingual frenulum (the piece of tissue attaching the tongue to the floor of the mouth) are described as “tongue-tied.” The medical term is ankyloglossia. These babies often find it hard to nurse. They may be unable to extend their tongue past their lower gum line or properly cup the breast during a feed. This can cause slow weight gain in the baby and nipple pain in the mother. If you think your baby may be tongue-tied, talk to your doctor.

How to tell if your baby is getting enough milk

• Your baby will appear content and satisfied after most feeds.
• They should be healthy and gaining weight (although it’s normal for babies to lose a little weight in the first days after birth). Talk to your midwife or health visitor if you are concerned your baby is not gaining weight and is unsettled during or after breast feeds.
• After the first few days, your baby should have at least six wet nappies a day.
• After the first few days, they should also pass at least two soft yellow poos (stools) every day.

How often you should feed your baby

How often babies feed varies. As a very rough guide, your baby should feed at least eight times or more every 24 hours during the first few weeks.

It’s fine to feed your baby whenever they are hungry, when your breasts feel full or if you just want to have a cuddle.

It’s not possible to overfeed a breastfed baby.

When your baby is hungry they may:

• get restless
• suck their fist or fingers
• make murmuring sounds
• turn their head and open their mouth (rooting)

It’s best to try and feed your baby during these early feeding cues as a crying baby is difficult to feed.

How to tell if your baby is getting enough milk

When you first start breastfeeding, you may be concerned your baby is not getting enough milk. You can’t always tell how much a breastfed baby is drinking.

It’s very rare that women don’t make enough breast milk for their babies, but it may take a little while before you feel confident your baby is getting what they need.

Your baby will generally let you know, but wet and dirty nappies are a good indication, as well as hearing your baby swallow.

If you need some reassurance your baby is getting enough milk, it’s a good idea to get a midwife, health visitor or breastfeeding specialist to watch your baby feed.

Try to carry on breastfeeding if you can. Introducing bottles of formula milk can fill up your baby’s stomach so they no longer want to breastfeed as frequently. This then reduces the stimulation for you to make more milk.

Signs your baby is getting enough milk

• Your baby starts feeds with a few rapid sucks followed by long, rhythmic sucks and swallows with occasional pauses.
• You can hear and see your baby swallowing.
• Your baby’s cheeks stay rounded, not hollow, during sucking.
• They seem calm and relaxed during feeds.
• Your baby comes off the breast on their own at the end of feeds.
• Their mouth looks moist after feeds.
• Your baby appears content and satisfied after most feeds.
• Your breasts feel softer after feeds.
• Your nipple looks more or less the same after feeds – not flattened, pinched or white.
• You may feel sleepy and relaxed after feeds.

Other signs your baby is feeding well

• Your baby gains weight steadily after the first two weeks – it’s normal for babies to lose some of their birth weight in the first two weeks.
• They appear healthy and alert when they’re awake.
• From the fourth day, they should do at least two soft, yellow poos (stools) every day for the first few weeks.
• From day five onwards, wet nappies should start to become more frequent, with at least six heavy, wet nappies every 24 hours. In the first 48 hours, your baby is likely to have only two or three wet nappies.

It can be hard to tell if disposable nappies are wet. To get an idea, take a nappy and add two to four tablespoons of water. This will give you an idea of what to look and feel for.

Things that can affect your milk supply

• Poor attachment and positioning.
• Not feeding your baby often enough.
• Drinking alcohol and smoking while breastfeeding – these can both interfere with your milk production.
• Previous breast surgery, particularly if your nipples have been moved.
• Having to spend time away from your baby after the birth – for example, because they were premature: Frequent gentle hand expression will help.
• Illness in you or your baby.
• Giving your baby bottles of formula or a dummy before breastfeeding is well established.
• Using nipple shields – although this may be the only way to feed your baby with damaged nipples and is preferable to stopping feeding.
• Some medications, including dopamine, ergotamine and pyridoxine.
• Anxiety, stress or depression.
• Your baby having a tongue tie that restricts the movement of their tongue.

