Leaking breast milk

Some nursing moms leak or spray milk from their breasts, especially when their breasts are full. Leaking is most likely to happen in the morning (when milk supply is at its peak) and during feedings (when one side leaks while the baby is nursing from the other side).

Some nursing moms leak only during the early weeks of breastfeeding, while others leak until their baby is weaned. For some women, leaking starts during pregnancy.

Some women continue to produce milk up to 2 years after they have stopped breastfeeding.

Figure 1. Normal breast

Breast leaking during pregnancy

Some women notice leaking from their nipples during pregnancy, and this is normal. In pregnancy, the breasts may start to produce milk weeks or months before you are due to have your baby.

If your nipples are leaking, the substance is usually colostrum, which is the first milk your breasts make in preparation for feeding your baby. Leaking is normal and nothing to worry about.

If it bothers you, you can try putting a tissue or an absorbent breast pad (sometimes called maternity breast pads, or nursing pads) in your bra to absorb the milk. Breast pads are available in some pharmacies and mother and baby shops.

How long will my breasts keep leaking?

Some women continue to leak for as long as they’re nursing, but many find that the problem goes away once their baby gets the hang of breastfeeding – usually within the first six to 10 weeks.

In the meantime, remember that your leaking breasts are a sign of your body’s efficiency making milk for your baby. And don’t worry – when the leaking eventually stops, you’ll still be making plenty of milk to meet your baby’s needs.

Leaking breast milk causes

Your breasts may leak when they become so full of milk that they overflow. Leaking is common in women who produce more milk than their baby needs. Or you might leak when your let-down reflex – which releases the milk – kicks in. This can happen when your nipples rub against a bed sheet, bath towel, or clothing, or when you hear a baby cry.

The let-down reflex is what makes your breastmilk flow. When your baby sucks at the breast, tiny nerves are stimulated. This causes two hormones – prolactin and oxytocin – to be released into your bloodstream. Prolactin helps make the milk, while oxytocin causes the breast to push out the milk. Milk is then released or let down through the nipple.

Some women feel the let-down reflex as a tingling sensation in the breasts or a feeling of fullness, although others don’t feel anything in the breast.

Most women notice a change in their baby’s sucking pattern as the milk begins to flow, from small, shallow sucks to stronger, slower sucks.

Some women also notice, while feeding or expressing from one breast, that milk drips from the other.

Your let-down reflex needs to be established and maintained to ensure a good supply of milk. This reflex requires no thought, unless you are having problems with breastfeeding.

Once you begin to recognize when your baby wants to eat, your breasts shouldn’t leak as often. Going too long without breastfeeding or pumping (more than three hours) can also cause leaking. If you are changing your nursing schedule from nursing on demand to nursing less often, you should expect a certain amount of leaking during this period. It will probably continue until your body has adjusted to the new schedule.

The let-down reflex occurs:

• in response to your baby sucking at the breast
• hearing, seeing or thinking about your baby
• using a breast pump, hand expressing or touching your breasts or nipples
• looking at a picture of your baby
• hearing your baby (or another baby) cry

The let-down reflex generally occurs 2 or 3 times a feed. Most women only feel the first, if at all. This reflex is not always consistent, particularly early on, but after a few weeks of regular breastfeeding or expressing, it becomes an automatic response.

The let-down reflex can also occur with other stimulation of the breast, such as by your partner.

The let-down reflex can be affected by stress, pain and tiredness. There are many things to try if you are experiencing difficulty.

• Ensure that your baby is correctly attached to the breast. A well-attached baby will drain a breast better.
• Feed or express in a familiar and comfortable environment.
• Try different methods to help you to relax: calming music, a warm shower or a warm washer on the breast, some slow deep breathing, or a neck and shoulder massage.
• Gently hand express and massage your breast before commencing the feed.
• Look at and think about your baby.
• If you are away from your baby, try looking at your baby’s photo.
• Always have a glass of water nearby.

Milk let-down can be quite forceful, particularly at the beginning of a feed. This fast flow of milk can upset your baby, but it might not mean you have oversupply. It can be managed through expressing before a feed, reclining slightly and burping your baby after the first few minutes. If you continue to have problems, seek advice.

What can I do about my leaking breasts?

Until you and your baby fine-tune breastfeeding, many sensations and thoughts can trigger your let-down reflex. Leaking breasts can be embarrassing, but should stop once breastfeeding is fully established.

In the meantime you can feed regularly before your breasts become too full, apply firm pressure to your breasts when you feel the first sensation of let-down, use breast pads and wear clothing that disguises milk stains.

If your breasts are full but your baby isn’t ready to eat, it may help to “pump to comfort.” This means pumping just enough to make your breasts compressible and comfortable, but not so much that you boost your milk supply. Manually expressing a little milk is another option.

It’s important to relieve the pressure, otherwise you could develop a clogged breast duct or mastitis, a breast infection.

You’ll soon establish a breastfeeding rhythm that works for you and your baby. Once you’re in sync with each other, you’ll probably produce just the right amount of milk for each upcoming feeding.

Here are other ways to deal with leaking breasts:

• Apply pressure. If you feel let-down happening at an awkward moment (like if you’re chatting with a co-worker about your baby and your milk starts to drip), cross your arms over your breasts and press firmly. If you’re sitting at a table, cup your chin in your hands and press your forearms into your breasts.
• Use nursing pads. Tuck nursing pads inside your bra to absorb leaks. You can buy disposable or cloth pads online or at the drugstore. Or make your own cloth pads from cut-up cloth diapers. Be sure to change the pads when they get damp so bacteria and fungi won’t grow on your nipples. A warm, moist environment can lead to fungal infections, such as thrush.
• Be prepared. If one breast always leaks when your baby is nursing on the other, put a cloth over that breast or a nursing pad inside your bra ahead of time.
• Dress for leaks and pack extras. When you’re out and about, bring along some nursing pads and extra top. Try wearing prints – they’re great for camouflaging milk stains. Or carry a jacket or sweater that you can throw on if you notice your breasts leaking.

If you want, you can try to collect your leaking breast milk to save for later with a product like Milkies Milk-Saver and Lacti-Cups. If you are concerned about leaking milk, call your lactation consultant.

Pumping breastmilk

Pumping breast milk is when you take milk out of your breast with either a hand-held pump or an electric pump. You might want to express your breastmilk because your breasts feel swollen or engorged or because you want to have some breastmilk stored in the fridge or freezer for using at a later time.

Some women find it easy to express, and other women find it more difficult. It can sometimes take a while to learn how to express. Most mums find pumping breastmilk easier if they’re in a comfortable, private place. Get yourself relaxed and comfortable, and have a glass of water handy to drink. Give yourself plenty of time too – especially when you’re first learning to express.

Different women can express different amounts of breastmilk. It depends on many things, including your body, your baby’s last feed, your baby’s age and how often you express. If you can’t express much (or any) milk, check with your midwife, child and family health nurse or lactation consultant to make sure you’re expressing correctly.

There are three ways to express breastmilk:

1. by hand
2. with a hand-held pump
3. with an electric pump.

When you are away from your baby, you can pump or hand express milk from your breasts ahead of time so that your baby can drink your breast milk from a bottle.

How to pump breast milk

Using the breast pump helpful suggestions:

1. Assemble the clean electric breast pump kit using the maker’s instructions. There will be written instructions with the kit and you would have been shown how to put it together by the your breastfeeding consultant from whom you hired the pump. If you have any questions please ring her so you know you have it connected properly.
2. Set the pump to the lowest suction setting. Try to start your let-down by using some of the ideas listed above. When putting on the breast cup, make sure the nipple is in the center and that the cup has good skin contact all around to stop air entering. If your nipple hurts when you start expressing with the pump, stop and check to make sure the nipple is centered in the breast cup and the suction is low.
3. At first, you may find it helps to keep the session short, gradually lengthening sessions. Some mothers find it useful to change breasts several times during the session. If you use a double pump kit, the session will be shorter than expressing with a single kit. Once you are comfortable with using the pump, you can increase the suction setting. Make sure it is still comfortable for you. Keep the kit upright while you are expressing to prevent milk from going into the tubing. If milk does go into the tubing, stop the pump and rinse the tubing with water. It is best not to use the pump when the tubing is wet, particularly in pumps where the tubing connects to the inside of the pump. It can draw moisture into the pump and cause damage. In pumps with a closed kit, slight dampness or moisture in the tubing should not be a problem. However, after expressing with wet tubing, take the kit apart to allow all parts to dry.
4. In the first few days or so after the birth, you will make only small amounts of the first milk, called colostrum. It is usually best to express this by hand. You will find that you will have a lot more milk a few days later, once the milk comes in. An electric breast pump is then very useful. The milk supply settles down within a few weeks to be the right amount to meet the baby’s needs. The mother of a premature baby makes slightly different milk to the mother of a term baby, because her milk is more suited to her baby’s level of maturity. Be guided by your medical advisers for your baby’s feeding needs. You will be able to express more milk as you get used to expressing.
5. While you still have colostrum in your breasts, the milk will have a yellow color and may look rather creamy. It will form layers on standing. The color of colostrum from different mothers can vary a lot, so don’t be surprised if yours looks quite different to another mother’s. This is quite normal. As your milk supply increases, the color of the milk becomes more bluish-white.
6. It still forms layers on standing, with the creamy layer at the top. Milk may look different at different times of the day and this also depends on how long it has been since you have expressed or fed your baby. Your milk is right for your baby.
7. Some mothers find that after expressing for many weeks their milk supply decreases. This is because a baby is better at getting the milk from the breast than a pump. When you are able to feed your baby at the breast, you will find that with frequent feeds, your supply will soon increase. If you are unable to feed your baby at the breast, expressing more often will help to increase your milk supply. After a week or so, you may be able to return to your previous expressing schedule. It can be helpful to finish off each session with a few minutes of hand expressing. This will help to empty your breasts and help increase your milk supply. If your supply is decreasing despite your attempts to increase it, you may wish to contact your breastfeeding consultant to discuss other ideas.
8. Contact the breastfeeding counselor from whom you hired the pump if any of the following happen:
   • the breast pump is not working (please check the instructions first)
   • your milk supply seems to be dropping
   • you feel the pump is not helping you
   • you need someone to talk to about breastfeeding or breastmilk.

Please contact your breastfeeding consultant at least once a week to let her know how you are getting on.

Figure 1. Normal breast (female)

How do breast pumps work?

All pumps have a shield that covers your breast and a container that collects breast milk. If you’re not sure what kind of pump is best for you, ask your lactation consultant. This is a person who has special training to help women breastfeed. Check with your health insurance company to see if it helps pay for a pump.

You may not know how often you’ll need to pump until you have your baby. So you may want to wait until after your baby is born to get one.

There are two kinds of breast pumps:

1. Manual breast pump. This is a pump that you work by hand. You can use a manual pump anywhere because it doesn’t need electricity. This kind of pump is good if you don’t need to pump very often or if you don’t need a lot of milk at one time.
2. Powered breast pump. This pump uses batteries or electricity. It has a motor to pump your breasts. You can use a single pump that works on one breast at a time. Or you can use a double pump that works on both breasts at the same time. If you’re going back to school or work, you may like double pumps because they’re faster than single pumps.

Do all breastfeeding moms use a breast pump?

No. But if there are times you’ll be away from your baby, like if you’re going back to work or school, you may need a breast pump. A breast pump helps you remove breast milk from your breasts. You can use the milk at a later time to feed your baby. Breast milk that you pump from your breasts is called expressed milk.

Breast pumps can help you in lots of ways:

• If you go back to work or school, you still can feed your baby breast milk.
• Your partner or another caregiver can feed your baby breast milk.
• Pumping helps keep your breast milk from building up in your breasts. This helps prevent discomfort and infection.

Expressing breastmilk with a hand-held pump

Hand-held breast pumps usually consist of a suction cup attached to a pump handle and collection bottle or container.

Just as with hand-expressing, the first step in expressing breastmilk with a hand-held pump is getting yourself relaxed and comfortable. This helps get your let-down happening in whatever way works for you. Gentle massage as described above is a good idea too.

Here are the next steps, when you’re ready:

• Place the suction cup of the pump directly over your breast with your nipple centered.
• Squeeze the pump handle gently and rhythmically – you might see only drops of milk until your let-down happens, and then it’ll spray.
• Pump until your milk flow stops.

Expressing breastmilk with an electric pump

Electric breast pumps are much like hand-held pumps, except that you don’t have to do the pumping yourself. Attach the suction cup to your breast (or breasts, in the case of double pumps).

As with expressing breastmilk by hand or by hand-help pump, get comfortable and relaxed to start. This helps with your let-down.

Here are the next steps, when you’re ready:

• Place the suction cup of the pump directly over your breast with your nipple centred.
• Start with low suction and increase it to a level that’s comfortable for you.
• Pump until your milk flow stops.

You can often get more milk by hand-expressing after the flow with the pump has stopped.

You can buy or hire electric breast pumps. You’ll need to buy your own pump kit to attach to the electric pump.

Expressing breastmilk by hand

Here are the basic steps for expressing breastmilk by hand.

Getting ready to express breastmilk by hand:

• Wash your hands with soap and warm water.
• Gently massage your breast. Start from the top of your breast and stroke towards your nipple. Massage the underside of your breast too. Do this several times to ensure the whole breast is massaged. This helps improve your let-down reflex.
• Place a clean plastic dish or a wide bowl under your breast, either between your legs or on a low table, leaving both your hands free. You might need a clean towel to catch any spills or to wipe slippery, wet fingers.

Expressing by hand:

• You can support your breast with one hand if you have large and heavy breasts.
• Place your thumb and finger directly opposite each other, either side of and well back from your nipple.
• Gently press inward towards the centre of the breast, until you feel the bulk of the breast. Expressing shouldn’t hurt.
• Gently press finger and thumb towards each other using a rhythmic rolling movement. This will compress the ducts, and milk will flow out of your nipple. There might be only drops until your let-down reflex happens. After this, you should get sprays from the nipple with each squeeze.
• Once the milk flow slows, move your fingers to a different position around the nipple and press again. This expresses more milk and empties all sectors of the breast. Change hands if your fingers get tired.
• Repeat the process on the other breast. Expressing milk can be tiring, so stopping for a drink of water might help you relax before you start again.
• If you need more milk, change from breast to breast, or wait and try again later.

How to keep your breast pump clean

Germs can grow quickly in breast milk or breast milk residue that remains on pump parts. Following these steps can keep your breast pump clean and help protect your baby from these germs. If your baby was born prematurely or has other health concerns, your baby’s health care providers may have more recommendations for pumping breast milk safely.

Before each use:

1. Wash hands. Wash your hands well with soap and water for 20 seconds.
2. Assemble. Assemble clean pump kit. Inspect whether the pump kit or tubing has become moldy or soiled during storage. If your tubing is moldy, discard and replace immediately.
3. Clean if using a shared pump.Clean pump dials, power switch, and countertop with disinfectant wipe.

After each use:

1. Store milk safely. Cap milk collection bottle or seal milk collection bag, label with date and time, and immediately place in a refrigerator, freezer, or cooler bag with ice packs.
   If milk collection container will be stored at a hospital or childcare facility, add name to the label.
2. Clean pumping area. Especially if using a shared pump, clean the dials, power switch, and countertop with disinfectant wipes.
3. Take apart and inspect pump kit. Take apart breast pump tubing and separate all parts that come in contact with breast/breast milk for example, flanges, valves, membranes, connectors, and milk collection bottles.
4. Rinse pump kit. Rinse breast pump parts that come into contact with breast/breast milk under running water to remove remaining milk
5. Clean pump kit. As soon as possible after pumping, clean pump parts that come into contact with breast/breast milk in one of the following ways.
   1. Clean by hand.
      1. Use a wash basin. Place pump parts in a clean wash basin used only for washing infant feeding equipment. Do not place pump parts directly in the sink, because germs in sinks or drains could contaminate the pump.
      2. Add soap and water. Fill wash basin with hot water and add soap.
      3. Scrub. Scrub items according to pump kit manufacturer’s guidance. If using a brush, use a clean one that is used only to clean infant feeding items.
      4. Rinse. Rinse by holding items under running water, or by submerging in fresh water in a separate basin that is used only for cleaning infant feeding items.
      5. Dry. Allow to air-dry thoroughly. Place pump parts, wash basin, and bottle brush on a clean, unused dish towel or paper towel in an area protected from dirt and dust. Do not use a dish towel to rub or pat items dry because doing so may transfer germs to the items.
   2. Clean in a dishwasher (if recommended by pump kit manufacturer).
      1. Wash. Place disassembled pump parts in dishwasher. Be sure to place small items into a closed-top basket or mesh laundry bag so they don’t end up in the dishwasher filter. If possible, run the dishwasher using hot water and a heated drying cycle (or sanitizing setting); this can help kill more germs.
      2. Remove from dishwasher. Wash your hands with soap and water before removing and storing cleaned items. If items are not completely dry, place items on a clean, unused dish towel or paper towel to air-dry thoroughly before storing. Do not use a dish towel to rub or pat items dry because doing so may transfer germs to the items.
6. Clean wash basin and bottle brush. If you use a wash basin or bottle brush when cleaning your pump parts, rinse them well and allow them to air-dry after each use. Consider washing them every few days, either in a dishwasher with hot water and a heated drying cycle, if they are dishwasher-safe, or by hand with soap and warm water.

For extra germ removal, sanitize pump parts at least once daily. Sanitizing is especially important if your baby is less than 3 months old, was born prematurely, or has a weakened immune system due to illness or medical treatment (such as chemotherapy for cancer). Daily sanitizing of pump parts may not be necessary for older, healthy babies, if the parts are cleaned carefully after each use. Sanitize all items (even the bottle brush and wash basin!) by using one of the following options.

Note: If you use a dishwasher with hot water and a heating drying cycle (or sanitizing setting) to clean infant feeding items, a separate sanitizing step is not necessary.

1. Clean first. Pump parts, bottle brushes, and wash basins should be sanitized only after they have been cleaned.
2. Sanitize. Sanitize the pump kit, bottle brushes, and wash basins using one of the following options. Check manufacturer’s instructions about whether items may be steamed or boiled.
   • Steam: Use a microwave or plug-in steam system according to the manufacturer’s directions.
   • Boil:
     • Place disassembled items that are safe to boil into a pot and cover with water.
     • Put the pot over heat and bring to a boil.
     • Boil for 5 minutes.
     • Remove items with clean tongs.
3. Allow to air-dry thoroughly. Place sanitized pump parts, wash basin, and bottle brush on a clean, unused dish towel or paper towel in an area protected from dirt and dust. Do not use a dish towel to rub or pat items dry because doing so may transfer germs to the items.

Allow the clean pump parts, bottle brushes, and wash basins to air-dry thoroughly before storing to help prevent germs and mold from growing. Once completely dry, the items should be stored in a clean, protected area to prevent contamination during storage.

• Wash hands. Wash hands well with soap and water.
• Reassemble. Put together the clean, dry pump parts.
• Store safely. Place reassembled pump kit in a clean, protected area such as inside an unused, sealable food storage bag. Store wash basins and bottle brushes in a clean area.

When to start pumping breast milk?

If you are planning to return to work or school or will be away from your baby for other reasons, you may want to start pumping 1 or 2 weeks in advance. This helps you learn how your pump works and will give you the chance to practice pumping and will give your baby time to get used to feeding from a bottle.

You can pump right after your baby eats or between feedings. Or you may prefer to pump from one breast while you feed your baby from the other.

Starting at home also helps you build a collection of breast milk. You can store it for your baby’s feedings when you return to work.

How long to pump breast milk?

It takes about the same time to pump breast milk as it does to breastfeed. With practice, you may be able to pump in as little as 10 to 15 minutes. While you are at work, try to pump as often as your baby usually feeds. This may be every 3 to 4 hours for 15 minutes each time. To keep up your milk supply, give your baby extra feedings when you are together. You also can pump right after your baby feeds to help your breasts make more milk.

How often to pump breast milk?

When away from your baby, try to pump at the same times or as often as your baby is breastfeeding. This will help remind your body to keep making the amount of milk your baby needs.

How much breast milk will I get when I pump?

You may not get much breast milk when you first start pumping. This will change as you continue to pump regularly. Pumping at the same times or as often as your baby normally breastfeeds should help your body make about the amount of milk your baby needs. Your breasts will begin to make more milk. This amount may differ from baby to baby and can change as babies grow. The more often you pump, the more milk your breasts make. Drink lots of water to stay hydrated. This will also help your milk supply.

If you find that you are not able to pump as much milk as your baby wants to eat while you are away, you may want to consider adding another pumping session to increase your milk supply.

Storing breast milk

By following recommended storage and preparation techniques, breastfeeding mothers and caretakers of breastfed infants and children can maintain the safety and quality of expressed breast milk for the health of your baby.

Table 1 are general guidelines for storing human milk at different temperatures. Various factors (milk volume, room temperature when milk is expressed, temperature fluctuations in the refrigerator and freezer, and cleanliness of the environment) can affect how long human milk can be stored safely.

The American Academy of Pediatrics recommends breastfeeding as the sole source of nutrition for your baby for about 6 months and can be continued for as long as both mother and baby desire it.

Stored breast milk can vary in color. It can be bluish, yellowish, or brownish. It is normal for breast milk to separate (the fatty part of the milk goes to the top). Shake the bottle or sealed bag and the fat should go back into the milk. If it does not, then the breast milk may be bad. You should smell the milk before feeding it to your baby. Bad milk smells sour. If you still aren’t sure, try tasting the milk. If it tastes sour, then it is bad and needs to be thrown away.

If you choose to freeze breast milk, you need to thaw it before giving it to your baby. Safe thawing of breast milk:

• Always thaw the oldest breast milk first. Remember first in, first out. Over time, the quality of breast milk can decrease.
• While many infants may be content drinking room temperature milk, some may have a preference for warmer milk. It is recommended to warm milk slowly in lukewarm water to protect fat content and nutrients.
• There are 2 ways you can thaw the milk:
  • Put the container of milk in warm water. Swirl the container around in the water until the milk thaws.
  • Put the container of milk in the refrigerator the day before it is to be used.
• Never thaw or heat breast milk in a microwave. Microwaving can destroy nutrients in breast milk and create hot spots, which can burn a baby’s mouth.
• Avoid boiling as this method will cause loss of nutritional properties of human milk and could unevenly hot making it dangerous for infants to drink.
• Use breast milk within 24 hours of thawing in the refrigerator (this means from the time it is no longer frozen or completely thawed, not from the time when you took it out of the freezer).
• Once breast milk is brought to room temperature or warmed after storing in the refrigerator or freezer, it should be used within 2 hours.
• Never refreeze breast milk once it has been thawed.

Thawed breast milk can be refrigerated for up to 24 hours, but it should not be refrozen. Do not use hot water to thaw breast milk. The milk could get too hot and burn your baby’s mouth. Do not thaw frozen breast milk in a microwave. This can damage valuable proteins in breast milk.

Table 1. Guidelines for storage of breastmilk at home for use with healthy, full-term babies

Breast milk status	Room temperature (78.8 °F [26°C] or lower)	Refrigerator (39.2 °F [4°C] or lower)	Freezer
Freshly expressed into container	6–8 hours If refrigerator is available store milk there	3–5 days Store at back where it is coldest	2 weeks in freezer compartment inside refrigerator 3 months in freezer section of refrigerator with separate door 6–12 months in deep freeze (-0.4 °F [-18°C] or lower)
Previously frozen thawed in refrigerator but not warmed	4 hours or less – that is, the next feeding	24 hours	NEVER refreeze human milk after it has been thawed
Thawed outside refrigerator in warm water	For completion of feeding	4 hours or until next feeding	NEVER refreeze human milk after it has been thawed
Infant has begun feeding	Only for completion of feeding	Discard	Discard

Breast milk storage containers

• Bottles
  • glass or hard-sided plastic containers with well-fitting tops
  • avoid containers made with the chemical bisphenol A (BPA), identified with a number 3 or 7 in the recycling symbol. A safe alternative is polypropylene, which is soft, semi-cloudy, and has the number 5 recycling symbol and/or the letters PP. You can avoid the risks of plastic completely by using glass.
  • containers which have been washed in hot, soapy, water, rinsed well, and allowed to air-dry before use or washed and dried in a dishwasher
  • containers should not be filled to the top – leave an inch of space to allow the milk to expand as it freezes
• Bags
  • freezer milk bags that are designed for storing human milk
  • squeeze out the air at the top before sealing, and allow about an inch for the milk to expand when frozen.
  • stand/lay the bags in another container at the back of the refrigerator shelf or in the back of freezer where the temperature will remain the most consistently cold.

Disposable bottle liners or plastic bags are not recommended. With these, the risk of contamination is greater. Bags are less durable and tend to leak, and some types of plastic may destroy nutrients in milk.

Before expressing or handling breast milk:

• Wash your hands well with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
• Mothers can express breast milk by hand or with a manual or electric pump.
• If using a pump, inspect the pump kit and tubing to make sure it is clean. Discard and replace moldy tubing immediately.
• If using a shared pump kit, clean pump dials, power switch, and countertop with disinfectant wipe.

Techniques you can use to encourage your let-down reflex when expressing your breast milk

There are several techniques you can use to encourage your let-down reflex when expressing. For example:

• Consciously try to relax, using whatever method suits you. Try to express in a quiet, warm, relaxing area, away from distractions. While expressing, breathe slowly and deeply. You could express in the place you usually sit to feed. Some mothers have a warm drink first or listen to soft music. Warmth (expressing after a warm shower, warm face washers on the breast for a few minutes before starting) may also help.
• Gently massaging your breasts by stroking down towards the nipple, and gently rolling the nipple between your fingers. While you can’t actually push the milk out of your breasts by massage, you can help trigger the let-down by touching your breasts.
• Thinking about your baby and how much your breastmilk is helping her will encourage your let-down reflex. If she is premature or sick in hospital,you might find it easier to express near her cot or just after you leave her. If you are away from her, looking at her photo can help.
• Having someone support you. Many mothers find they manage much better when they have an encouraging partner or friend.

Safe cleaning of infant feeding items and pumping equipment

• Carefully cleaning, sanitizing, and storing your pump equipment, baby’s bottles, and other feeding items will help to protect your breast milk from contamination. CDC has guidance on how to safely clean and store pump equipment and infant feeding items.

Storing breast milk after expressing:

• Use breast milk storage bags or clean food-grade containers with tight fitting lids made of glass or plastic to store expressed breast milk.
  • Avoid bottles with the recycle symbol number 7, which indicates that the container may be made of a BPA-containing plastic.
• Never store breast milk in disposable bottle liners or plastic bags that are not intended for storing breast milk.
• Freshly expressed or pumped milk can be stored:
  • At room temperature (77 °F [25 °C] or colder) for up to 4 hours.
  • In the refrigerator for up to 4 days.
  • In the freezer for about 6 months is best; up to 12 months is acceptable. Although freezing keeps food safe almost indefinitely, recommended storage times are important to follow for best quality.

Storage tips:

• Clearly label the breast milk with the date it was expressed.
• Do not store breast milk in the door of the refrigerator or freezer. This will help protect the breast milk from temperature changes from the door opening and closing.
• If you don’t think you will use freshly expressed breast milk within 4 days, freeze it right away. This will help to protect the quality of the breast milk.
• Freeze breast milk in small amounts of 2 to 4 ounces (or the amount that will be offered at one feeding) to avoid wasting breast milk that might not be finished.
• When freezing breast milk, leave about an inch of space at the top of the container because breast milk expands as it freezes.
• If you will be delivering breast milk to a childcare provider, clearly label the container with the child’s name and talk to your childcare provider about other requirements they might have for labeling and storing breast milk.
• Breast milk can be stored in an insulated cooler bag with frozen ice packs for up to 24 hours when you are traveling. Once you arrive at your destination, milk should be used right away, stored in the refrigerator, or frozen.

Feeding expressed breast milk

• Breast milk does not need to be warmed. It can be served room temperature or cold.
• If you decide to warm the breast milk, here are some tips:
  • Keep the container sealed while warming.
  • Warm breast milk by placing the container of breast milk into a separate container or pot of warm water for a few minutes or by running warm (not hot) tap water over the container for a few minutes.
  • Do not heat breast milk directly on the stove or in the microwave.
  • Test the temperature of the breast milk before feeding it to your baby by putting a few drops on your wrist. It should feel warm, not hot.
• Swirl the breast milk to mix the fat, which may have separated.
• If your baby did not finish the bottle, the leftover breast milk can still be used within 2 hours after the baby is finished feeding. After 2 hours, leftover breast milk should be discarded.

How to store breast milk

There are a couple of ways you can store breast milk. You can use a plastic or glass bottle with a sealable top. Or you can use a sterile, sealable bag. Store your breast milk in the amount your baby consumes in a feeding. This way you don’t waste any milk. For example, if your baby eats 4 ounces in a feeding, put 4 ounces of breast milk in the storage container. Always put a date on the container of breast milk so you know how long it will last.

Where should I store my breast milk?

Store your pumped breast milk in a refrigerator or cooler with ice as soon as possible. You also can freeze the milk if you aren’t going to use it right away.

How long can I store my breast milk?

The life of breast milk varies based on how it is stored.

• At room temperature (less than 77°F), it lasts up to 6 hours.
• In a cooler with ice packs, it lasts up to 24 hours.
• At the back of a refrigerator, it lasts for 3 to 8 days.
• At the back of a freezer, it lasts up to 6 months.

Why does my milk smell or taste soapy?

Sometimes thawed milk may smell or taste soapy. This is due to an enzyme in milk known as lipase ¹⁾. The milk is safe and most babies will still drink it. If there is a rancid smell from high lipase when the milk has been chilled or frozen, the milk can be heated to scalding (bubbles around the edges, not boiling) after expression, then quickly cooled and frozen. This deactivates the lipase enzyme. Scalded milk is still a healthier choice than commercial infant formula.

Why is my milk separating?

Human milk naturally separates into a milk layer and a cream top when it is stored. This is normal. It is safe to shake or swirl the milk to combine the cream prior to feeding.

How do I thaw and warm breast milk once I’m ready to use it?

To thaw frozen breast milk:

1. Make sure the container is sealed tight.
2. Put the container under running cold water.
3. Pour the amount of thawed milk you need for your baby into a bottle for feeding.
4. Use the thawed milk within 24 hours. Don’t refreeze breast milk after it’s been thawed.

To warm thawed or refrigerated milk:

1. Put the container under running hot water or in a bowl of warm water.
2. Pour the amount of milk you need for your baby into a bottle for feeding.
3. Put a drop or two of milk on the back of your hand to test the temperature. If it’s too hot, let it cool.

Never heat breast milk in the microwave. It kills nutrients in the milk and can burn your baby’s mouth.

Is it safe to refreeze my milk after thawing?

Previously frozen milk that has been thawed can be kept in the refrigerator for up to 24 hours ²⁾. There is currently limited research that supports the safety of refreezing breastmilk as this may introduce further breakdown of nutrients and increases the risk of bacterial growth. At this time, the accepted practice is not to refreeze thawed milk.

Can I reuse previously fed milk if my baby does not finish?

If baby does not finish the bottle during a feed, the recommendation is milk may be reused within 1-2 hours and after this time frame should be discarded to avoid transfer of bacteria from baby’s mouth to bottle ³⁾. Many moms find storing milk in smaller quantities can help reduce waste if baby does not finish the bottle.

Is it safe to store my milk in a shared refrigerator?

Expressed milk can be kept in a common refrigerator at the workplace or in a day care center. The US Centers for Disease Control and Prevention (CDC) and the US Occupational Safety and Health Administration agree that human milk is not among the body fluids that require special handling or storage in a separate container.

CDC does not list human breast milk as a body fluid to which universal precautions apply ⁴⁾. Occupational exposure to human breast milk has not been shown to lead to transmission of HIV or Hepatitis B infection. However, because human breast milk has been implicated in transmitting HIV from mother to infant, gloves may be worn as a precaution by health care workers who are frequently exposed to breast milk (e.g., people working in human milk banks (defined below). For additional information regarding universal precautions as they apply to breast milk in the transmission of HIV and Hepatitis B infections, visit the following resources:

• Centers for Disease Control and Prevention. Perspectives in disease prevention and health promotion update: universal precautions for prevention of transmission of human immunodeficiency virus, Hepatitis B virus, and other bloodborne pathogens in health-care settings (https://www.cdc.gov/mmwr/preview/mmwrhtml/00000039.htm)
• Centers for Disease Control and Prevention. Recommendations for prevention of HIV transmission in health-care settings (https://www.cdc.gov/mmwr/preview/mmwrhtml/00023587.htm)

I have thrush; is my breast milk safe?

If you or your baby has a thrush or yeast/fungus infection, continue to breastfeed during the outbreak and treatment. While being treated, you can continue to express your milk and give it to your baby. Label any milk stored while you or baby is undergoing treatment. Be aware that refrigerating or freezing milk does not kill yeast. The safest, most conservative option is to discard pumped milk during thrush treatment. Some research shows using frozen milk pumped during thrush treatment should not pose any risk to healthy babies especially if the milk is boiled prior to use ⁵⁾.

How long should a mother breastfeed?

The American Academy of Pediatrics recommends that infants be exclusively breastfed for about the first 6 months with continued breastfeeding along with introducing appropriate complementary foods for 1 year or longer. The World Health Organization (WHO) also recommends exclusive breastfeeding up to 6 months of age with continued breastfeeding along with appropriate complementary foods up to 2 years of age or longer.

Mothers should be encouraged to breastfeed their children for at least 1 year. The longer an infant is breastfed, the greater the protection from certain illnesses and long-term diseases. The more months or years a woman breastfeeds (combined breastfeeding of all her children), the greater the benefits to her health as well.

The American Academy of Pediatrics recommends that children be introduced to foods other than breast milk or infant formula when they are about 6 months old.

Will there be times that my baby needs more milk than I have ready?

Yes, your baby needs more milk during growth spurts. These occur at about 2 weeks and 6 weeks of age and again at about 3 months and 6 months of age. The best way to increase your milk supply for a growth spurt is to breastfeed or pump more often.

Can what I eat and drink affect my breast milk?

Yes. Nutrients in foods and drinks help make your breast milk healthy. When you’re breastfeeding, eat healthy foods, like fruits, vegetables, whole-grain breads and lean meats. Eat fewer sweets and salty snacks. You may need 450 to 500 extra calories a day when you’re breastfeeding to make breast milk for your baby.

Drink lots of water. It’s important to stay hydrated (have fluid in your body) when you’re breastfeeding. Drink when you’re thirsty. A simple way to make sure you drink enough water is to have a glass each time you breastfeed.

Limit caffeine when you’re breastfeeding. Caffeine is a drug that’s found in things like coffee, tea, soda, energy drinks, chocolate and some energy drinks and medicines. Too much caffeine in breast milk can make your baby fussy or have trouble sleeping. If you drink coffee, have no more than two cups a day while you’re breastfeeding.

Do I need to take vitamins or supplements when I’m breastfeeding?

Yes. Food is the best source of nutrients. But even if you eat healthy foods every day, you may not get all the nutrients you need. So you may need a little help from supplements. A supplement is a product you take to make up for certain nutrients that you don’t get enough of in food. For example, you may take a vitamin supplement to help you get more vitamin B or C. Or you may take an iron or calcium supplement.

When you’re breastfeeding, take a multivitamin every day or keep taking your prenatal vitamin. A multivitamin contains many vitamins (like vitamins B and C and folic acid) and minerals (like iron and calcium) that help your body stay healthy. A prenatal vitamin is a vitamin made for pregnant women. Don’t take any vitamin or supplement without talking to your provider first.

Here are some nutrients you may need supplements for during breastfeeding:

DHA is short for docosahexaenoic acid. DHA is a kind of fat called omega-3 fatty acid that helps with growth and development. If you’re breastfeeding, you need 200 to 300 milligrams of DHA each day to help your baby’s brain and eyes develop. You can get this amount from foods, like fish that are low in mercury, like herring, salmon, trout, anchovies and halibut. Or you can get it from foods that have DHA added to them, like orange juice, milk and eggs. If you don’t get enough DHA from food, you can take a DHA supplement. Talk to your provider to make sure you get the right amount of DHA each day.

Iodine. When you’re breastfeeding, you need 290 micrograms of iodine each day. Iodine in your breast milk helps your baby’s body make thyroid hormones that help his bones and nerves develop. You may not get enough iodine from food you eat. And not all multivitamins and prenatal vitamins contain iodine. So talk to your provider to make sure you’re getting enough iodine each day. You can get iodine by:

• Eating foods that are high in iodine, like fish, bread, cereal and milk products
• Taking an iodine or iodide supplement. Iodide is a form of iodine.
• Using iodized salt. This is salt that has iodine added to it. Read the package label to make sure your salt is iodized.

Vitamin B12. Vitamin B12 in your breast milk supports your baby’s brain development and helps him make healthy red blood cells. You can get vitamin B12 from foods, like meat, fish, eggs, milk and products made from milk. Or you may need a supplement. Ask your provider about taking a vitamin B12 supplement to make sure you and your baby get the right amount. You may need extra vitamin B12 if you:

• Are a strict vegetarian or vegan. A vegetarian is someone who doesn’t eat meat and mostly east foods that come from plants. A vegan is someone who doesn’t eat meat or anything made with animal products, like eggs or milk.
• Have had gastric bypass surgery. This is surgery on the stomach and intestines to help you lose weight.
• Have digestive conditions, like celiac disease or Crohn’s disease. These conditions affect how your body digests (breaks down) food.

Don’t take herbal products, like ginkgo or St. John’s wort, when you’re breastfeeding. Herbal products are made from herbs. Herbs are plants used in cooking and medicine. Even though herbs are natural, they may not be safe for your baby. It’s best not to use these products while you’re breastfeeding.

Can smoking while breastfeeding hurt my baby?

Yes. Don’t smoke if you’re breastfeeding. Nicotine is a drug found in cigarettes. It passes to your baby in breast milk and can cause problems, like:

• Making your baby fussy
• Making it hard for your baby to sleep
• Reducing your milk supply so your baby may not get all the milk he needs

Secondhand smoke also is bad for your baby. Secondhand smoke is smoke from someone else’s cigarette, cigar or pipe. It can cause lung and breathing problems. Babies of mothers who smoke are more likely than babies of non-smokers to die from sudden infant death syndrome (also called SIDS). SIDS is the unexplained death of a baby younger than 1 year old.

If you do smoke, it’s OK to breastfeed. But smoke as little as possible and don’t smoke around your baby.

Can I pass alcohol or street drugs to your baby through breast milk?

Yes. Don’t drink alcohol when you’re breastfeeding. Alcohol includes beer, wine, wine coolers and liquor. If you do drink alcohol, don’t have more than two drinks a week. Wait at least 2 hours after each drink before you breastfeed.

You also can pass street drugs, like heroin and cocaine, to your baby through breast milk. Tell your health care provider if you need help to quit using street drugs.

If you’re breastfeeding, don’t use marijuana. It’s not safe for your baby. You may pass THC and other chemicals from marijuana to your baby through breast milk. If you breastfeed your baby and smoke marijuana, your baby may be at increased risk for problems with brain development. Marijuana also may affect the amount and quality of breast milk you make. Even if marijuana is legal to use in your state, don’t use it when you’re breastfeeding.

Are prescription medicines safe to take when I’m breastfeeding?

Some are, and some aren’t. A prescription medicine (drug) is one your provider says you can take to treat a health condition. You need a prescription (an order from your provider) to get the medicine. Some prescription drugs, like medicine to help you sleep, some painkillers and drugs used to treat cancer or migraine headaches, aren’t safe to take while breastfeeding. Others, like certain kinds of birth control, may affect the amount of breast milk you make.