With skilled help, lots of these problems can be sorted out. If you have concerns about how much milk your baby is getting, it’s important to ask for help early. Speak to your midwife, health visitor or a breastfeeding specialist. They can also tell you where you can get further support.

Breast engorgement symptoms

Breast engorgement is the overfilling of breasts with milk leading to swollen, hard and painful breasts. Many women experience this during the first few days after giving birth, although it can occur later. A little breast fullness during the first few days after birth is normal, but excessive breast engorgement, which can occur from missed feedings or a change in how often your baby nurses, can be quite painful. Breast engorgement is more common when the timing of breastfeeding is restricted or the baby has difficulty sucking or the mother is separated from her newborn. This leads to the breasts not being emptied properly. Breast engorgement may make it difficult for women to breastfeed. It may lead to complications such as inflammation of the breast, infection and sore/cracked nipples.

Breast engorgement treatment

To ease the discomfort of breast engorgement, apart from your baby feeding, you could try expressing a little breast milk by hand.

You don’t need to strip the breast of as much milk as you can. This will only lead you to produce more. But taking a little off can relieve the pressure.

Ask your midwife, doctor or breastfeeding specialist to show you how.

Lastly, as strange as it might sound, one treatment for engorgement that many breastfeeding women have found effective involves cabbage. Clean, refrigerated cabbage leaves can be either torn into smaller pieces or left whole and applied directly to the breast. Whole leaves will conform to the shape of the breast if the large central stem portion is removed first. Held in place by the bra, the cabbage is left against the breast as desired or until it becomes warm and wilts. The wilted leaves can be replaced by fresh, cool ones. Either green or red cabbage can be used, but red cabbage is more likely to stain a bra or clothing. Many mothers experience an improvement in the pain and swelling of engorgement within hours after using the cabbage. There is limited clinical research on the use of cabbage for engorgement, and the exact way in which cabbage decreases breast swelling is unknown, but the treatment appears to be harmless. For engorgement, cabbage should be used only until the swelling and pain begin to subside. Continued use may decrease the milk supply too much. Some mothers regularly apply cabbage to hasten the resolution of swelling or discomfort that occurs with weaning, especially when weaning occurs over a relatively brief time.

How can I relieve engorgement?

• Take your bra off completely before beginning to breastfeed.
• Gentle breast massage or use of warmth for up to a few minutes before feeds may help trigger your let-down reflex.
• If your baby has trouble attaching to your breast, use ‘reverse pressure softening’ (see below) to soften the breast tissue under your areola or express some milk (by hand or with a pump).
• Feed your baby frequently.
• Massage the breast gently while you are feeding.
• If necessary, express for comfort after feeds.
• Use cold packs or chilled, washed, cabbage leaves after a feed to reduce inflammation.
• Ask your doctor about taking anti-inflammatory medication or pain relief if needed.

Reverse pressure softening: The aim is to push fluid in the tissue under the nipple and areola further back into the breast, to relieve the pressure. To do this, apply pressure with two or three fingers of each hand placed flat at the sides of and close to your nipple, and hold for 1–3 minutes. Or use all fingertips of one hand around the nipple and push in, holding for 1–3 minutes, until the tissue softens.

For severe engorgement

A small percentage of mothers experience severe engorgement around the time their ‘milk comes in’. In these situations, it is important to ensure that the baby is attaching well and feeding effectively, and that the length and frequency of feeds are being determined by the baby’s needs. In addition, mothers who experience severe engorgement often find it helpful to use a breast pump to completely express out the milk from their breasts.

Engorgement in the armpit

A small percentage of mothers have extra breast tissue in the axilla (armpit). This extra breast tissue is called accessory (or supernumerary) breast tissue and is not connected to the main ductal network of the breast. Accessory breast tissue is different to the breast tissue that normally extends into the armpit called the Tail of Spence. The Tail of Spence or accessory breast tissue can become engorged just like any other breast tissue can. Management for engorgement, regardless of what breast tissue it occurs in, is the same.

Expressing and storing breast milk

Expressing breast milk means squeezing milk out of your breast so you can store it and feed it to your baby later.