Here’s what you can do to make sure prescription medicine you take is safe for your baby when you’re breastfeeding:

• Talk to your health care provider and your baby’s provider about breastfeeding before your baby is born. Tell each provider about any medicine you take. If you take a medicine that’s not safe for your baby, your provider may switch you to a safer one. Don’t start or stop taking any medicine during breastfeeding without talking to your providers first.
• Make sure any doctor who prescribes you medicine knows that you’re breastfeeding.
• Check with your provider even if you take medicine that’s usually prescribed for your baby, like baby aspirin.
• Tell your baby’s doctor if your baby has any signs that may be a reaction to your medicine, like diarrhea, sleepiness, a change in eating or crying more than usual.

If you have a chronic health condition and you plan to breastfeed, talk to your providers about how your condition affects breastfeeding. You most likely can breastfeed even with a chronic health condition. Your provider can help you make sure that any medicine you take is safe for your baby. A chronic health condition is one that lasts for 1 year or more. It needs ongoing medical care and can limit a person’s usual activities and affect daily life. Examples are diabetes, high blood pressure, obesity and depression. Chronic health conditions need treatment from a health care provider.

Is it safe to take prescription opioids when I’m breastfeeding?

Prescription opioids are painkillers your provider may prescribe if you’ve been injured or had surgery or dental work. They’re sometimes used to treat a cough or diarrhea. If you had an episiotomy or a cesarean birth (also called a c-section), your provider may prescribe an opioid like codeine or tramadol to help relieve your pain. An episiotomy is a cut made at the opening of the vagina to help let your baby out. A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus (womb).

Opioid use during pregnancy is the most common cause of neonatal abstinence syndrome also called NAS. Neonatal abstinence syndrome is a group of conditions caused when a baby withdraws from certain drugs she’s exposed to in the womb before birth. If your baby has neonatal abstinence syndrome, breastfeeding may help make her symptoms less severe. This may help her need less medicine and be able to leave the hospital sooner. If your baby has neonatal abstinence syndrome, talk to your provider and your baby’s provider about breastfeeding and how to make sure it’s safe for your baby.

If you’re using prescription opioids with your doctor’s supervision, you can breastfeed depending on the opioid you take. Some opioids can cause life-threatening problems for your baby. Make sure the provider who prescribes you the opioid knows you’re breastfeeding, and take the medicine exactly as our provider tells you to. If you take any of these opioids, talk to your provider about switching to a safer medicine:

• Codeine or medicines that contain codeine
• Hydrocodone
• Meperidine
• Oxycodone
• Tramadol

If you’re in treatment for opioid use disorder with medicines like methadone or buprenorphine (also called medication-assisted therapy or MAT or opioid-assisted therapy or OAT), you can breastfeed your baby if:

• Your health is stable and you’re no longer misusing opioids or using street drugs, like cocaine or marijuana.
• You don’t have HIV (stands for human immunodeficiency virus. HIV is the virus that causes AIDS (stands for acquired immunodeficiency syndrome).
• Your treatment is closely supervised and monitored.
• You have social support from friends and family throughout your treatment.
• Your baby continues to gain weight as you breastfeed.

If you’re breastfeeding and taking tramadol, codeine or medicines that contain codeine, call your baby’s doctor or emergency services number right away if your baby:

• Is sleepier than usual. Breastfed babies usually eat every 2 to 3 hours and shouldn’t sleep more than 4 hours at a time.
• Is limp
• Has trouble breathing
• Has trouble breastfeeding

Are over-the-counter medicines safe to take when you’re breastfeeding?

Most over-the-counter also called OTC medicine, like pain relievers and cold medicine, are OK to take when you’re breastfeeding. For example, OTC pain relievers like ibuprofen (Advil®) or acetaminophen (Tylenol®) are safe to use when breastfeeding.

Here’s what you can do to help make sure an OTC medicine is safe for your baby:

• Don’t take an OTC medicine during breastfeeding without talking to your provider first. If you take a medicine that’s not safe for your baby, your provider can recommend a safer one.
• Read the label on the package for information about how an OTC drug may affect breastfeeding.
• Take the smallest dose (amount) of medicine to help lessen the amount that gets passed to your baby in breast milk.
• Don’t take medicine that is extra-strength, long-acting (you take it just once or twice a day) or multi-symptom (treats more than one symptom). These medicines may have larger doses that stay in your body and breast milk longer than medicines with smaller doses.
• Tell your baby’s doctor if your baby has signs of reaction, like diarrhea, sleepiness, a change in eating, or crying more than usual.

What medical conditions make breastfeeding unsafe for your baby?

Breastfeeding may be harmful to a baby if:

• Your baby has galactosemia. Babies with this genetic condition can’t digest the sugar in breast milk (or any kind of milk). They can have brain damage or even die if they eat or drink breast milk, milk or anything made with milk. Babies with galactosemia need to eat a special formula that is not made with milk of any kind. Your baby gets tested for this condition soon after birth as part of newborn screening.
• You have human immunodeficiency virus (HIV). You can pass HIV to your baby through breast milk. Note: recommendations about breastfeeding and HIV may be different in other countries ⁶⁾.
• You have cancer and are getting treated with medicine or radiation.
• You have human T-cell lymphotropic virus type I or type II ⁷⁾. This is a virus that can cause blood cancer and nerve problems.
• You have untreated, active tuberculosis. This is an infection that mainly affects the lungs.
• You have Ebola, a rare but very serious disease that can cause heavy bleeding, organ failure and death. It’s spread by coming in contact with body fluids from a person who has the disease. A mother who has Ebola should not have close contact—including breastfeeding—with her baby. This can help keep her baby safe from the disease. While the virus has been found in breast milk, we don’t know for sure if you can pass Ebola to your baby through breast milk.
• You are using an illicit street drug, such as PCP (phencyclidine) or cocaine1 (Exception: Narcotic-dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection and other illicit drugs can breastfeed)

Mothers should temporarily NOT breastfeed and should NOT feed expressed breast milk to their infants if:

• Mother is infected with untreated brucellosis ⁸⁾.
• Mother is taking certain medications ⁹⁾.
• The mother is undergoing diagnostic imaging with radiopharmaceuticals ¹⁰⁾.
• Mother has an active herpes simplex virus (HSV) infection with lesions present on the breast ¹¹⁾. Note: Mothers can breastfeed directly from the unaffected breast if lesions on the affected breast are covered completely to avoid transmission.

Mothers should temporarily NOT breastfeed, but CAN feed expressed breast milk if:

• Mother has untreated, active tuberculosis ¹²⁾. Note: The mother may resume breastfeeding once she has been treated appropriately for 2 weeks and is documented to be no longer contagious.
• Mother has active varicella (chicken pox) infection that developed within the 5 days prior to delivery to the 2 days following delivery ¹³⁾.

If you’ve had breast surgery or piercing, it’s most likely safe to breastfeed. Breast surgery includes getting implants, having a breast reduction or having a lump removed. Piercing means inserting jewelry into the breast, including nipple piercing. If you’ve had surgery or piercing, talk to your doctor or lactation consultant. A lactation consultant is a person with special training in helping women breastfeed.

If I’ve been exposed to lead, is it safe to breastfeed?

It depends on the amount of lead you have in your body. Lead is a metal that comes from the ground, but it can be in the air, water and food. You can’t see, smell or taste it. High levels of lead in your body called lead poisoning can cause serious health problems.

If you think you’ve been exposed to lead and are breastfeeding or planning to breastfeed, tell your provider. She can test your lead levels to see if breastfeeding is safe for your baby. If you have more than 40 micrograms/dL of lead in your system, it’s not safe to breastfeed. Pump your breast milk and throw it out until your lead levels are safe.

What are human milk banks?

Human milk banks are a service established for the purpose of collecting milk from donors and processing, screening, storing, and distributing donated milk to meet the specific needs of individuals for whom human milk is prescribed by licensed health care providers. When possible, human milk banks also serve healthy infants who have been adopted or are not able to get their own mother’s milk.

Is it safe for families to buy breast milk on the internet?

The American Academy of Pediatrics (https://www.aappublications.org/content/34/12/29.6) and the Food and Drug Administration (https://www.fda.gov/science-research/pediatrics/use-donor-human-milk) recommend avoiding Internet-based milk sharing sites and instead recommend contacting milk banks. Research ¹⁴⁾ has demonstrated that some milk samples sold online have been contaminated with a range of bacteria.

Nonprofit donor human milk banks, where processed human milk comes from screened donors, have a long safety record in North America. All member banks of the Human Milk Banking Association of North America (HMBANA) must operate under specific evidence-based guidelines that require extensive testing and processing procedures as well as self-reported health information and a health statement from both the donor’s health care provider and the infant’s health care provider. Because most of the milk from milk banks is given to hospitalized and fragile infants, milk banks may not have enough to serve healthy infants at all times. To find a human milk bank, contact HMBANA (https://www.hmbana.org).

Latching on breastfeeding tips

With breastfeeding, a latch refers to how the baby fastens onto the breast. Getting a good latch is important. In fact, how your baby latches is actually more important than how you hold your baby. 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. Learn signs of a good latch. Get tips to help your baby have a good latch.

Latching on (see the steps below)

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

Signs of a good latch include the following:

• 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.
• You see little or no areola (the darker skin around the nipple), depending on the size of your areola and the size of your baby’s mouth.
• When your baby is positioned well, his or her mouth will be filled with 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 touches your breast.

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

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.

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.

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.

How to breastfeed twins, triplets or more

What does it mean to have a good latch?

A good latch means that the bottom of your areola (the darker area around the nipple) is in your baby’s mouth and your nipple is back inside his or her mouth, where it’s soft and flexible. A shallow latch happens when your baby does not have enough of your breast in his/her mouth or is too close to the end of your nipple. A shallow latch can make the nipple sore, cracked, and bleeding.

Check your nipples

The sensitivity of the skin on your nipples and breasts helps your breasts respond to your baby and know how much milk to make. When the baby is latched correctly, the bottom part of the areola is also in his or her mouth. But a shallow latch, even if it doesn’t hurt right away, will start to hurt soon. And your baby has to work harder to get the milk out.

Not sure if baby’s latch is too shallow?

Ask yourself:

• Are you in pain? If the pain lasts longer than a few seconds, the latch is probably too shallow. Gently break the suction by placing a clean finger into your baby’s mouth and help your baby latch on again.
• How’s your nipple? When the baby unlatches, look down. Your nipple should look the same or slightly longer than usual. Pain or pinching is a sign of a poor latch.

Check your comfort

Both you and your baby should be comfortable both during and after feedings.

• During feeds. A little bit of discomfort at first is okay, but if your baby has been at the breast more than a few seconds and it still hurts, or if you find yourself using the breathing they taught you for labor and delivery to get through pain, that’s not good. Take your baby off, look at how you’re positioned, and try again. Your baby needs a good latch to get maximum milk, and you need a good latch for comfort.
• Between feeds. You might sometimes feel your breasts getting fuller when it’s time for a feeding. Some moms can feel a tingling sensation in their breasts just by thinking about their baby or hearing another baby cry. You may even leak a little milk between feedings. These are normal signs. But if your breasts feel painful, achy, itchy, hot, or burning, or you feel a hard lump that can’t be massaged out, call a doctor or nurse right away. These can be signs of an infection. Regardless of the diagnosis, even if you’re prescribed medicine, keep breastfeeding if the doctor or nurse tells you to. Why? Continued breastfeeding keeps the milk moving through the breast, which helps the healing process and speeds recovery.

Sometimes, even when you do everything right and the latch looks good, you may still experience pain. Remember, pain is a red flag. So get help from a breastfeeding expert, doctor, or nurse.

How can I help my baby get a good latch while learning to breastfeed?

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.

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 (ankyloglossia). 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.” 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.

When can I start breastfeeding?

Most women can start breastfeeding within 1 hour after their baby is born. A nurse or lactation consultant can help you get started:

• Tell the nurses that you want to breastfeed.
• Ask to have your baby stay in the room with you so you can breastfeed him when he needs to eat.
• Ask your nurses, the lactation consultant and your baby’s provider to help make sure breastfeeding is going well before you leave the hospital.

Is breastfeeding good for babies with special needs?

Yes. Some babies are born premature (before 37 weeks of pregnancy) or with birth defects or other medical conditions. Breastfeeding a baby with special needs like these can help her grow and protect her from illness. But you may need help to make breastfeeding work for you and your baby.

Talk to your health care provider or lactation consultant about breastfeeding your baby with special needs. A lactation consultant is a person with special training in helping women breastfeed.

Is any amount of breastfeeding good?

Yes. It’s best to feed your baby only breast milk for at least 6 months. This means no water, formula, other liquids or solid food—just breast milk. But any amount of breastfeeding is good for your baby’s health and development. Even breastfeeding for a short time is good for your baby.

How do you know when your baby’s ready to eat?

Look for her feeding cues. Feeding cues are ways that your baby tells you that she’s hungry. Examples are:

• Rooting (turning her head toward anything that strokes her cheek or mouth)
• Sucking movements or sounds
• Putting her hand to her mouth
• Crying — This is a late feeding cue. Try to breastfeed your baby before she starts to cry.

How often do you breastfeed?

Feed your baby when she’s hungry. This is called on-demand feeding. Most newborns eat about eight to 12 times over 24 hours, which is about once every 2 to 3 hours. But each baby is different. Your baby may want to feed more often or less often. As your baby grows, her feeding patterns may change, and she may go longer between feedings.

To make nighttime feedings easier, put the baby’s crib in your room. Just don’t sleep with the baby in your bed.

How long does each feeding last?

Let your baby feed as long as she wants at one breast. This is called feeding unlimited at the breast. This usually takes about 15 to 30 minutes. Your baby may take more or less time. When she is finished with one breast, burp her. Then switch her to feed from the other breast. It’s OK if she only wants to nurse from one breast. Just be sure to start her on the other breast at the next feeding. Let your baby end breastfeeding on her own.

How do you know if your baby is getting enough milk?

Lots of new moms ask this question. Your body is pretty amazing. As you breastfeed, your body learns when your baby needs more milk. Your body makes exactly the right amount for your baby. But what if you’re still not sure he’s eating enough? Your baby is probably getting enough milk if he:

• Is gaining weight
• Is making six to eight wet diapers a day by the time he’s 5 to 7 days old

Is breastfeeding good for the mother?

Yes. Breastfeeding your baby helps you because:

• It increases the amount of a hormone in your body called oxytocin. This helps your uterus (womb) go back to the size it was before you got pregnant. It also helps stop bleeding that you have after giving birth.
• It burns extra calories. This helps you get back to your pre-pregnancy weight (your weight before pregnancy).
• It may help lower your risk for diabetes, breast cancer and ovarian cancer.
• It can help you bond with your baby.

Breastfeeding also delays the return of your period. But this can make it hard to know when your body can get pregnant again. Use birth control when you start having sex again. Talk to your provider about birth control that’s safe to use when you’re breastfeeding.

Can breastfeeding help me lose weight?

Besides giving your baby nourishment and helping to keep your baby from becoming sick, breastfeeding may help you lose weight. Many women who breastfed their babies said it helped them get back to their pre-pregnancy weight more quickly, but experts are still looking at the effects of breastfeeding on weight loss.

Is breastfeeding safe for all moms and babies?

No. Breastfeeding may not be safe for your baby if you have certain medical conditions, take certain medicines or have other problems, like using street drugs or abusing prescription drugs. You can pass some infections, medicines and drugs to your baby through breast milk. Some can be very harmful to your baby. Talk to your provider if you think you have a condition that may make breastfeeding unsafe for your baby.

How long should a mother breastfeed?

The American Academy of Pediatrics recommends that breastfeeding continue for at least 12 months, and thereafter for as long as mother and baby desire. The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond.

What can happen if someone else’s breast milk is given to another child?

HIV and other serious infectious diseases can be transmitted through breast milk. However, the risk of infection from a single bottle of breast milk, even if the mother is HIV positive, is extremely small. For women who do not have HIV or other serious infectious diseases, there is little risk to the child who receives her breast milk.

Should mothers who smoke breastfeed?

Mothers who smoke are encouraged to quit, however, breast milk remains the ideal food for a baby even if the mother smokes. Although nicotine may be present in breast milk, adverse effects on the infant during breastfeeding have not been reported. American Academy of Pediatrics recognizes pregnancy and lactation as two ideal times to promote smoking cessation, but does not indicate that mothers who smoke should not breastfeed.

When should a baby start eating solid foods such as cereals, vegetables, and fruits?

Breast milk alone is sufficient to support optimal growth and development for approximately the first 6 months after birth. For these very young infants, the American Academy of Pediatrics ¹⁾ states that water, juice, and other foods are generally unnecessary. Even when babies enjoy discovering new tastes and textures, solid foods should not replace breastfeeding, but merely complement breast milk as the infant’s main source of nutrients throughout the first year. Beyond one year, as the variety and volume of solid foods gradually increase, breast milk remains an ideal addition to the child’s diet.

How to stop breastfeeding?

You can breastfeed your baby for as long as you want. When you stop breastfeeding, it’s called weaning your baby. Some babies begin weaning on their own between 6 and 12 months as they start eating solid food and become more active. Weaning is a slow process that doesn’t happen in a few days. Taking your time can make weaning easier for you and your baby.

If you wean your baby off breast milk before she’s 12 months old, feed her formula. She can stay on formula until she’s ready to drink regular milk after she turns 1.

Does your baby need vitamin supplements if you breastfeed?

Yes. A supplement is a product you take to make up for certain nutrients that you don’t get enough of in the foods you eat.

Breast milk doesn’t have enough vitamin D for your baby. Vitamin D helps make bones and teeth strong and helps prevent a bone disease called rickets. Give your baby vitamin D drops starting in the first few days of life. Talk to your baby’s provider about vitamin D drops for your baby.

If you’re a vegan or if you’ve had gastric bypass surgery, you need extra vitamin B12. A vegan is someone who doesn’t eat meat or anything made with animal products, like eggs or milk. Gastric bypass is surgery on the stomach and intestines to help a person lose weight. Ask your provider about taking a vitamin B12 supplement to make sure you and your baby get the right amount.

How does breastfeeding help in an emergency?

During an emergency, such as a natural disaster, breastfeeding can save your baby’s life:

• Breastfeeding protects your baby from the risks of an unclean water supply.
• Breastfeeding can help protect your baby against respiratory illnesses and diarrhea.
• Your breast milk is always at the right temperature for your baby. It helps to keep your baby’s body temperature from dropping too low.
• Your breast milk is always available without needing other supplies.

Do you need special clothes to breastfeed?

No, but nursing bras have flaps that make breastfeeding easier than if you’re wearing your regular bra. You may want to get one or two while you’re pregnant so you have them when your baby is born. Get a nursing bra that is one size larger than your regular bra size so it will fit when your breasts get larger when your breast milk comes in.

You may find it easier to breastfeed in shirts that pull up, rather than shirts that button. Sometimes it’s hard to get buttons undone quickly when you’ve got a hungry baby wanting to eat.

How to hold baby when breastfeeding

Before you breastfeed your baby, have a drink beside you – something thirst quenching like a big glass of water. There are a few different breastfeeding positions you can try, 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.

The following are 3 of the most popular breastfeeding positions:

1. Cradle hold
2. Lying on your side
3. Clutch or “football” hold

Figure 1. Breastfeeding positions

Cradle hold

This is the probably the most popular breastfeeding position. However, if you’ve had a caesarean, this may be uncomfortable as your baby lies across your tummy near the scar (try lying on your side or the rugby hold instead). For the cradle hold, sit in a comfy chair with arm rests, or a bed with cushions or pillows around you.

Positioning:

1. Lie your baby across your lap, facing you.
2. Place your baby’s head on your forearm – nose towards your nipple. Your hand should support the length of their body.
3. Place your baby’s lower arm under yours.
4. Check to make sure your baby’s ear, shoulder and hip are in a straight line.

If you’re sitting on a chair, rest your feet on a stool or small table – this will stop you from leaning forward which can make your back ache.

Figure 2. Cradle hold

Lying on your side

This is a good position if you’ve had a caesarean or difficult delivery, or if you’re breastfeeding in the middle of the night.

Positioning:

1. Start by getting comfy lying on your side. Your baby lies facing you, so you are tummy to tummy. Check to make sure your baby’s ear, shoulder and hip are in a straight line – not twisted.
2. Put some cushions or pillows behind you for support. A rolled up baby blanket placed behind your baby will help support them. If you’ve got a pillow under your head, make sure it’s not too close to your baby’s head or face.
3. Tuck the arm you’re lying on under your head or pillow (ensuring your baby’s position isn’t altered by the pillow) and use your free arm to support and guide your baby’s head to your breast.

Figure 3. Lying on your side

Football hold (Clutch)

The football hold is a good position for twins as you can feed them at the same time, as well as caesarean babies as there’s no pressure on the tummy and scar area.

Positioning

1. Sit in a chair with a cushion or pillow along your side.
2. Position your baby at your side (the side you want to feed from), under your arm, with their hips close to your hips.
3. Your baby’s nose should be level with your nipple.
4. Support your baby’s neck with the palm of your hand.
5. Gently guide your baby to your nipple.

Figure 4. Football hold

Checking your position

Both you and your baby need to be comfortable. Although it takes practice to get a good latch, you should never have to work hard to stay in the right position while your baby is breastfeeding. You can only know which nursing hold works best for you and your baby through trial and error. But whatever the position, you should be relaxed with your baby snuggled close, belly-to-belly with you, so your baby doesn’t have to turn his or her head to the side.

Not sure if your baby is positioned right?

Here are two easy tricks:

1. Look for your baby’s belly button. If you can see the belly button while your baby’s latched, the baby’s not comfortable enough to latch well. Scoot your baby’s body inward a little so that the belly button is facing toward you.
2. Look around. If you can chat and use your hands without concentrating on holding your position, that’s a good position for a latch.

Burping your baby

Burping your baby also known as winding, is an important part of feeding. Newborns might have wind if they swallow air when crying or feeding. When your baby swallows, air bubbles can become trapped in their tummy and cause a lot of discomfort. Some babies find it easy to burp, while others need a helping hand. Some babies might be unsettled during and after a feed until they’ve been burped. Burping your baby part way through a feed might help. Use the position that works best for your baby.

There are no rules on when you should burp your baby, some babies need burping during their feed, some after. Look for clues – if your baby seems uncomfortable while feeding, have a little burping break. If they seem fine while feeding, wait until they’ve finished. Your baby will let you know.

To burp a baby support your baby’s head and neck, make sure their tummy and back is nice and straight (not curled up), and repeated gentle patting on your baby’s back should do the trick. Cup your hand while patting — this is gentler on the baby than a flat palm. To prevent messy cleanups when your baby spits up or has a “wet burp,” you might want to place a towel or bib under your baby’s chin or on your shoulder.

You don’t need to spend ages burping your baby, a couple of minutes should be enough.

There are a few ways to burp your baby. Try them all out and see which works best or use a combination.

Try different positions for burping that are comfortable for you and your baby. Many parents use one of these three methods:

1. Sit upright and hold your baby against your chest. Your baby’s chin should rest on your shoulder as you support the baby with one hand. With the other hand, gently pat your baby’s back. Sitting in a rocking chair and gently rocking with your baby while you do this may also help.
2. Hold your baby sitting up, in your lap or across your knee. Support your baby’s chest and head with one hand by cradling your baby’s chin in the palm of your hand. Rest the heel of your hand on your baby’s chest, but be careful to grip your baby’s chin, not the throat. Use the other hand to pat your baby’s back.
3. Lay your baby on your lap on his or her belly. Support your baby’s head and make sure it’s higher than his or her chest. Gently pat your baby’s back.

If your baby seems fussy while feeding, stop the session, burp your baby, and then begin feeding again. Try burping your baby every 2 to 3 ounces (60 to 90 milliliters) if you bottle-feed and each time you switch breasts if you breastfeed.

Try burping your baby every ounce during bottle-feeding or every 5 minutes during breastfeeding if your baby:

• tends to be gassy
• spits a lot
• has gastroesophageal reflux disease (GERD)
• seems fussy during feeding

If your baby doesn’t burp after a few minutes, change the baby’s position and try burping for another few minutes before feeding again. Always burp your baby when feeding time is over.

To help prevent the milk from coming back up, keep your baby upright after feeding for 10 to 15 minutes, or longer if your baby spits up or has GERD. But don’t worry if your baby spits sometimes. It’s probably more unpleasant for you than it is for your baby.

Sometimes your baby may awaken because of gas. Picking your little one up to burp might put him or her back to sleep. As your baby gets older, don’t worry if your child doesn’t burp during or after every feeding. Usually, it means that your baby has learned to eat without swallowing excess air.

Babies with colic (3 or more hours a day of continued crying) might have gas from swallowing too much air during crying spells, which can make the baby even more uncomfortable. Using anti-gas drops has not proven to be an effective way to treat colic or gas, and some of these medicines can be dangerous.

If your newborn is often unsettled after feeding and burping, or you’re worried for any other reason, see your doctor.

How long to burp a baby?

You don’t need to spend ages burping your baby, a couple of minutes should be enough.

Over your shoulder

Put a cloth over your shoulder. Put baby over your shoulder and support baby with your hand on the same side. With your baby’s chin resting on your shoulder, support the head and shoulder area with one hand, and gently rub and pat your baby’s back. It might help to walk around as you are doing this.

Your baby might vomit up some milk during burping. This is normal.

After burping, your baby will give you baby cues about what to do next. If baby is comfortable, it might be time for play and activities with you.

If your baby is still upset after being burped, the problem might be something other than wind. Is your baby still hungry? Does baby have a dirty nappy? Is baby unwell?

Figure 5. Over your shoulder to burp a baby

Sitting on your lap

Sit your baby upright on your lap facing away from you. Place the palm of your hand flat against their chest and support their chin and jaw (don’t put any pressure on the throat area). Lean your baby forwards slightly with baby’s tummy against your hand and with your free hand, gently rub or pat your baby’s back. The pressure of your hand on baby’s tummy might bring up wind.

Your baby may bring some milk up while burping, so have a burp cloth or muslin square ready (this is perfectly normal and nothing to worry about).

After burping, your baby will give you baby cues about what to do next. If baby is comfortable, it might be time for play and activities with you.

If your baby is still upset after being burped, the problem might be something other than wind. Is your baby still hungry? Does baby have a dirty nappy? Is baby unwell?

Figure 6. Sitting on your lap to burp a baby

Lying across your lap

Lie your baby across your lap or your forearm face down so baby is looking sideways and is supported by your knee or hand. Supporting their chin (don’t put any pressure on the throat area), use your free hand to gently rub or pat your baby’s back with your other hand.

Your baby may bring some milk up while burping, so have a burp cloth or muslin square ready (this is perfectly normal and nothing to worry about).

After burping, your baby will give you baby cues about what to do next. If baby is comfortable, it might be time for play and activities with you.

If your baby is still upset after being burped, the problem might be something other than wind. Is your baby still hungry? Does baby have a dirty nappy? Is baby unwell?

Figure 7. Lying across your lap to burp a baby

What if my baby won’t burp?

If these methods don’t work and your baby shows signs of trapped wind (crying, arched back, drawing legs into tummy, clenched fists), try lying them on their back and gently massaging their tummy. Also move your baby’s legs back and forth – like they’re riding a bicycle. If this doesn’t work, talk to your health care provider, they’ll be able to advise you on the best thing to do.

Breastfeeding benefits

Why breastfeeding is good for your baby

• Breast milk has hormones and the right amount of protein, sugar, fat and most vitamins to help your baby grow and develop. Breast milk has antibodies that help protect your baby from many illnesses. Antibodies are cells in the body that fight off infection. Breastfed babies have fewer health problems than babies who aren’t breastfed. Breastfed babies don’t have as many ear, lung or urinary tract infections. And they’re less likely to have asthma, certain cancers and diabetes (having too much sugar in your blood) later in life. They’re also less likely to be overweight.
• Breast milk has fatty acids, like DHA (docosahexaenoic acid), that may help your baby’s brain and eyes develop. It may lower the chances of sudden infant death syndrome (SIDS). SIDS is the unexplained death of a baby younger than 1 year old.
• Breast milk is easy to digest. A breastfed baby may have less gas and belly pain than a baby who is fed formula. Formula is a man-made product that you buy and feed your baby.
• Breast milk changes as your baby grows so he gets exactly what he needs at the right time. For example, for the first few days after giving birth, your breasts make a thick, yellowish form of breast milk called colostrum. Colostrum has nutrients and antibodies that your baby needs in the first few days of life. It changes to breast milk in 3 to 4 days. Breast milk is always ready when your baby wants to eat. The more you breastfeed, the more milk you make. Most breastfeeding moms make as much breast milk as their babies need.

In the United States, most new moms (about 4 in 5 or 80 percent) breastfeed their babies. About half of these moms breastfeed their babies for at least 6 months.

Breastfeeding benefits for infants

Infants who are breastfed have reduced risks of ²⁾:

• Asthma
• Obesity (during childhood)
• Type 2 diabetes
• Ear and respiratory infections
• Sudden infant death syndrome (SIDS)
• Leukemia (during childhood)
• Ear infections
• Eczema (atopic dermatitis)
• Diarrhea and vomiting
• Lower respiratory infections
• Necrotizing enterocolitis, a disease that affects the gastrointestinal tract in premature babies, or babies born before 37 weeks of pregnancy

Your breastmilk helps your baby grow healthy and strong from day one.

Your first milk is liquid gold. Called liquid gold for its deep yellow color, colostrum is the thick first milk that you make during pregnancy and just after birth. This milk is very rich in nutrients and includes antibodies to protect your baby from infections.

1. Colostrum also helps your newborn’s digestive system to grow and function. Your baby gets only a small amount of colostrum at each feeding, because the stomach of a newborn infant is tiny and can hold only a small amount. (Read How do I know if my baby is getting enough breastmilk? to see just how small your newborn’s tummy is!)
2. Your milk changes as your baby grows. Colostrum changes into mature milk by the third to fifth day after birth. This mature milk has just the right amount of fat, sugar, water, and protein to help your baby continue to grow. It looks thinner than colostrum, but it has the nutrients and antibodies your baby needs for healthy growth.

Breastfeeding benefits for mothers

Breastfeeding helps a mother’s health and healing following childbirth. Breastfeeding leads to a lower risk of these health problems in mothers ³⁾:

• Heart disease
• Type 2 diabetes
• Ovarian cancer
• Breast cancer

According to a report by the Centers for Disease Control and Prevention ⁴⁾, the proportion of mothers who breastfed their infants rose from 70.3 percent to 83 percent between 2004 and 2014. Babies are also breastfeeding for longer; 55% of U.S. babies born in 2014 were being breastfed at 6 months, up from 42% in 2004. Despite these overall increases, racial disparities between black and white infants persist ⁵⁾.

A recent Centers for Disease Control and Prevention study, published in the Morbidity and Mortality Weekly Report ⁶⁾, describes how breastfeeding rates continue to differ between African American and white infants within states.

• Among infants born during 2010–2013, 64.3% of African American infants started breastfeeding, compared to 81.5% of non-Hispanic white infants, a gap of 17.2 percentage points.
• Most of the 34 states included in the study reported lower rates of breastfeeding initiation rates among African American infants than among non-Hispanic white infants. Among low-income mothers (participants in the Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]), the breastfeeding initiation rate was 67.5%, but in those with a higher income ineligible for Women, Infants, and Children, it was 84.6% ⁷⁾. Breastfeeding initiation rate was 37% for low-income African American mothers ⁸⁾. Similar disparities are age-related; mothers younger than 20 years initiated breastfeeding at a rate of 59.7% compared with the rate of 79.3% in mothers older than 30 years. The lowest rates of initiation were seen among African American mothers younger than 20 years, in whom the breastfeeding initiation rate was 30%
• ⁹⁾.
• In 14 states (primarily in the South and Midwest) the percentage of African American infants who ever breastfed was at least 15 percentage points lower than among non-Hispanic white infants.
• African American infants also had significantly lower rates than non-Hispanic white infants of exclusive breastfeeding at 6 months and breastfeeding for 12 months.

Many factors influence a woman’s decision to start and continue breastfeeding. Some barriers disproportionately affect African American women, such as:

• Returning earlier to work.
• Not receiving enough information about breastfeeding from providers.
• Lack of access to professional breastfeeding support.

Swaddling baby

Swaddling is a technique of wrapping a blanket snuggly around your baby’s body in order to resemble the mother’s womb and help soothe a newborn baby. Research shows that swaddling, a technique that mimics the coziness of the womb — can keep your baby warm and secure, as well as possibly calm a baby with colic. New parents often learn how to swaddle their infant from the nurses in the hospital. Some experts feel that swaddling in the early weeks can help newborns sleep more comfortably on their backs. This can help minimize the startle reflex and ease colic symptoms in some babies. If you choose to swaddle, take time to learn how to swaddle properly before you leave the hospital. When swaddling isn’t done properly, however, it can pose risks for your baby. Take care not to swaddle too loosely, as the blanket can come loose and accidently suffocate your baby. Take care not to swaddle too tightly as this can compress your baby’s chest and make it difficult to breathe. Tight swaddling can also cause problems with your baby’s hips and legs. Once your baby starts to wiggle around during sleep, it is probably time to stop swaddling.

Is swaddling safe?

The American Academy of Pediatrics says that when done correctly, swaddling can be an effective technique to help calm infants and promote sleep ¹⁾. It is fine to swaddle your baby. However, make sure that the baby is always on his or her back when swaddled. The swaddle should not be too tight or make it hard for the baby to breathe or move his or her hips. When your baby looks like he or she is trying to roll over, you should stop swaddling.

The 2 most important things to remember about safe sleep practices:

1. Healthy babies are safest when sleeping on their backs at nighttime and during naps. Side sleeping is not as safe as back sleeping and is not advised.
2. Tummy time is for babies who are awake and being watched. Your baby needs this to develop strong muscles.

If you plan to swaddle your infant at home, you need to follow a few guidelines. To reduce the risk of Sudden Infant Death Syndrome (SIDS), it’s important to place your baby to sleep on his back, every time you put him to sleep. This may be even more important if your baby is swaddled. Some studies have shown an increased risk of SIDS and accidental suffocation when babies are swaddled if they are placed on their stomach to sleep, or if they roll onto their stomach.

American Academy of Pediatrics Safe Sleep Recommendations

The American Academy of Pediatrics recommends parents follow the safe sleep recommendations every time they place their baby to sleep for naps or at nighttime:

• Place your baby on her back to sleep, and monitor her to be sure she doesn’t roll over while swaddled.
• Do not have any loose blankets in your baby’s crib. A loose blanket, including a swaddling blanket that comes unwrapped, could cover your baby’s face and increase the risk of suffocation.
• Use caution when buying products that claim to reduce the risk of Sudden Infant Death Syndrome (SIDS). Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS, according to the American Academy of Pediatrics.​
• Your baby is safest in her own crib or bassinet, not in your bed.
• Swaddling can increase the chance your baby will overheat, so avoid letting your baby get too hot. The baby could be too hot if you notice sweating, damp hair, flushed cheeks, heat rash, and rapid breathing.
• Consider using a pacifier for naps and bedtime.
• Place the crib in an area that is always smoke-free.

How to keep your sleeping baby safe

Until their first birthday, babies should sleep on their backs for all sleep times—for naps and at night. Experts know babies who sleep on their backs are much less likely to die of Sudden Infant Death Syndrome (SIDS) than babies who sleep on their stomachs or sides. The problem with the side position is that the baby can roll more easily onto the stomach. Some parents worry that babies will choke when on their backs, but the baby’s airway anatomy and the gag reflex will keep that from happening. Even babies with gastroesophageal reflux (GERD) should sleep on their backs.

Newborns should be placed skin-to-skin with their mother as soon after birth as possible, at least for the first hour. After that, or when the mother needs to sleep or cannot do skin-to-skin, babies should be placed on their backs in the bassinet. While premature babies may need to be on their stomachs temporarily while in the NICU due to breathing problems, they should be placed on their backs after the problems resolve, so that they can get used to being on their backs and before going home.

Some babies will roll onto their stomachs. You should always place your baby to sleep on the back, but if your baby is comfortable rolling both ways (back to tummy, tummy to back), then you do not have to return your baby to the back. However, be sure that there are no blankets, pillows, stuffed toys, or bumper pads around your baby, so that your baby does not roll into any of those items, which could cause blockage of air flow.

If your baby falls asleep in a car seat, stroller, swing, infant carrier, or sling, you should move him or her to a firm sleep surface on his or her back as soon as possible.

Use a firm sleep surface. A crib, bassinet, portable crib, or play yard that meets the safety standards of the Consumer Product Safety Commission (CPSC) is recommended along with a tight-fitting, firm mattress and fitted sheet designed for that particular product. Nothing else should be in the crib except for the baby. A firm surface is a hard surface; it should not indent when the baby is lying on it. Bedside sleepers that meet Consumer Product Safety Commission safety standards may be an option, but there are no published studies that have examined the safety of these products. In addition, some crib mattresses and sleep surfaces are advertised to reduce the risk of SIDS. There is no evidence that this is true, but parents can use these products if they meet Consumer Product Safety Commission safety standards.

Room share—keep baby’s sleep area in the same room where you sleep for the first 6 months or, ideally, for the first year. Place your baby’s crib, bassinet, portable crib, or play yard in your bedroom, close to your bed. The American Academy of Pediatrics recommends room sharing because it can decrease the risk of SIDS by as much as 50% and is much safer than bed sharing. In addition, room sharing will make it easier for you to feed, comfort, and watch your baby.

Only bring your baby into your bed to feed or comfort. Place your baby back in his or her own sleep space when you are ready to go to sleep. If there is any possibility that you might fall asleep, make sure there are no pillows, sheets, blankets, or any other items that could cover your baby’s face, head, and neck, or overheat your baby. As soon as you wake up, be sure to move the baby to his or her own bed.

Never place your baby to sleep on a couch, sofa, or armchair. This is an extremely dangerous place for your baby to sleep.

Bed-sharing is not recommended for any babies. However, certain situations make bed-sharing even more dangerous. Therefore, you should not bed share with your baby if:

• Your baby is younger than 4 months old.
• Your baby was born prematurely or with low birth weight.
• You or any other person in the bed is a smoker (even if you do not smoke in bed).
• The mother of the baby smoked during pregnancy.
• You have taken any medicines or drugs that might make it harder for you to wake up.
• You drank any alcohol.
• You are not the baby’s parent.
• The surface is soft, such as a waterbed, old mattress, sofa, couch, or armchair.
• There is soft bedding like pillows or blankets on the bed.

Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the baby’s sleep area. These include pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides. If you are worried about your baby getting cold, you can use infant sleep clothing, such as a wearable blanket. In general, your baby should be dressed with only one layer more than you are wearing.

Try giving a pacifier at nap time and bedtime. This helps reduce the risk of SIDS, even if it falls out after the baby is asleep. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes 2-3 weeks. If you are not breastfeeding your baby, you can start the pacifier whenever you like. It’s OK if your baby doesn’t want a pacifier. You can try offering again later, but some babies simply don’t like them. If the pacifier falls out after your baby falls asleep, you don’t have to put it back in.