Some mothers find it very easy to express milk and they produce more milk than the baby requires; others need more time and may produce just enough to feed their babies. Don’t think that you are a failure if you are finding it very time-consuming to express. It does not mean that you will find breastfeeding equally difficult. After all, nature has equipped babies with a very efficient system of getting milk from the breast.

You might want to express your breast milk if:

• you have to be away from your baby, for example, because your baby is in special care or because you’re going back to work
• your breasts feel uncomfortably full (breast engorgement)
• your baby isn’t able to suck well but you still want to give them breast milk
• your partner is going to help with feeding your baby
• you want to boost your milk supply

How do I express breast milk?

You can express milk by hand or with a breast pump. How often you express your milk, and how much you express, will depend on why you are doing it.

Sometimes it takes a little while for your milk to start flowing. Try to choose a time when you feel relaxed. Having your baby (or a photo of them) nearby may help your milk to flow.

You may find it easier to express in the morning, when your breasts can sometimes feel fuller.

Expressing milk if your baby is premature

It’s recommended you express eight to 10 times a day to begin with, including at least once at night, to keep your milk supply up. In the early days, it’s often easier to express your milk by hand. Your midwife or a breastfeeding supporter can show you how.

You’ll probably only express a few drops to begin with but, if you hand express often, this will increase.

In the early days you can collect your breast milk in a small, sterile cup and store it in a syringe. Every drop is beneficial for your baby.

Once you are producing more milk, you could try using a breast pump. If your baby is in a neonatal unit, the hospital will usually be able to lend you an electric breast pump for expressing your milk. If they can’t lend you one, you can hire one.

Expressing breast milk by hand

Some women find it easier to express milk by hand than to use a pump, especially in the first few days or weeks. It also means you won’t have to buy or borrow a pump, or rely on an electricity supply.

Hand expressing allows you to encourage milk to flow from a particular part of the breast. This may be useful, for example, if one of the milk ducts in your breast becomes blocked.

Hold a sterilized feeding bottle or container below your breast to catch the milk as it flows.

These tips may help:

• Before you start, wash your hands thoroughly with soap and warm water.
• Some mothers find gently massaging their breasts before expressing helps their milk to let down.
• Cup your breast with one hand then, with your other hand, form a “C” shape with your forefinger and thumb.
• Squeeze gently, keeping your finger and thumb near the darker area around your nipple (areola) but not on it (don’t squeeze the nipple itself as you could make it sore). This shouldn’t hurt.
• Release the pressure, then repeat, building up a rhythm. Try not to slide your fingers over the skin.
• Drops should start to appear, and then your milk usually starts to flow.
• If no drops appear, try moving your finger and thumb slightly, but still avoid the darker area.
• When the flow slows down, move your fingers round to a different section of your breast, and repeat.
• When the flow from one breast has slowed, swap to the other breast. Keep changing breasts until your milk drips very slowly or stops altogether.

Expressing milk with a breast pump

There are two different types of breast pump: manual (hand-operated) and electric.

Different pumps suit different women, so ask for advice or see if you can try one before you buy.

Manual pumps are cheaper but may not be as quick as an electric one.

You may be able to hire an electric pump. Your midwife, health visitor or a local breastfeeding supporter can give you details of pump hire services near you.

The suction strength can be altered on some electric pumps. Build up slowly. Setting the strength to high straightaway may be painful or damage your nipple.

You may also be able to get different funnel sizes to fit your nipples. The pump should never cause bruising or catch your nipple as it is sucked into the funnel.

Always make sure that the pump and container are clean and sterilized before you use them.

Sterilizing baby bottles and baby feeding equipment

It’s important to sterilize all your baby’s feeding equipment, including bottles and teats, until they are at least 12 months old.

This will protect your baby against infections, in particular diarrhea and vomiting.