Recommendations for prenatal and postnatal

• Do not smoke during pregnancy or after your baby is born. Keep your baby away from smokers and places where people smoke. If you are a smoker or you smoked during pregnancy, it is very important that you do not bed share with your baby. Also, keep your car and home smoke-free. Don’t smoke anywhere near your baby, even if you are outside.
• Do not use alcohol or illicit drugs during pregnancy or after the baby is born. It is very important not to bed share with your baby if you have been drinking alcohol or taken any medicines or illicit drugs that can make it harder for you to wake up.
• Breastfed babies have a lower risk of SIDS. Breastfeed or feed your baby expressed breast milk. The AAP recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. Even after you add solid foods to your baby’s diet, continue breastfeeding for at least 12 months, or longer if you and your baby desire.
• Schedule and go to all well-child visits. Your baby will receive important immunizations at these doctor visits. Recent evidence suggests that immunizations may have a protective effect against SIDS.
• Make sure your baby has tummy time every day. Awake tummy time should be supervised by an awake adult. This helps with baby’s motor development and prevents flat head syndrome.
  • There are ways to reduce the risk of the baby developing a flat spot:
    • Alternate which end of the crib you place the baby’s feet. This will cause her to naturally turn toward light or objects in different positions, which will lessen the pressure on one particular spot on her head.
    • When the baby is awake, vary her position. Limit time spent in freestanding swings, bouncy chairs, and car seats. These items all put added pressure on the back of the baby’s head.
    • Spend time holding the baby in your arms as well as watching her play on the floor, both on her tummy and on her back.
    • A breastfed baby would normally change breasts during feeding; if the baby is bottle fed, switch the side that she feeds on during feeding.

Use caution when buying products

Use caution when a product claims to reduce the risk of SIDS. Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS, according to the American Academy of Pediatrics.

Do not rely on home heart or breathing monitors to reduce the risk of SIDS. If you have questions about using these monitors for other health conditions, talk with your pediatrician.

There isn’t enough research on bedside or in-bed sleepers. The AAP can’t recommend for or against these products because there have been no studies that have looked at their effect on SIDS or if they increase the risk of injury and death from suffocation.

How to swaddle a baby

To safely swaddle your baby, follow these tips.

How to swaddle correctly:

1. To swaddle, spread the blanket out flat, with one corner folded down.
2. Lay the baby face-up on the blanket, with her head above the folded corner.
3. Straighten her left arm, and wrap the left corner of the blanket over her body and tuck it between her right arm and the right side of her body.
4. Then tuck the right arm down, and fold the right corner of the blanket over her body and under her left side.
5. Fold or twist the bottom of the blanket loosely and tuck it under one side of the baby.
6. Make sure her hips can move and that the blanket is not too tight. You want to be able to get at least two or three fingers between the baby’s chest and the swaddle.

Keep baby’s hips loose

Babies who are swaddled too tightly may develop a problem with their hips. Studies have found that straightening and tightly wrapping a baby’s legs can lead to hip dislocation or hip dysplasia, an abnormal formation of the hip joint where the top of the thigh bone is not held firmly in the socket of the hip.

Getting started

To place your baby in a swaddle, spread out a blanket and slightly fold over one corner. Lay your baby face-up on the blanket, placing his or her head at the edge of the folded corner. While holding your baby in place, pick up one corner of the blanket. Bring the blanket across your baby’s body. Tuck the blanket beneath him or her.

Figure 1. Swaddling – getting started

Covering baby’s feet

Fold the bottom point of the blanket up over the baby’s feet.

Figure 2. Swaddling – covering baby’s feet

Completing the swaddle

While holding your baby in place, pick up the other corner of the blanket and wrap it across your baby’s body. The swaddle will leave only your baby’s head and neck exposed.

Don’t rigidly extend your baby’s legs or make the swaddle too tight. Swaddling a baby in a way that prevents his or her hips or knees from being able to move freely within the blanket can lead to developmental dysplasia of the hip — a condition in which the hip joint has not formed normally and might be easy to dislocate.

Figure 3. Swaddling – completing the swaddle

Keeping a swaddled baby safe

Once you’ve swaddled your baby, be sure to practice safe sleep habits. Always place a swaddled baby on his or her back to sleep. Stop swaddling when your baby learns to roll onto his or her stomach.

If you have questions about how to safely swaddle your baby, consult your baby’s doctor.

Figure 4. Swaddling – keeping a swaddled baby safe

When to stop swaddling a baby?

Experts recommend parents stop swaddling by age 2 months, before the baby intentionally starts to try to roll. By about three months old swaddling should have been phased out because the babies are more active and rolling If babies are swaddled, they should be placed only on their back and monitored so they don’t accidentally roll over.

Parents should know that there are some risks to swaddling. Swaddling may decrease a baby’s arousal, so that it’s harder for the baby to wake up. That is why parents like swaddling – the baby sleeps longer and doesn’t wake up as easily. But experts know that decreased arousal can be a problem and may be one of the main reasons that babies die of SIDS.

When do babies start walking?

Babies usually start walking sometime between 8 and 18 months old. Before walking, babies will usually have been crawling (between 6 and 13 months) and pulling themselves up to stand (usually between ages 9 and 12 months).

All babies develop according to the same sequence of events. For example, all babies learn to sit before they learn to walk. However, some children reach developmental milestones such as sitting and walking early, and others later.

Babies generally develop from the top down. The first thing to develop is head control and strengthening of the neck muscles. Later, hand coordination develops, which allows a baby to pull themselves forward before learning how to crawl. Once a baby has better control of their lower body, they can use their hands and knees to crawl. All of this happens in preparation for learning to walk.

A baby develops as their central nervous system matures. Along the way, many of the primitive reflexes they had as a baby, such as the grasp and walking reflexes, are lost. These primitive reflexes need to disappear in order for a baby to learn to move themselves voluntarily. The walking reflex, for example, disappears by the end of the first month of life. The grasp reflex starts to disappear at two to three months of age. Also, while a young baby wildly moves their arms and legs in every direction, an older baby learns to make specific responses.

How walking develops

To walk, your baby needs to have many skills, including balance, coordination, standing up and being able to support their body weight from one leg to the other.

Each new skill your baby develops builds on the previous skills your baby has learnt.

As your baby gets older, the skills they learn get more and more complex.

While your baby was busy crawling and pulling up to stand, then cruising between pieces of furniture, they were building valuable muscle strength and skills like balance and coordination, which are all needed for walking and, later, running.

Other areas of development

While walking is an exciting milestone, it’s important to remember that there’s a lot happening for your baby around this time. Your baby is also developing new communication and thinking skills (for example, first words) and learning to handle new emotions such as coping with separating from you and dealing with strangers. And once your baby is up and walking, they have a whole new view of their world and the people in it to take in and try to make sense of.

What you can do

Here are some things you can do to help your baby with walking include:

• Play together — being with or near your child when they explore helps them feel safe and builds their confidence.
• Encourage moving — being active and moving around builds your child’s muscle strength and posture, which helps your child get better at walking and prepares them for running.
• Make your home safe — as your baby starts to move around the house more, keeping the area around them clear ensures there are no accidents and creates lots of opportunities to walk and explore.
• Avoid baby walkers — these do not help your baby learn to walk and can actually delay development of walking skills. They also cause thousands of injuries every year in the US.

Children in baby walkers can:

• Roll down the stairs—which often causes broken bones and severe head injuries. This is how most children get hurt in baby walkers.
• Get burned—a child can reach higher in a walker. It is now easier for a child to pull a tablecloth off a table and spill hot coffee, grab pot handles off the stove, and reach radiators, fireplaces, or space heaters.
• Drown—a child can fall into a pool or bathtub while in a walker.
• Be poisoned—reaching high objects is easier in a walker.

Most walker injuries happen while adults are watching. Parents or caregivers simply cannot respond quickly enough. A child in a walker can move more than 3 feet in 1 second! That is why walkers are never safe to use, even with an adult close by.

Baby growth spurt

When your baby was born, her birth weight included excess body fluid, which she lost during her first few days. Most babies lose about one-tenth of their birth weight during the first five days, then regain it over the next five, so that by about day ten they usually are back to their original birth weight. Most babies grow very rapidly after regaining their birth weight, especially during growth spurts, which occur around seven to ten days and again between three and six weeks. The average newborn gains weight at a rate of 2⁄3 of an ounce (20–30 grams) per day and by one month weighs about ten pounds (4.5 kg). She grows between 1 1⁄2 and 2 inches (4.5 to 5 cm) during this month. Boys tend to weigh slightly more than girls (by less than 1 pound, or approximately 350 grams). They also tend to be slightly longer than girls at this age (by about 1⁄2 inch, or 1.25 cm).

Most healthy, full-term newborn babies double their birth weight by four months and triple it by their first birthday. Keep in mind, though, that all babies grow at their own pace (see Growth Charts in figures 1 to 4). A small or large baby may be perfectly healthy. Also, babies have growth spurts and fluctuations in their rate of weight gain.

The first year of life is a time of amazing change during which babies, on average, grow 10 inches (25 centimeters) in length and triple their birth weights. On average, babies between 3 and 6 months grow in length and weight at a steady but slightly slower rate compared with the first 2 months of life. Sometimes, it may seem like your baby is outgrowing clothes every other day and you can’t keep up. Don’t worry. Rapid growth will start to slow down in the second half of the first year (see Growth Charts in figures 1 to 4).

Given all the growth that happens then, new parents might be surprised when their child doesn’t continue to grow so fast after the first year. But no child continues the rate of growth of infancy. After age 1, a baby’s growth in length slows quite a bit. By age 2, growth in height usually continues at a fairly steady rate of about 2½ inches (6 centimeters) per year until adolescence.

No child grows at a perfectly steady rate throughout this period of childhood, though. Weeks or months of slightly slower growth alternate with mini “growth spurts” in most children. Kids actually tend to grow a bit faster in the spring than during other times of the year.

A major growth spurt happens at the time of puberty, usually between 8 to 13 years of age in girls and 10 to 15 years in boys. Puberty lasts about 2 to 5 years. This growth spurt is associated with sexual development, which includes the appearance of pubic and underarm hair, the growth and development of sex organs, and in girls, the start of menstruation.

By the time girls reach age 15 and boys reach age 16 or 17, the growth of puberty has ended for most and they will have reached physical maturity.

If your baby is not growing at the expected rate, or the growth rate slows, your doctor will want to make sure your baby is getting enough to eat.

Your doctor may ask you about:

• How many feedings a day your baby gets. At 2 months old, a breastfed baby may feed about 8 times in a 24-hour period; formula-fed babies usually eat less frequently, about every 4 hours. Now that babies are drinking more at a time they will feed less often and sleep longer at night.
• How much your baby eats at each feeding. A baby generally nurses for at least 10 minutes, should be heard to swallow, and should seem satisfied when done. Bottle-fed babies eat about 5 to 6 ounces (148–177 milliliters) — some more and some less — at each feeding. Breastfeeding mothers may benefit from seeing a lactation consultant to increase comfort and improve technique.
• How many bowel movements your baby has each day, and their volume and consistency. Most babies will have 1 or more bowel movements daily, but it may be normal to skip 1 or 2 days if consistency is normal. Breastfed babies’ stools tend to be soft and slightly runny. The stools of formula-fed babies tend to be a little firmer, but should not be hard or formed.

Most of the time, a baby’s growth will simply be tracked over the next few months during routine well-baby visits. But if your doctor is concerned about your baby’s growth, he or she will want to see your baby more often.

What parents can do to ensure your child grows and develops normally:

You can do a few things to help ensure that your child grows and develops normally. Critical to kids’ overall health and wellness are:

• Enough rest: Sleep patterns vary by age and individual child. But most kids need an average of 10 to 12 hours of sleep per night. Sleep gives growing bodies the rest they need to grow well.
• Good nutrition: A balanced diet full of essential vitamins and minerals will help kids reach their full growth potential.
• Regular exercise: Because obesity is a problem for many kids, parents should make sure that their kids exercise regularly. Bicycling, hiking, in-line skating, sports, or any enjoyable activity that will motivate kids to get moving will promote good health and fitness and help them maintain a healthy weight.

Figure 1. Girls growth chart birth to 2 years length for age and weight for age percentiles

Figure 2. Girls growth charts from birth to 24 months for head circumference for age and weight for length percentiles

Figure 3. Boys growth chart birth to 2 years length for age and weight for age percentiles

Figure 4. Boys growth charts from birth to 24 months for head circumference for age and weight for length percentiles

What is growth?

Physical growth refers to the increases in height and weight and other body changes that happen as kids mature. Hair grows; teeth come in, come out, and come in again; and eventually puberty hits. It’s all part of the growth process.

What are growth problems?

A child’s growth and development can be influenced by:

• genetics
• eating habits and nutrition
• sleeping patterns
• endocrine function (hormones)
• presence or absence of chronic illness

Each child grows at a different pace. Try not to compare your child’s growth with children of the same age. Every parent needs to regularly monitor their child’s growth. This can be done with the help of growth charts and the child’s doctor.

If a child’s growth is not monitored closely, growth disorders may be missed. A growth disorder prevents the child from reaching the optimum height and weight. It can influence other aspects of the child’s mental, physical, or emotional development.

Types of growth disorders

Failure to thrive

Failure to thrive is not a growth disorder. It is a label given to children whose weight or rate of weight gain is significantly lower than other children of the same age and gender.

Failure to thrive can be caused by many factors:

• feeding problems
• illness, poverty
• malnutrition
• poor interaction between parent and child

Regardless of its cause, all children who are failing to thrive are at risk for slow or stalled growth.

Short stature

Short stature is also a descriptive label. It is not a growth disorder. It refers to children whose height or rate of height gain is lower than other children of the same age and gender.

Short stature can have some of the same causes as failure to thrive. More commonly, it is associated with genetics and not disease. Some children grow more slowly but stop growing at a later age and so they reach normal heights. Other children simply inherit a parent’s final height.

Children with short stature may not eat as much as you would like because they do not need to until they have a growth spurt. Pressuring children to eat more may make them gain weight but not height.

Endocrine diseases

The endocrine system is the body’s chemical messenger system. It transports hormones throughout the body. The hormones help regulate processes in the body, including growth. When there is a disorder with the endocrine system, growth can be stunted.

Endocrine disorders include:

• Growth hormone deficiency: This rare disease happens when a child has little or no growth hormone. Growth hormone is made by the pituitary gland. Growth hormone stimulates growth through chemical interactions in the body. Without it, or without enough of it, growth is slowed or stunted completely.
• Hypothyroidism: This is a condition caused by low levels of thyroid hormone in the blood. Without enough of this hormone, babies can suffer from poor brain development. Older children can have slow growth and slow metabolism.

Turner syndrome

Short stature is found in girls with Turner syndrome. Turner syndrome is when a girl is born with a missing or damaged X chromosome. Girls with Turner syndrome are not able to reproduce because their ovaries do not develop properly. They may also show other physical signs.

What are growth charts?

Kids grow at their own pace. Big, small, tall, short — there is a wide range of healthy shapes and sizes among children. Genetics, gender, nutrition, physical activity, health problems, environment, and hormones all play a role in a child’s height and weight. And many of these things can vary widely from family to family.

So how do doctors figure out whether kids’ height and weight measurements are “healthy”? Whether they’re developing on track? Whether any medical problems are affecting growth?

Doctors use growth charts to help answer those questions. Here are some facts about growth charts and what they say about a child’s health.

Why do doctors use growth charts?

Growth charts are a standard part of your child’s checkups. They show how kids are growing compared with other kids of the same age and gender. They also show the pattern of kids’ height and weight gain over time, and whether they’re growing proportionately.

Let’s say a child was growing along the same pattern until he was 2 years old, then suddenly started growing much more slowly than other kids. That might mean there is a health problem. Doctors could see that by looking at a growth chart.

Does a different growth pattern mean there’s a problem?

Not necessarily. Doctors consider the growth charts along with a child’s overall well-being, environment, and genetic background. For example:

• Is the child meeting other developmental milestones?
• Are there other signs that a child is not healthy?
• How tall or heavy are the child’s parents and siblings? Was the child born prematurely?
• Has the child started puberty earlier or later than average?

Are all kids measured on one growth chart?

No. Girls and boys are measured on different growth charts because they grow in different patterns and at different rates.

And one set of charts is used for babies, from birth to 36 months. Another set is used for kids and teens ages 2–20 years old. Also, special growth charts can be used for children with certain conditions, such as Down syndrome, or who were born early.

What measurements are put on the growth charts?

Until babies are 36 months old, doctors measure weight, length, and head circumference (distance around the largest part of the head).

With older kids, doctors measure weight, height, and body mass index (BMI). It’s important to look at and compare weight and height measurements to get a full picture of a child’s growth.

Why is head circumference measured?

Your pediatrician will pay particular attention to your child’s head growth, because it reflects the growth of her brain. The bones in your baby’s skull are still growing together, and the skull is growing faster during the first four months than at any other time in her life.

In babies, head circumference can give clues about brain development. If a baby’s head is bigger or smaller than most other kids’ or the head stops growing or grows too quickly, it may mean there is a problem.

The average newborn’s head circumference measures about 13 3⁄4 inches (35 cm), growing to about 15 inches (38 cm) by one month. Because boys tend to be slightly larger than girls, their heads are larger, though the average difference is less than 1⁄2 inch (1 cm).

For example, an unusually large head may be a sign of hydrocephalus, a buildup of fluid inside the brain. A head that’s smaller than average may be a sign that the brain is not developing properly or has stopped growing.

What are percentiles?

Percentiles are measurements that show where a child is compared with other kids. On the growth charts, the percentiles are shown as lines drawn in curved patterns.

When doctors plot a child’s weight and height on the chart, they see which percentile line those measurements land on:

• The higher the percentile number, the bigger a child is compared with other kids of the same age and gender, whether it’s for height or weight.
• The lower the percentile number, the smaller the child is.

For example, if a 4-year-old boy’s weight is in the 10th percentile, that means that 10% of boys that age weigh less than he does and 90% of boys that age weigh more.

Being in a high or a low percentile doesn’t necessarily mean that a child is healthier or has a growth or weight problem. Let’s say that the 4-year-old boy who is in the 10th percentile for weight is also in the 10th percentile for height. So 10% of kids are shorter and weigh less than he does, and most kids — 90% — are taller and weigh more. That just shows that he’s smaller than average, which usually doesn’t mean there is a problem. If his parents and siblings are also smaller than average, and there are other signs that he’s healthy and developing well, doctors would likely decide that there’s no reason to worry.

What is the ideal percentile for my child?

There is no one ideal number. Healthy children come in all shapes and sizes, and a baby who is in the 5th percentile can be just as healthy as a baby who is in the 95th percentile.

Ideally, each child will follow along the same growth pattern over time, growing in height and gaining weight at the same rate, with the height and weight in proportion to one another. This means that usually a child stays on a certain percentile line on the growth curve. So if our 4-year-old boy on the 10th percentile line has always been on that line, he is continuing to grow along his pattern, which is a good sign.

What could signal a problem?

A few different growth chart patterns might signal a health problem, such as:

• When a child’s weight or height percentile changes from a pattern it’s been following. For example: If height and weight have both been on the 60th percentile line until a child is 5 years old, and then the height drops to the 30th percentile at age 6, that might suggest a growth problem because the child is not following his or her usual growth pattern. But changing percentiles doesn’t always mean there’s a problem. Many kids may show changes in growth percentiles at some points in development, when it’s normal for growth rates to vary more from child to child. This is particularly common during infancy and puberty.
• When kids don’t get taller at the same rate at which they’re gaining weight. For example: If a boy’s height is in the 40th percentile and his weight is in the 85th percentile, this means he’s taller than 40% of kids his age, but weighs more than 85% of kids his age. That might be a problem. On the other hand, if he’s in the 85th percentile for both height and weight and follows that pattern over time, that usually means that he’s a healthy child who’s just larger than average.

If you have any questions about your child’s growth — or growth charts — talk with your doctor.

How often should I feed my baby?

It’s generally recommended that babies be fed whenever they seem hungry, which is called demand feeding (or feeding on demand). Most newborns who are formula-fed feed every 2 to 3 hours. As they get bigger and their tummies can hold more milk they usually eat every 3 to 4 hours.

And if your baby is very young, or having problems gaining weight, you shouldn’t go too long without feeding, even if it means waking your baby. In this case, talk to your doctor about how often your baby should be fed.

How do I know my baby is hungry?

Signs that babies are hungry include:

• moving their heads from side to side
• opening their mouths
• sticking out their tongues
• placing their hands, fingers, and fists to their mouths
• puckering their lips as if to suck
• nuzzling again their mothers’ breasts
• showing the rooting reflex (when a baby moves its mouth in the direction of something that’s stroking or touching its cheek)
• crying

Despite what you might think, crying is a late sign of hunger. You should give a feeding before your baby gets so hungry that he or she gets upset and becomes difficult to calm down.

It’s also important, however, to realize that every time your baby cries it is not necessarily because of hunger. Sometimes babies just need to be cuddled or changed. Or they could be overstimulated, bored, or too hot or too cold. If your baby cries only an hour after a good feeding, there may be something else causing the distress.

How much should my baby drink?

In the first few weeks, mix 2- to 3-ounce (60- to 90-milliliter) bottles for your newborn. Gradually increase this amount as you become familiar with your baby’s eating patterns and appetite. Here’s a general look at how much your baby may be eating at different stages:

• On average, a newborn drinks about 1.5-3 ounces (45-90 milliliters) every 2-3 hours. This amount increases as your baby grows and is able to take more at each feeding.
• At about 2 months, your baby may be taking 4-5 ounces (120-150 milliliters) at each feeding and the feedings may be every 3-4 hours.
• At 4 months, your baby may be taking 4-6 ounces (120-180 milliliters) at each feeding, depending on the frequency of feedings and his or her size.
• By 6 months, your baby may be taking 6-8 ounces (180-230 milliliters) every 4 to 5 hours. This also depends on whether you’ve introduced any baby food.

Why does my baby seem hungrier than usual?

As babies gain weight, they should begin to eat more at each feeding and go longer between feedings. Still, there may be times when your little one seems hungrier than usual.

Your baby may be going through a period of rapid growth (called a growth spurt). These can happen at any time, but in the early months growth spurts often occur at around:

• 7-14 days old
• between 3-6 weeks
• 4 months
• 6 months

During these times and whenever your baby seems especially hungry, follow his or her hunger cues and continue to feed on demand, increasing the amount of formula you give as needed.

Is my baby eating enough?

Babies grow at different rates, and at times you may wonder whether your baby is getting enough nutrients to develop properly. To help determine whether your baby is eating enough, follow the schedule of regular well-child checkups so that your little one can be weighed and measured.

In the meantime, your newborn’s diapers are a good indicator of whether your baby is getting enough to eat. You’ll probably be changing at least six wet and four dirty (soiled or “poopy”) diapers each day at first.

Newborns’ poop is thick and tarry in the beginning and then becomes more yellow or green as they get older. Formula-fed babies often have firmer, less seedy stools than breast-fed babies.

Wet diapers should have clear or very pale urine. If you see orange crystals in a wet diaper, contact your baby’s doctor. Crystals are usually not a cause for concern, but sometimes they can be a sign of a baby not getting enough fluid or of dehydration. Other possible signs of underfeeding include:

• not gaining enough weight
• seeming unsatisfied, even after a complete feeding

If you’re concerned or notice any signs that your baby isn’t getting enough nutrition, see your doctor.

1 month growth spurt

The first month of life is a period of rapid growth. Your baby will gain about 1 to 1½ inches (2.5 to 3.8 centimeters) in length this month and about 2 more pounds (907 grams) in weight. These are just averages — your baby may grow somewhat faster or slower. Next month, you can expect to see your baby grow 1 to 1½ inches (2.5 to 3.8 centimeters) in length and gain about 2 pounds (907 grams). At this rate, it may seem like your baby is outgrowing clothes every other day and you can’t keep up. Don’t worry. Rapid growth will slow down in the second half of the first year.

Your baby can go through periods of increased hunger and fussiness. This increase in hunger means your baby is going through a period of fast growth (a growth spurt). If you breastfeed, you might find your baby wants to eat more often (sometimes every hour!) during certain times of the day. This is often called “cluster feeding.” Formula-fed babies may want to eat more often or will drink more formula than usual during feedings.

You’ll learn to see the signs that tell you that your baby is hungry or when your baby is full. You will know your baby is hungry when she seems restless, cries a lot, sticks out her tongue or sucks on her hands and lips. You will know your baby is full when she is no longer interested in feeding or just falls asleep at the end of a feeding session. Remember, babies’ tummies are very small and they need to be burped after feedings to release gas that can cause discomfort.

Your doctor will measure your baby’s weight, length, and head circumference and track his or her growth on a standardized growth chart (there are different charts for boys and girls). Your baby might be large, small, or medium-sized. As long as this growth pattern stays consistent over time, chances are your baby’s progress is just fine.

If your baby is born prematurely, keep in mind that growth and development should not be compared with that of a full-term child. Preemies will need to be followed more closely and may need to be weighed more often during the first months to make sure they are growing properly. They have some catching up to do.

If your baby is not growing at the expected rate, or the growth rate slows, your doctor will want to make sure your baby is getting enough to eat.

Your doctor may ask you about:

• How many feedings a day your baby gets. At 1 month, a breastfed baby may feed about 8 times in a 24-hour period (roughly every 2–3 hours); bottle-fed babies usually eat less frequently, perhaps every 3 to 4 hours.
• How much your baby eats at each feeding. A baby generally nurses for at least 10 minutes, should be heard to swallow, and should seem satisfied when done. At this age, bottle-fed babies may drink up to 4 to 5 ounces (118–148 milliliters) at a time.
• How often your baby urinates. Babies should have at least 4 to 6 wet diapers a day.
• How many bowel movements your baby has each day, and their volume and consistency. Most babies will have 1 or more bowel movements daily, but it may be normal to skip 1 or 2 days if consistency is normal. Breastfed babies’ stools tend to be soft and slightly runny. The stools of formula-fed babies tend to be a little firmer, but should not be hard or formed.

Most of the time, a baby’s growth will be tracked over the next few months during routine well-baby visits. But if your doctor is concerned about your baby’s growth, he or she will want to see your baby more often.

What can your baby do?

At 1 month, most of what babies do is still caused by reflexes. They aren’t thinking about their actions. They will be sucking, swallowing, searching for milk and grasping an object if you put it in the palm of their hand (although most of the time they’ll keep their hands clenched in tight little fists). They will also step one foot in front of the other if you put their feet on a flat surface.

They will start to focus with both eyes at 1 month and should be able to follow a moving object from side to side. They will probably prefer looking at a human face to looking at an object and will gaze deeply into your eyes if you hold them about 45 cm away. Most babies can recognize their parents by this age.

One-month-old babies love the sound of your voice, but they will get startled if they hear a loud noise. They might fall backward and throw their arms and legs out, blink their eyes and breathe faster.

By the end of the first month, most babies can raise their head when you lay them on their stomach, and they will turn their head to one side. As their neck muscles get stronger, they will be able to turn their head and lift it up when they’re in a car seat or carrier.

Your baby will cry loudly when they are hungry or uncomfortable. When they are happy and content, they usually make little gurgling noises. Respond to your baby’s sounds by gurgling and cooing back.

At 1 month, some babies will be learning how to soothe themselves, with a dummy or even by sucking their fingers or thumbs. Helping your baby to suck is a good way to calm them down.

How to help your baby develop

Spend as much time with your baby as possible. Looking deep into their eyes and smiling at them will help them to bond and to feel safe and secure.

Read and sing to your baby. Even though they can’t understand, they will enjoy hearing your voice. Music helps to stimulate their senses and will keep them amused. Playing with them will also strengthen your bond.

Help your baby to develop neck strength by putting them on their tummy for 1 to 5 minutes at a time. This is called tummy time. Always keep an eye on your baby during tummy time and always put them to sleep on their back.

Development problem signs

Babies develop at a different rate. At 1 month, you will still be learning about your baby and their needs. But talk to your doctor if:

• they aren’t feeding well
• they are regularly sleeping a lot more than 16 hours a day
• they aren’t moving their arms or legs
• they aren’t following your face with their eyes or responding when they see you
• they aren’t making gurgling sounds
• they don’t startle or seem not be hearing things
• you are worried about your baby’s crying or sleeping

2 month growth spurt

Babies continue to grow quickly in weight and length this month. The first 2 months of life is a period of rapid growth. Your baby will continue to grow at a similar rate, gaining about 1 to 1½ inches (2.5 to 3.8 centimeters) in length and 2 pounds (907 grams) in weight this month. These are just averages, your baby may grow somewhat faster or slower, and is likely to have growth spurts.

Your baby can go through periods of increased hunger and fussiness. This increase in hunger means your baby is going through a period of fast growth (a growth spurt). If you breastfeed, you might find your baby wants to eat more often (sometimes every hour!) during certain times of the day. This is often called “cluster feeding.” Formula-fed babies may want to eat more often or will drink more formula than usual during feedings.

You’ll learn to see the signs that tell you that your baby is hungry or when your baby is full. You will know your baby is hungry when she seems restless, cries a lot, sticks out her tongue or sucks on her hands and lips. You will know your baby is full when she is no longer interested in feeding or just falls asleep at the end of a feeding session. Remember, babies’ tummies are very small and they need to be burped after feedings to release gas that can cause discomfort.

Your doctor will measure your baby’s weight, length, and head circumference and track his or her growth on a standardized growth chart (there are different charts for boys and girls). Your baby might be large, small, or medium-sized. As long as this growth pattern stays consistent over time, chances are your baby’s progress is just fine.

If your baby is born prematurely, keep in mind that growth and development should not be compared with that of a full-term child. Preemies will need to be followed more closely and may need to be weighed more often during the first months to make sure they are growing properly. They have some catching up to do!

What can your baby do?

By 2 months your baby will have discovered their fingers and hands. They will hold their hands open and grab an object (although they don’t know how to let go yet!) They might also clasp both hands together.

Two-month-old babies will start to learn how to coordinate their movements. Instead of the jerky arm and leg movements that made when they were born, they can move more smoothly and in more of a circular motion. They will kick both legs strongly and will be very wriggly. They may even roll over, so don’t ever leave them alone on a change table.

Their neck will be getting stronger all the time. During tummy time they might be lifting their head and moving it from side to side. Some babies can even lift their chest off the ground by now.

Some (though very few) babies can sleep through the night by the time they reach 2 months. But even if you’re not one of the lucky parents or carers, your baby will at least be sleeping for longer stretches at a time. They’ll probably be having 2 to 4 long sleeps and will be more awake and alert during the day – although babies’ sleep patterns still vary widely at this age.

Your baby’s eyes, which may have been crossed when they were younger, move together most of the time now. They will clearly recognize you, will look at you when you talk to them, and can follow you with their eyes. They will love looking at your face and will be giving you some lovely smiles. They will like looking at objects with more complex patterns and colors.

They will also be making a lot more sounds and gurgling, including sounds like ‘a’ or ‘o’, and they will seem to listen to you and talk back to you.

How to help your baby develop

As your baby develops more of a rhythm, you’ll find they are awake more during the day. This gives you more time to interact with them and help them develop. Spend plenty of time reading to them, singing, and talking. That way they’ll get used to sounds and words and will start to develop language and communication skills.

You can play with them by letting them look at and feel a variety of objects with different designs, colors, and shapes. Plastic toys and soft balls work well.

They will love looking at you, so make sure you smile at them a lot. It releases ‘feel-good’ chemicals in your baby’s body and helps them to feel safe and secure. You could also give your baby a massage to relax them. After a bath is a good time.

Continue with 1 to 5 minutes tummy time to strengthen their neck and upper body. It will help them develop the muscles they’ll need later to sit and crawl. But always put your baby to sleep on their back.

Development problem signs

Babies develop at a different rate. At 2 months, talk to your doctor if:

• they aren’t smiling by 8 weeks
• they don’t calm down, even for a little while, when you pick them up to comfort them
• one side of their body seems to be stronger than the other
• they’re still holding their fingers in a tight fist
• sudden noises don’t startle them
• they aren’t feeding properly
• they’re floppy or stiff

3 month growth spurt

Your baby will continue to grow in length and weight at a steady rate this month. By 4 months, most babies have doubled their birth weight. If your baby is not growing at the expected rate, or the growth rate slows, your doctor will want to make sure your baby is getting enough to eat.

Your doctor may ask you about:

• How many feedings a day your baby gets. At 3 months old, a breastfed baby may feed 8 times in a 24-hour day; formula-fed babies usually eat less frequently, about every 4 hours.
• How much your baby eats at each feeding. A baby generally nurses for at least 10 minutes, should be heard to swallow, and should seem satisfied when done. At this age, bottle-fed babies may eat up to 6 to 7 ounces (177–207 milliliters) at each feeding.
• How many bowel movements your baby has each day, and their volume and consistency. Most babies will have 1 or more bowel movements daily, but it may be normal to skip 1 or 2 days if consistency is normal. Breastfed babies’ stools should be soft and slightly runny. The stools of formula-fed babies tend to be a little firmer, but should not be hard or formed.

Most of the time, a baby’s growth will be tracked over the next few months during routine well-baby visits. But if your doctor is concerned about your baby’s growth, he or she will want to see your baby more often.

By 3 months, your baby will have formed a strong attachment to you. They will respond to you with lots of smiles, and might even talk back to you in their own way. The worst of the crying should be nearly over, and you can really enjoy your baby as they grow into their own little person.

What can your baby do?

By now your baby will be starting to experience emotions and communication. They will respond to different expressions, know your voice and will turn to look for you when they hear you. They may start laughing out loud and look around them in wonder – especially at their fingers and toes.

They will smile at strangers, but they definitely know who their parents are by now. Their brain is growing fast and they will start to recognise people by sight and smell as well as by their voice.

They will be gurgling a lot and trying to respond to you when you talk to them. Their sense of touch is also becoming more sensitive and they will be able to pay attention to things for longer.

From now on, your baby will start to reach out for objects as the muscles develop in their arms and hands. They will try to put things in their mouth, although they can’t quite coordinate their hands and eyes yet, take a long look at objects and shake or rattle them.

Physically, your baby will have better control of their head movements and will start to hold their head up when they’re sitting up. When you give them tummy time, you might notice they roll from their front to their back, lift up their head or push up their chest with their hands.

They will be waving their arms and kicking their legs strongly. If you hold them upright with their feet on the floor or your lap, they’ll probably push down on their legs.

A lot of the time, if they are near a dangling object, they will bat at it with closed fists. However, they can also open their fingers to grasp an object and they will be better coordinated, so they can bring their hands together.

How to help your baby develop

This is the time when the foundations of language are built. Talk and read to your baby as much as possible. It will help them learn how language works and how conversations go back and forth. Respond to your baby with words or with different noises, to encourage them to express themselves.

Choose baby books with large, bright pictures. It doesn’t really matter what the words are, it’s the sound of your voice that counts. Point to things around your baby and tell them the names. If you live in a bilingual home, it’s OK to use both languages to describe the world to your baby.

You can help your baby to develop the muscles in their neck and back by dangling a toy in front of them when they’re on their tummy. Or offer a toy to them to help them learn to grasp it. Stimulate their sense of touch by stroking them with different materials like fur, felt and tissue. Cuddles, massage and moving them through the air will all help to calm them down.

Development problem signs

Babies develop at a different rate. At 3 months, talk to your doctor if:

• they aren’t smiling by 8 weeks
• they don’t calm down, even for a little while, when you pick them up to comfort them
• one side of their body seems to be stronger than the other
• they’re still holding their fingers in a tight fist
• sudden noises don’t startle them
• they aren’t feeding properly
• they’re floppy or stiff

6 month growth spurt

By the time they reach 6 months, babies have a much better sense of who they are and how they fit into their world. They will have a good sense of the difference between their parents, siblings and other people, and may even start to be anxious of people they don’t know.

Six months is the recommended age to introduce solid food. If you haven’t already started, you can try offering small amounts of smooth, pureed or mashed food once a day, and still continue breastfeeding or formula feeding. When you are giving your baby solids, you can also offer some small sips of cool, boiled water from a sippy cup. If you have allergies in your family, talk to your doctor or child and family health nurse before you introduce common allergy foods like eggs or cow’s milk.

Your baby is now due for their 6 months check. This is when you and your doctor will discuss sleep patterns, safe sleeping and prevention of sudden infant death syndrome (SIDS), healthy diet and teeth care, growth and safety. Your baby also needs their third scheduled vaccination, which involves just one injection this time.

What can your baby do?

From about 6 months – sometimes a little later – your baby’s hand control will have developed enough so they can grab an object and move it towards them. They might even be able to pass an object from hand to hand and will learn how to let go of something (and to understand that it fell). It’s too early to tell whether they are left or right handed; they will tend to use one hand a lot and then switch to the other.

Most babies can roll over by 6 months, which means you need to be very careful to keep hold of them on the change table or bed. They are starting to push themselves up into a crawling position and may be able to rock back and forth on their hands and knees. They can push up and down with their legs in a standing position and may be able to sit with support. They will often be able to turn themselves in the direction they want to go by now.

Six-month-old babies love interacting with you and will start to let you know what they want. They are learning how to attract your attention in ways other than crying. They will also start to understand your emotions from the tone of your voice, for example if you speak to them harshly. Some babies at this age can understand a few words, like “bath”, and can recognize their own name.

Their communication skills will be developing fast. You will be hearing lots of babbling, singing, squeals and bubble blowing, sometimes referred to as ‘vocal play’. They love language games and understand how to take turns as you ‘talk’ to each other. About half of 6 month-old babies can repeat a sound over and over again (“babababa”). Some will even combine several sounds together (“baga”). Mimic the sounds back to them to help them learn to talk.

How to help your baby develop

Your baby will love exploring the world. Surround them with safe things they can touch and put in their mouth, like a soft ball, different fabrics, teething rings or bells.

Talk and listen to your baby, looking them straight in the eye, making facial expressions and responding to their sounds. They will love being read to, especially books with bright pictures. Have a cuddle while you read to them so you can enjoy this special time together. Reassure them when they’re with people they don’t know, to help them feel safe and secure.

Start introducing solid foods to your baby now. This is important to give them the nutrients they need, including iron, but also to strengthen their jaw to help with chewing food and talking.

If you haven’t done so already, now is the time to baby proof your house. Your baby will soon be on the move so make sure their environment is safe.

Development problem signs

All babies develop at different rates. At 6 months, talk to your doctor or maternal child health nurse if:

• your baby doesn’t seem interested in things around them
• doesn’t seem to know their parents or respond to people they know well
• isn’t showing any interest in their surroundings
• isn’t reaching for objects
• isn’t starting to babble or make any voice sounds
• doesn’t make eye contact
• can’t be comforted by a parent or a close carer.

When can babies sit up on their own?

Babies must be able to hold their heads up without support and have enough upper body strength before being able to sit up on their own. Babies often can hold their heads up around 2 months, and begin to push up with their arms while lying on their stomachs.

At 4 months, a baby typically can hold his/her head steady without support, and at 6 months, he/she begins to sit with a little help. At 9 months he/she sits well without support, and gets in and out of a sitting position but may require help. At 12 months, he/she gets into the sitting position without help.

Tummy time helps strengthen the upper body and neck muscles that your baby needs to sit up. Around 6 months, encourage sitting up by helping your baby to sit or support him/her with pillows to allow him/her to look around.

When do babies roll over?

Babies start rolling over as early as 4 months old. They will rock from side to side, a motion that is the foundation for rolling over. They may also roll over from tummy to back. At 6 months old, babies will typically roll over in both directions. It’s common for babies to roll over from tummy to back for a month or two before rolling over from their back to front.

To encourage rolling over, place your baby on a blanket on the floor with a toy or book to one side near him/her to reach toward with her arms.

When do babies crawl?

At 6 months old, babies will rock back and forth on hands and knees. This is a building block to crawling. As the child rocks, he may start to crawl backward before moving forward. By 9 months old, babies typically creep and crawl. Some babies do a commando-type crawl, pulling themselves along the floor by their arms.