Before sterilizing, you need to:

• Clean bottles, teats and other feeding equipment in hot, soapy water as soon as possible after feeds.
• Use a clean bottle brush to clean bottles (only use this brush for cleaning bottles), and a small teat brush to clean the inside of teats. You can also turn teats inside out and wash in hot soapy water. Don’t be tempted to use salt to clean teats, this can be dangerous for your baby.
• You can put your baby’s feeding equipment in the dishwasher to clean it if you prefer. (Putting feeding equipment through the dishwasher cleans it but doesn’t sterilize it.) Make sure bottles, lids and teats are facing downwards. You may prefer to wash teats separately by hand to make sure they are completely clean.
• Rinse all your equipment in clean, cold running water before sterilizing.

The advice above applies to all your baby’s feeding equipment, and whether you are using expressed breast milk or formula milk.

How to sterilize baby feeding equipment

There are several ways you can sterilize your baby’s feeding equipment. These include:

• cold water sterilizing solution
• steam sterilizing
• boiling

Cold water sterilizing solution

• Follow the manufacturer’s instructions.
• Leave feeding equipment in the sterilizing solution for at least 30 minutes.
• Change the sterilizing solution every 24 hours.
• Make sure there are no air bubbles trapped in the bottles or teats when putting them in the sterilizing solution.
• Your sterilizer should have a floating cover or a plunger to keep all the equipment under the solution.

Steam sterilizing (electric sterilizer or microwave)

• It’s important to follow the manufacturer’s instructions, as there are several different types of sterilizers.
• Make sure the openings of the bottles and teats are facing downwards in the sterilizer.
• Manufacturers will give guidelines on how long you can leave equipment in the sterilizer before it needs to be sterilized again.

Sterilizing by boiling

• Make sure that whatever you want to sterilize in this way is safe to boil.
• Boil the feeding equipment in a large pan of water for at least 10 minutes, making sure it all stays under the surface.
• Set a timer so you don’t forget to turn the heat off.
• Remember that teats tend to get damaged faster with this method. Regularly check that teats and bottles are not torn, cracked or damaged.

After you’ve finished sterilizing

• It’s best to leave bottles and teats in the sterilizer or pan until you need them.
• If you do take them out, put the teats and lids on the bottles straightaway.
• Wash and dry your hands before handling sterilized equipment. Better still, use some sterile tongs.
• Assemble the bottles on a clean, disinfected surface or the upturned lid of the sterilizer.

Storing breast milk

You can store breast milk in a sterilised container or in special breast milk storage bags:

• in the fridge for up to five days at 39.2 °F (4 °C) or lower (you can buy cheap fridge thermometers online)
• for two weeks in the ice compartment of a fridge
• for up to six months in a freezer

Breast milk that’s been cooled in the fridge can be carried in a cool bag with ice packs for up to 24 hours.

Storing breast milk in small quantities will help to avoid waste. If you’re freezing it, make sure you label and date it first.

Defrosting frozen breast milk

Breast milk that’s been frozen is still good for your baby and is better than formula milk. It’s best to defrost frozen milk slowly in the fridge before giving it to your baby. If you need to use it straightaway you can defrost it by putting it in a jug of warm water or holding it under running warm water. Once it’s defrosted, use it straightaway. Don’t re-freeze milk that has been defrosted.

Warming breast milk

You can feed expressed milk straight from the fridge if your baby is happy to drink it cold. Or you can warm the milk to body temperature by putting the bottle in a jug of warm water or holding it under running warm water.

Once your baby has drunk from a bottle of breast milk it should be used within the hour and anything left over thrown away.

Don’t use a microwave to heat up or defrost breast milk. This can cause hot spots, which can burn your baby’s mouth.

Breast milk if your baby is in hospital

If you’re expressing breast milk because your baby is premature or sick, ask the hospital staff caring for your baby for advice on how to store it.

Babies don’t normally learn to coordinate the sucking, swallowing and breathing needed for feeding until about 34 to 36 weeks of pregnancy.

If your baby is born before this time, they may need to have your breast milk via a feeding tube to begin with. This goes through their nose or mouth into their stomach. The staff in the neonatal unit can show you how to feed your baby this way.

Breast milk fortifiers, which contain a mixture of minerals, vitamins and protein, may be added to your breast milk.

Babies who are very premature or sick may need to be fed via an intravenous (IV) line to begin with. A fluid containing nutrients is fed straight into your baby’s vein.