To encourage a child’s crawling development, allow your baby to play on the floor in a safe area away from stairs. Place favorite toys just out of reach as the baby is rocking back and forth. Encourage him/her to reach for his/her toy.

As your baby becomes more mobile, it’s important to childproof your home. Lock up household cleaning, laundry, lawn care and car care products. Use safety gates and lock doors to outside and the basement.

When do babies start talking?

Children develop language at different rates. From the moment they’re born, babies have a very effective way of telling you what they’re thinking and feeling. It’s called crying. Babies communicate from birth through crying and eye contact, and then simple sounds and gestures. Crying is how babies let you know they want or need something – more cuddles please, no more cuddles please, hungry, not hungry enough, too tired, not tired enough, feeling too cold, feeling too warm. And sometimes babies cry for no obvious reason. Crying is the only way your new baby knows how to communicate her needs to you. Your baby doesn’t cry to annoy you – there’s no such thing as a naughty newborn. You can’t spoil your baby by responding when she cries.

Your baby absorbs a huge amount of information about words and talking from birth. Just listening to you and watching you talk helps your baby understand the basics of communicating. For example, your new baby uses eye contact to communicate with you. He might gaze into your face and watch your mouth. He’s also listening intently to every word and sound you make.

At about 7-8 weeks of age, your baby discovers that she has a voice. You can expect her to start cooing and making simple sounds. And as your baby grows, he’ll start to make more sounds. For example, he’ll experiment with sounds like sneezing, coughing, gagging and squealing to get your attention. He’ll also start to smile and wave his arms and feet around. And then he’ll use gestures like pointing and waving bye-bye.

Your child will also learn to talk by watching how you communicate with others. If you talk in a positive way, your child will learn to speak positively to others. For example, when you’re talking together at mealtimes, you can use positive language like ‘What was good about your day today?’

Your baby is getting the idea of conversation and wants to tell you all sorts of interesting things. By communicating back and forth with your baby, you’re also creating and sharing experiences together, which strengthens your relationship with your child. And a strong relationship with you is essential to your baby’s healthy development.

Toddlers or young children use their parent’s faces and tone of voice, along with their increasing understanding of language to make sense of their experiences. Talking with your baby or toddler can help his language and communication development. The more you talk with your baby or toddler, the better. This is because parents who talk a lot to their young children use lots of different sounds and words. When children hear more words and lots of different words, it improves their understanding of language. It also increases the number and variety of words that they understand and use. And it’s not just about better language skills. Talking with babies helps their brains develop and can help children do better at school when they’re older.

Latest research informs us that a child’s first 1001 days are crucial in developing attachment, physical development, communication and early language. While all three areas are key to a young child’s development this article unpacks how mums, dads, family and friends can support a child’s early communication skills. Again, research states the importance of early communication and language and the need for children to be experimenting with sounds, babbling, making noises, learning vocabulary, and communicating from as early an age as possible.

It’s great to start talking with your baby as early as you can. In fact, from birth your baby absorbs a huge amount of information about words and talking, just from listening and watching you talk.

Conversations with your baby might feel one-sided to begin with. But even though your young baby doesn’t have words yet, she’ll be listening to you, and she’ll try to join the conversation! She’ll use crying, eye contact and listening to communicate. Later on, she’ll coo, smile, laugh, make more sounds and move her body to communicate with you.

Tips for talking with babies and toddlers

You might feel silly having conversations with a baby or a toddler who’s not talking much, but keep at it. Conversations and activities that include some of the ideas below are good for developing your child’s language skills.

Tune into your child

• Reduce distractions. Turn off the TV or computer or do whatever helps you to just ‘be present’ to talk to your child.
• Notice what your child is interested in, ask a question or make a comment, and then give your child time to respond. For example, at bath time you could say, ‘Is that Ducky? Ducky’s swimming. Splash!’
• As your toddler learns to talk, give him time to find words for his ideas and really listen when he talks. For example, try not to finish his sentences for him, and make sure he’s finished before you talk. This sends the message that what your child has to say matters.
• Use natural pauses. Your child will eventually fill in these pauses when her language develops. This also teaches her ‘give and take’ in a conversation.

Be interesting

• Talk to your child about things he’s interested in – for example, what grandpa might be doing today, a story you’ve read together, or something that’s happening outside.
• Talk about an experience you shared – for example, ‘It’s sunny today. But remember how wet we got on the way home yesterday? Your socks were soaked!’
• Use lots of expression to make your conversation interesting and engaging. What you talk about doesn’t matter as much as how you talk about it.
• If you use complex words, explain them and build on them by using lots of descriptive words. For example, ‘We’re going to see the pediatrician – that’s a special doctor who knows all about babies and children’.

Read, tell stories, sing songs and make rhymes

• Read books and tell stories to your baby from birth, every day if you can. After a few weeks, your baby will know that this is when you enjoy a quiet, special time together.
• Talk about the pictures in books, wonder out loud what might happen next in the story, point out words and letters, and let your child touch and hold the book and turn the pages. You can make up your own stories to go with the pictures in the book.
• Help your child learn that books and reading are fun. You can do this by having a special reading spot, making cuddles part of reading time and letting your child choose some books – even if you have to read the same ones over and over again!
• Sing songs and rhymes in the car, in the bath, at bedtime – even if it’s off-key. Your baby will love the rhythm of the words and will be soothed by your voice.

How do speech and language develop?

The first 3 years of life, when the brain is developing and maturing, is the most intensive period for acquiring speech and language skills. These skills develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and language of others.

There appear to be critical periods for speech and language development in infants and young children when the brain is best able to absorb language. If these critical periods are allowed to pass without exposure to language, it will be more difficult to learn.

What are the milestones for speech and language development?

The first signs of communication occur when an infant learns that a cry will bring food, comfort, and companionship. Newborns also begin to recognize important sounds in their environment, such as the voice of their mother or primary caretaker. As they grow, babies begin to sort out the speech sounds that compose the words of their language. By 6 months of age, most babies recognize the basic sounds of their native language.

Children vary in their development of speech and language skills. However, they follow a natural progression or timetable for mastering the skills of language. A checklist of milestones for the normal development of speech and language skills in children from birth to 5 years of age is included below. These milestones help doctors and other health professionals determine if a child is on track or if he or she may need extra help. Sometimes a delay may be caused by hearing loss, while other times it may be due to a speech or language disorder.

What are voice, speech, and language?

Voice, speech, and language are the tools we use to communicate with each other.

Voice is the sound you make as air from your lungs is pushed between vocal folds in your larynx, causing them to vibrate.

Speech is talking, which is one way to express language. It involves the precisely coordinated muscle actions of the tongue, lips, jaw, and vocal tract to produce the recognizable sounds that make up language.

Language is a set of shared rules that allow people to express their ideas in a meaningful way. Language may be expressed verbally or by writing, signing, or making other gestures, such as eye blinking or mouth movements.

What is the difference between a speech disorder and a language disorder?

Children who have trouble understanding what others say (receptive language) or difficulty sharing their thoughts (expressive language) may have a language disorder. Specific language impairment is a language disorder that delays the mastery of language skills. Some children with specific language impairment may not begin to talk until their third or fourth year.

Children who have trouble producing speech sounds correctly or who hesitate or stutter when talking may have a speech disorder. Apraxia of speech is a speech disorder that makes it difficult to put sounds and syllables together in the correct order to form words.

What should I do if my child’s speech or language appears to be delayed?

Talk to your child’s doctor if you have any concerns. Your doctor may refer you to a speech-language pathologist, who is a health professional trained to evaluate and treat people with speech or language disorders. The speech-language pathologist will talk to you about your child’s communication and general development. He or she will also use special spoken tests to evaluate your child. A hearing test is often included in the evaluation because a hearing problem can affect speech and language development. Depending on the result of the evaluation, the speech-language pathologist may suggest activities you can do at home to stimulate your child’s development. They might also recommend group or individual therapy or suggest further evaluation by an audiologist (a health care professional trained to identify and measure hearing loss), or a developmental psychologist (a health care professional with special expertise in the psychological development of infants and children).

Baby language development

Your baby’s communication skills grow dramatically in her first year of life. She will learn how to express herself, respond to you and understand when you communicate with her. All this happens before she says her first real words around her first birthday. As part of his language development in the first year, your baby will express himself in many ways.

At 3-4 months, he might:

• make eye contact with you
• say ‘ah goo’ or another combination of vowels and consonants.
• babble and combine vowels and consonants, like ‘ga ga ga ga’, ‘ba ba ba ba’, ‘ma ma ma ma’ and ‘da da da da’.

At 5-7 months, she might:

• copy some of the sounds and gestures you make, like coughing, laughing, clicking or making ‘raspberries’
• play with making different sounds, like ‘aaieee’, ‘booo’ and ‘ahh’ at varying (sometimes earsplitting!) pitches and volumes.

At 8-9 months, he might:

• make longer sequences of sounds, which might sound like normal speech – this is sometimes called the ‘jargon phase’ and might continue when first words begin
• say ‘mama’ or ‘dada’, although he might not know what these mean yet.

At 10-11 months, she might:

• communicate with purpose, mainly to request, insist, refuse, reject or greet someone
• ask for something by pointing, or by looking at a person then at something she wants.

By around 12-14 months, your baby might say a few words and know what they mean, like ‘mama’ or ‘dada’ to refer to mum or dad.

In these months, your baby will respond to you in many ways. For example, he might:

• make sounds, look excited or go quiet when you talk with him or say his name
• coo and laugh – for example, while you’re changing his nappy
• smile and laugh when you play with him
• enjoy games like peekaboo and other action games
• use gestures like waving or pointing
• respond to his own name by looking, widening his eyes, listening or smiling.

Understanding

It’s amazing how much your baby understands already – she’s listening and learning all the time, as she makes sense of her world.

For example, in these months, you might find that your baby understands:

• the word ‘no’ at around 10 months – although he still won’t always do as you say
• very simple instructions with verbal and visual cues – for example, at around 12 months, when you hold your hand out and say ‘ta’, he’ll give you the toy he’s holding.

Typical stages of speech and language development in babies

0-6 months

This is a guide to how children develop speech and language between 0-6 months.

Children develop skills at different rates but by 6 months, usually children will:

• Turn towards a sound when they hear it
• Be startled by loud noises
• Watch your face when you talk to them
• Recognize your voice
• Smile and laugh when other people smile and laugh
• Make sounds to themselves, like cooing, gurgling and babbling
• Make noises, like coos or squeals, to get your attention
• Have different cries for different needs. For example, one cry for hunger, another when they are tired.

How to support your child

There are lots of things you can do to encourage your child at this stage:

• Copy sounds your baby makes. This will encourage more noises and is the start of turn-taking and conversations
• Hold your baby near your face when you talk to them so that they can see you clearly
• Talk to your baby about what you are doing. This will help them to start to learn words
• Talk in a sing-song voice to your baby. This will keep them interested in what you are saying
• Have some special time with your child each day to play with toys and picture books.

Things to look out for

Speech and language skills develop from a very early age. However, some children do not develop the early skills they need.

These can be very difficult to spot from an early age. Here are four examples that would cause concern at 6 months:

• If a baby is not startled by loud noises
• If a baby does not engage in eye contact when spoken to
• If a baby does not smile back at someone smiling at them
• If a baby does not watch a speaker’s face with interest.

6-12 months

Children develop skills at different rates but by their first year, usually children will:

• Listen carefully, and turn to someone talking on the other side of the room
• Look at you when you speak and when their name is called
• Babble strings of sounds, like ‘no-no’ and ‘go-go’
• Make noises, point and look at you to get your attention
• Smile at people who are smiling at them
• Start to understand words like ‘bye-bye’ and ‘up’ especially when a gesture is used at the same time
• Recognize the names of familiar objects, things like ‘car’ and ‘daddy’
• Enjoy action songs and rhymes and get excited when sung to
• Take turns in conversations, babbling back to an adult.

How to support your child

There are lots of things you can do to encourage your child at this stage:

• Make different sounds to interest your child. This can be varying the sound of your voice or things like a rattle or squeaky toy.
• Pointing to sounds will help develop your child’s listening skills. This will also help develop their awareness of the world around them.
• Encourage your child to look at you during activities. This could be dressing, feeding or nappy changing. This will help your child’s attention and communication skills.
• Talk about everyday activities, like getting dressed, eating and bathing.
• Copy your baby when they are babbling. This is a very good way to show how to take turns in communication. This will encourage them to make even more sounds.
• Use actions with words. Try waving as you say ‘bye-bye’ or picking up their cup as you say ‘drink’. This will help your child to relate what they see and do with the words they need .
• Sing action songs and play games like ‘peek-a-boo’ to encourage communication and attention skills.
• Have some special time with your child each day to play with toys and picture books.

Things to look out for

Speech and language skills develop from a very early age. However, some children do not develop the early skills they need.

This can be very difficult to spot from an early age. However, you should talk to a doctor if your child does not:

• Respond to noises by 9 months
• Point to things they are interested in by one year

Try to gain your attention by making noises by one year. This could be through eye contact, facial expressions or reaching.

12-18 months

Children develop skills at different rates but by 18 months, usually children will:

• Enjoy listening to music and singing, and sometimes move their body to ‘dance’ along to music
• Enjoy looking at simple picture books together with an adult
• Understand many more words than they can say, including the names of everyday objects like furniture, clothing and body parts
• Understand some simple questions and instructions like ‘where’s teddy?’ and ‘kiss Mummy’
• Say up to 20 single words (such as ‘cup’, ‘daddy’, ‘dog’) to ask for things or to comment on what they see, even though they may not be very clear yet
• Use a lot of babble and single words while they are playing, often sounding like they are speaking in sentences even though they aren’t always saying real words
• Copy a lot of things that they see adults doing, like saying ‘Hello’ or waving goodbye
• Enjoy simple pretend play, such as giving dolly a drink or pretending to talk on the phone

How to support your child

There are lots of things you can do to encourage your child at this stage:

• Look at your child when you are talking to them. This is easier to do if you are at the same level, so get down to their eye level or bring them up to yours.
• Talk to your child in short, simple sentences. This helps them to understand what you’re saying, and also gives them a better chance of copying a word or two when they’re ready.
• Talk about the things your child is looking at or doing. Follow their lead when playing with them and talk about what interests them.
• Repeat words often – children need to hear words many times before they remember them and say them.
• Talk to your child often during daily routines like mealtimes and bath time.
• Repeat back what you think your child means when they don’t have the words. For example, if your child points at the biscuit tin and babbles, you could say ‘Biscuit? You want a biscuit?’.
• Give your child choices between two things to encourage communication. For example, instead of saying, ‘What do you want to drink?’, you could say, ‘Do you want milk or juice?’, holding both choices up in front of them.

Things to look out for

While all children develop differently, it’s worth seeking advice from a professional if your child does not:

• Babble to communicate by 12 – 15 months
• Say their first words by 18 months
• Appear to understand some of what you say to them by 18 months

18-24 months

This is a guide to how children develop speech and language between 18-24 months.

At this stage, children try out new things and explore the world around them more actively. They will often choose their own activities and may not always like being told what to do.

Children develop skills at different rates but by 2 years, usually children will:

• Concentrate on activities for longer, such as playing with a toy they like
• Sit and listen to simple stories with pictures
• Understand between 200 and 500 words
• Understand more simple questions and instructions. For example, ‘where is your shoe?’ and ‘show me your nose’
• Copy sounds and words a lot
• Use 50 or more single words. These will also become more recognisable to others
• Start to put short sentences together with 2-3 words, such as ‘more juice’ or ‘bye nanny’.
• Enjoy pretend play with their toys, such as feeding dolly
• Use a more limited number of sounds in their words than adults – often these sounds are p, b, t, d, m and w. Children will also often miss the ends off words at this stage. They can usually be understood about half of the time.

How to support your child

There are lots of things you can do to encourage children at this stage:

• Talk about everyday activities like putting away the shopping. This helps children to connect language to the world around them. Remember to leave little gaps or pauses so that your child can respond.
• Use objects and gestures to help them understand instructions and questions. It is also useful to give a child two or three options, such as, ‘do you want teddy or the car?’, ‘is this your nose or your foot?’
• Read books together. Looking at the pictures and describing them is just as good as actually reading the story. ’Lift-the-flap’ books also help concentration
• Repeat and expand on what a child says. If a child says ‘juice’ you can say ‘more juice’, ‘juice please’ or ‘juice gone’. This shows your child how words can be put together to make short sentences
• Children learn speech sounds gradually. It is better to say the whole word back to a child rather than correcting them. It also helps them if they can see your face when you are talking to them. This helps them to watch and copy the movements of your lips
• Children can be frustrated when adults don’t understand them. This can lead to tantrums. Encouraging a child to use gestures or actions for objects can help. Try to be patient and wait for them to finish what they are saying or trying to show you.

Things to look out for

For some children, developing communication can be a very difficult process. They may need extra help to develop their skills. You should be concerned if by 2 years, they are:

• Slow to follow simple instructions
• Not saying 25 recognizable words.

2-3 years

This is a guide to how children develop speech and language between 2 and 3 years.

Children develop skills at different rates, but by 3 years usually children will:

• Listen to and remember simple stories with pictures
• Understand longer instructions, such as ‘make teddy jump’ or ‘where’s mummy’s coat?’
• Understand simple ‘who’, ‘what’ and ‘where’ questions
• Use up to 300 words
• Put 4 or 5 words together to make short sentences, such as ‘want more juice’ or ‘he took my ball’
• Ask lots of questions. They will want to find out the name of things and learn new words
• Use action words such as ‘run’ and ‘fall’ as well as words for the names of things,
• Start to use simple plurals by adding ‘s’, for example ‘shoes’ or ‘cars’
• Use a wider range of speech sounds. However, many children will shorten longer words, such as saying ‘nana’ instead of ‘banana’. They may also have difficulty where lots of sounds happen together in a word, e.g. they may say ‘pider’ instead of ‘spider’
• Often have problems saying more difficult sounds like sh, ch, th and r. However, people that know them can mostly understand them
• Now play more with other children and share things
• Sometimes sound as if they are stammering or stuttering. They are usually trying to share their ideas before their language skills are ready. This is perfectly normal at this age, just show you are listening and give them plenty of time. It’s not helpful to draw attention to their ‘stammering’ by saying things like ‘take your time’. Just try to be patient and not interrupt them.

How to support your child

There are lots of things you can do to encourage children at this stage:

• Adding words to children’s sentences can show them how words fit together. For example, if a child says, ‘dolly hair’ you can say ‘brush dolly’s hair’
• Often children enjoy helping. Sharing daily jobs gives a chance to talk about objects and actions
• Use puppets and pictures to help children listen to stories. Don’t be afraid to tell a story more than once. Repetition helps children to understand and remember words
• Give children the correct example for sounds and words. This helps if they are having problems saying a certain word or sound. If you correct them or make them say it again, you can make them feel anxious. Simply repeat what they have said using the right words and sounds. With time they will be able to do it themselves.

Things to look out for

For some children, developing communication skills can be very difficult. It is important that parents seek advice from a speech and language therapist if:

• A child points or shows what they want rather than says it.
• They only say single words instead of joining words together into short sentences.
• They are slow to respond to your instructions.
• They rely on being shown what to do rather than being told.
• You cannot understand most of what they say.

3-4 years

Children at 3 to 4 years will usually be actively learning language and asking many questions.

Children develop skills at different rates, but by 4 years usually children will:

• Listen to longer stories and answer questions about a storybook they have just read
• Understand and often use color, number and time related words, for example, ‘red’ car, ‘three’ fingers and ‘yesterday / tomorrow’
• Start to be able to answer questions about ‘why’ something has happened, although this still might be at quite a basic level
• Use longer sentences and link sentences together
• Describe events that have already happened, even if their sentences aren’t exactly like adults’ e.g. ‘we went park’
• Enjoy make-believe play
• Start to like simple jokes even if they don’t understand them
• Ask many questions using words like ‘what’ ‘where’ and ‘why’
• Still make mistakes with tense such as say ‘runned’ for ‘ran’ and ‘swimmed’ for ‘swam’
• Have difficulties with a small number of sounds – for example r, w, l, f, th, sh, ch and j
• Start to be able to plan games with others.

How to support your child

There are lots of things you can do to encourage children at this stage:

• Have a special time to talk about the day. Talking about what has happened that day will help their memory skills. It will also help them to talk about things they cannot see and things that happened in the past which is an important skill for learning in school
• Wherever possible, use pictures, objects, puppets, acting, gestures and facial expressions. This will keep a child’s interest
• Talk about or play games involving opposites like ‘on and off’ or ‘big and little’
• Join a child in pretend play. Let them take the lead. This will help their language and creativity. Talk about what they are saying and doing rather than asking lots of questions. Your commentary helps their language skills and shows you are listening and interested
• Reversing roles can be great fun for a child. Let them be the ‘mummy’ or the ‘teacher’. This helps them to talk about new situations
• Play with and talk about sequences of coloured bricks or shapes, numbers and days of the week.

Things to look out for

By 3 and a half years old a child should be understood by people outside the family. If not, parents should seek advice from a speech and language therapist.

You should be concerned if:

• They are struggling to turn ideas into sentences
• The language they use is jumbled and difficult to understand
• They are unresponsive or slow to follow instructions.

4-5 years

This is a guide to how children develop speech and language between 4 and 5 years.

At this stage, they need to listen, understand more and share their ideas within the classroom. They will use their language skills to help them learn to read.
Children develop skills at different rates but by 5 years usually children will:

Understand spoken instructions without stopping what they are doing to look at the speaker
Choose their own friends and play mates
Take turns in much longer conversations
Understand more complicated language such as ‘first’, ‘last’, ‘might’, ‘may be’, ‘above’ and ‘in between’
Understand words that describe sequences such as “first we are going to the shop, next we will play in the park”
Use sentences that are well formed. However, they may still have some difficulties with grammar. For example, saying ‘sheeps’ instead of ‘sheep’ or ‘goed’ instead of ‘went’
Think more about the meanings of words, such as describing the meaning of simple words or asking what a new word means
Use most sounds effectively. However, they may have some difficulties with more difficult words such as ‘scribble’ or ‘elephant’.

How to support your child

There are lots of things you can do to encourage your child at this stage:

• Building relationships with your child’s pre-school or school is very important. Find out what topics or songs they are learning. This can help you support new words and ideas your child is learning
• Playing board games that involve taking turns helps them to listen and concentrate for longer
• Encourage children to talk without being questioned. This can help them to talk more about their experiences. Open questions like ‘what are you going to play with today?’ encourage children to say more than ‘yes’ and ‘no’. If they find it difficult to answer such open questions, give them choices, such as ‘cars or animals?’
• Although children may know lots of different words it is important to introduce new words and phrases. This helps them to continue learning
• Having fun with words and rhymes can help children learn skills they need for reading and writing
• Children may need time to think before responding to questions and instructions. Give them time without answering for them or finishing their sentences.

Things to look out for

For some children, developing communication can be a very difficult process and they may need extra help. By 5 years you may see the following:

• Difficulty with abstract ideas such as size or time.
• Difficulty with complex sentences.
• Not having the right words to be able to say what they want.
• Difficulty organizing ideas in order.
• Missing out some words. For example, saying ‘playing ball’ instead of ‘the dog is playing with the ball’.
• Talking about lots of different topics in the same group of sentences.
• Not using the right sounds so that their speech is difficult to understand.

5-7 years

This is a guide to how children develop speech and language between 5 and 7 years. Often by 5 or 6 years, children have good communication skills. They are better at using language in different ways e.g. discussing ideas or giving opinions.

Children develop skills at different rates, but beyond 5 years, usually children will:

• Focus on one thing for longer without being reminded
• Rely less on pictures and objects to learn new words
• Use their language skills in learning to read, write and spell
• Learn that the same word can mean two things, such as ‘orange’ the fruit and ‘orange’ the colour
• Learn that different words can mean the same thing such as ’minus’ and ‘take away’
• Understand feelings and descriptive words like ‘carefully’, ‘slowly’ or ‘clever’
• Use language for different purposes such as asking questions or persuading
• Share and discuss more complex ideas
• Use language in a range of social situations.

How to support your child

There are lots of things you can do to encourage children at this stage:

• Help them to learn new words, such as words to do with positions, times and size.
• Make time to talk about your day
• Give a child time to talk to you
• Ask open questions like ‘tell me something you liked about today’.

Things to look out for

A child at this age should have well-developed speech, language and communication skills. If they are finding language difficult, you might notice that they:

• Find it hard to learn and understand the meanings of words
• Find it hard to understand language about things in the past or future
• Struggle to understand phrases that can mean more than one thing, such as “pull your socks up”
• Respond to just part of an instruction, usually the beginning or end
• Use short sentences, often with words missing or in the wrong order
• Find it hard to make up stories. This shows in written work as well as talking
• Are not learning at school, but nobody can explain why
• Are struggling to make and keep friends.

7-11 years

This is a guide to how children develop speech and language between 7 and 11 years.

Speech, language and communication development is a gradual process. Children develop skills at different rates but beyond 8 years, usually children will:

• Use language to predict and draw conclusions
• Use long and complex sentences
• Understand other points of view and show that they agree or disagree
• Understand comparative words e.g. ‘it was earlier than yesterday’
• Keep a conversation going by giving reasons and explaining choices
• Start conversations with adults and children they don’t know
• Understand and use passive sentences where the order of the words can still be confusing for younger children e.g. “the thief is chased by the policeman”.

How to support your child

Good communication is two-way and requires good listening skills. To help a child, you will need to demonstrate good listening skills yourself. Make sure that you have time for this in your day. You may need to explain words that a child still does not know.

A child’s vocabulary will be growing. Help them to understand new words they learn by talking about their meaning. Make sure they are not afraid to ask if they don’t understand a word. If you don’t know the exact meaning of a word – look it up in a child-friendly dictionary such as Collins Co-Build.

Just by having good conversations with children, you are supporting their language. So, talk to them. Ask them how their day at school was and how their friends are. Hopefully they don’t need too much encouragement to talk. Try to encourage conversations rather than just you doing the talking.

Things to look out for

At this stage, children should have well-developed speech, language and communication skills. A child with delayed language might show the following behaviors:

• They may struggle to join in group conversations. This is because there is too much language
• They may find it hard to make up stories. This will show in their written work as well as talking
• Their stories may be muddled, making them difficult to follow
• They may find it hard to learn and understand the meanings of words
• They may struggle to understand language about things in the past or future
• They may find it hard to make predictions
• They may find it difficult to understand language where the meaning isn’t clearly stated e.g. when the conversation involves new concepts or involves people or objects not present and visible to the child
• They may be struggling to learn at school. They could find it hard to understand what it is they are supposed to be doing, even though they have been told.

11-17 years

This is a guide to how children develop speech and language between 11-17 years. Language development at this stage is a gradual process. Changes still take place but they are harder to see. Children need to learn to develop relationships and join in social activities on their own.

What to expect between the ages of 11 and 14

At this stage children will:

• Use longer sentences; usually 7-12 words or more
• Build their sentences using a range of conjunctions or joining words, such as ‘meanwhile’, ‘however’, ‘except’ so that they can convey complex ideas
• Know how to use sarcasm. Know when others are being sarcastic to them
• Be able to change topic well in conversations
• Use more subtle and witty humor
• Show some understanding of idioms, such as “put your money where your mouth is!”
• Know that they talk differently to friends than to teachers and be able to adjust this easily
• Understand and use slang terms with friends. They keep up with rapidly changing ‘street talk’.

What to expect between 14-17 years

As they get older, young people can:

• Follow complicated instructions
• Know when they haven’t understood. They will ask to be told again or have something specific explained
• Easily swap between ‘classroom’ talk and ‘break-time’ talk
• Tell long and very complicated stories.

How to support your child

There are lots of things you can do to encourage young people at this stage:

• Encourage opportunities to talk without making them feel under pressure
• Use opportunities for chatting, like mealtimes
• Give everyone a chance to talk about their day, including you
• Help by explaining any words or phrases that they don’t understand
• Show that you are interested by making time to listen.

Things to look out for

At this stage, children should have well-developed speech, language and communication skills. At this age, a child might have delayed language if they:

• Have difficulty giving specific answers or explanations
• Have difficulty sequencing their ideas in the right order
• Are better at understanding individual instructions than group instructions
• Find it difficult to understand language where the meaning isn’t clearly stated e.g. be able to infer that someone wants to close the window or turn up the heating when they say ‘It’s a bit chilly in here!’
• Find long and complicated instructions hard to understand
• Have trouble learning new words
• Take a long time to organize what they are going to say or write
• Take things too literally. For example, “I’ll be back in a minute”
• Have difficulty taking turns in conversations
• Talk to teachers and friends in the same way.

How to encourage babies talking

When babies are alert, they’re more interested in communicating.

When your baby shows signs of wanting to communicate, you can respond by:

• being enthusiastic, warm and encouraging
• using lots of facial expressions
• talking about what she’s pointing at, if she points
• praising her if she waves, and waving back.

It’s good to leave a gap after you’ve responded to your baby. This teaches your baby about the ‘serve and return’ pattern of conversation. If your baby doesn’t take a turn, or isn’t interested in chatting right now, you can try again another time. Let your baby’s interest and responses guide you.

Lots of parents feel a bit silly talking to a little baby who doesn’t talk back. The more you talk with your baby, the easier it becomes – and you’ll be rewarded with your baby’s responses. The way you respond, however silly, will help your baby learn to communicate.

The main thing is to create a loving, warm feeling between you and your baby. You can use simple, enjoyable interactions and play to encourage your baby’s talking and language skills.

0 to 6 months

• Hold your baby close and look at them as you talk to them. Babies love faces and will watch you and respond as you talk.
• Chat about what you’re doing as you feed, change and bathe them.
• Sing to your baby – this helps them tune in to the rhythm of language.
• Repeat the sounds your baby makes back to them – this teaches your baby lessons about listening and taking turns in a conversation.
• Talk in a sing-song voice – this helps to keep your baby’s attention.

6 to 12 months

• Name and point to things you can both see, for example, “Look, a cat”. This will help your baby learn words and, in time, they’ll start to copy you. As your baby gets older, add more detail, such as, “Look, a black cat”.
• Start looking at books with your baby – you do not have to read the words on the page, just talk about what you can see.
• Only offer a dummy when it’s time for sleep. It’s hard to learn to talk with a dummy in your mouth. Aim to stop using dummies completely by 12 months.
• Play games like “peek-a-boo” and “round and round the garden”. This teaches your baby important skills like taking turns, paying attention and listening.

12 to 18 months

• If your child is trying to say a word but gets it wrong, say the word properly. For example, if they point to a cat and say “Ca!” you should respond with, “Yes, it’s a cat”. Do not criticize or tell them off for getting the word wrong.
• Increase your child’s vocabulary by giving them choices, such as, “Do you want an apple or a banana?”.
• Toys and books that make a noise will help your child’s listening skills.
• Enjoy singing nursery rhymes and songs together as your baby grows, especially those with actions, such as “Pat-a-cake”, “Row, row, row your boat” and “Wind the bobbin up”. Doing the actions helps your child to remember the words.

18 to 24 months

• Repeat words, for example, “Where are your shoes?”, “Are you wearing blue shoes today?” and “Let’s put your shoes on”. Repetition helps your child to remember words.
• Use simple instructions – your child will understand some instructions at this age, such as “Get your coat” or ‘”Shut the door”. Keeping instructions short and simple will help your child understand.
• Try asking “Where’s your…” – ask your child to point to their ear, nose, foot, and so on.
• Limit your child’s daily TV time to no more than 30 minutes for children younger than 24 months. Playing and listening to stories is more helpful when they’re learning to talk.

2 to 3 years

• Help them build sentences – your child will start to put simple sentences together at around age 2. Try to reply using sentences that are a few words longer. For example, if they say, “sock off”, respond with “yes, we’re taking your sock off”.
• Get your child’s attention by saying their name at the start of a sentence. If you ask a question, give them plenty of time to answer you.
• Teach them about words that go together – for example, you could show them a ball, teddy and a rattle and then say the word ‘toy’.
• Start using sounds with meaning (symbolic sounds), like saying “whoops” or “uh-oh” when you drop something accidentally, or saying “meow” while showing them a picture of a cat.
• Switch off the television and radio – background noise makes it harder for your child to listen to you.
• Talk as you clean – children this age love to help. Chat about what you’re doing as you do chores like shopping, cooking and cleaning together.

When do babies crawl?

Crawling is an important skill for your baby to learn and is a big milestone in their development. Your baby will crawl when they’re ready, with their own unique style. Babies usually start crawling between 6 and 13 months old. They are usually able to get into a crawling position on their hands and knees between 6 and 9 months, and will probably be rolling around and crawling on their tummies, called ‘commando crawling’, by around 8 months, though this varies. Approximately 10% of babies will never crawl and skip crawling altogether!

As with most developmental milestones, it is “normal” for crawling to happen at any point across a fairly wide span of time—anywhere from 6 to 10 months of age. Also, if a child is a bit bigger or heavier than is typical for his age, he may crawl later as it is more challenging for babies to push up onto all fours and move their extra body weight. Babies who were born prematurely may also crawl later.

Your baby will probably crawl on their hands and knees, but not all babies crawl the same way, and that’s OK. There are some other crawling styles you might notice, such as shuffling on the tummy ‘commando-style’, sliding along on their bottom (‘bum-shuffling’), or crawling backwards instead of forwards.

At 6 months old, babies will rock back and forth on hands and knees. This is a building block to crawling. As the child rocks, he may start to crawl backward before moving forward. By 9 months old, babies typically creep and crawl. Some babies do a commando-type crawl, pulling themselves along the floor by their arms.

To encourage a child’s crawling development, allow your baby to play on the floor in a safe area away from stairs. Place favorite toys just out of reach as the baby is rocking back and forth. Encourage him/her to reach for his/her toy.

As your baby becomes more mobile, it’s important to childproof your home. Lock up household cleaning, laundry, lawn care and car care products. Use safety gates and lock doors to outside and the basement.

There are many things you can do to help your baby learn to crawl:

• Do tummy time together — tummy time is when you place your baby on their stomach as part of their daily play routine. This helps strengthen and prepare your baby’s head, neck, back and leg muscles for crawling when they’re older. Try tummy time in different locations, such as indoors on a mat or outdoors on a blanket, and talk and sing while you do it. Always supervise your baby during tummy time.
• Play on the floor together — play is how your baby learns and playing with you is fun for your baby. Incorporating movement during your play, such as moving objects from side to side in front of their face or turning pages of a picture book, can help build your baby’s physical skills.
• Encourage reaching — place a favorite object or toy or even you just out of your baby’s reach, to get them reaching and moving. Reaching across the midline is particularly good for their motor development.
• Make your home safe — move any obstacles (such as furniture) out of the way so your baby can crawl around without the risk of getting injured.
• Avoid baby walkers — these do not help your baby’s crawling or movement and can actually delay their crawling. They also result in thousands of injuries every year in the US.

Is crawling an important milestone?

Researchers agree that crawling is an important milestone in terms of a baby learning to independently move around for the first time. For many infants it’s their first opportunity to be able to move by themselves to reach for toys, people or other objects in their environment. This in turn is thought to help with other areas of development such as cognitive (thinking) and behavioral (socio-emotional) development. Crawling enables an infant to learn how to co-ordinate their arms and legs and spatial awareness.

Crawling is a new skill for your baby to learn. Each new skill your baby develops builds on all the previous skills they have learnt, with each one being more complex than the last. Before crawling, your baby has been busy developing skills like controlling their head, moving their arms, sitting up with and without support, rolling over from front to back and back to front, and holding their own weight through their arms and legs. All of these things are important for developing their strength and ability to start crawling and, later, walking. Approximately 10% of babies will never crawl.

In the last two decades, researchers have found that babies are crawling later and later. In 1994, the Back-to-Sleep campaign was launched to place babies to sleep on their backs in a successful effort to reduce the rate of sudden infant death syndrome (SIDS).

In 1998, two separate studies from the United Kingdom and United States ¹⁾ were conducted to assess the impact of babies sleeping on their backs and their motor development.

The studies found that babies who followed the important safe sleep guidelines and slept on their backs in line with the SIDS campaign had a slight delay in sitting, rolling and crawling. However, by 18 months, the delay was no longer relevant. In other words, the toddlers showed no delay and had caught up with their tummy sleeping peers.

The research shows the age a baby starts to crawl (if they even do) and the length of time spent crawling isn’t significant. However, if a baby does crawl, crawling on all fours (hands and knees) as opposed to the ‘bum shuffle’ is considered better. Bottom shuffling babies can be very determined, and sometimes there is absolutely nothing you can do about it. But bottom shuffling is probably the least desirable method of locomotion for a baby, predominantly because it is inefficient compared to four-point crawling, but also because the baby doesn’t get the opportunity to bear weight through their upper limbs for that period in their development.

In 2005, a study ²⁾ noted that back sleeping babies with limited tummy time while they were awake, were more likely to have developmental delays, than back sleepers with plenty of tummy time.

Many scientists believe that crawling is important to develop strength around the shoulders and hips, along with learning to move the arms and legs in a reciprocal motion (one side, then the other side). But, there are many other creative ways an infant can learn to do this, such as climbing, pulling to stand and eventually walking.

How can I encourage my baby to crawl?

1. Give your baby plenty of tummy time, starting from birth. By playing on their bellies, babies develop the muscle strength in their shoulders, arms, back and trunk (torso) that helps them learn to crawl.
2. Encourage your baby to reach for the toys she is interested in. Lay interesting toys at just a short distance from your almost-crawler. See if she is able to move herself toward these objects.
3. Make sure your baby has space to explore that is safe and supervised. Now is the time to begin child-proofing your home. Take a walk through (or better yet, a crawl-through) your home and see what potential hazards may be at your baby’s level.
4. Place the palms of your hands behind your child’s feet when he is on all fours. This stabilizes him and gives him something to “push off” from when he is just learning to crawl.

Parents can start tummy time from as soon as their baby comes home from hospital as a newborn. Parents, siblings and other carers should get down on the ground with their baby and play with them. Take your baby out of the ‘containers’ that restrict his/her movement. Containers are things such as rockers, baby capsules, bouncers, activity centers and jumpers. Containers are lovely baby sitters for short periods (like when you need a shower) but it is so tempting to leave babies in them for long periods. And that’s where babies of today get into trouble.

However, if you feel like something is wrong with your baby and their development, then never be embarrassed to seek help.

Your doctor or physiotherapists are there to support you and even if it is just for reassurance, then that is perfectly okay.

What to avoid

• Baby walkers. Not only are they potentially dangerous, they limit practice time on the floor learning to crawl. Walkers can also hamper muscle development.
• Spending lots of time in baby seats and baby carriers. Babies learn how to crawl, and later pull up to stand and then walk, when they have plenty of time each day to play, move, and explore.
• Pushing your child to learn to crawl. Pressing a child to develop a skill he isn’t ready for can actually slow the learning process.

What if my child is part of the 10% who skip crawling?

For parents concerned about their baby not crawling, it is important to look at the big picture. What is far more important is to consider the wider pattern of development for the baby.

• Was your child late to achieve other gross motor milestones such as head control and sitting? A baby should have developed head control by four months and be sitting independently by nine months.
• What is his/her social development and communication like compared to other babies of the same age?
• Is your child demonstrating an interest in toys that other babies of the same age are playing with? Are they using both sides of their body equally?

Skipping crawling alone is certainly not an indicator of future developmental delay, but if it is combined with other concerns in a baby’s development then it is certainly worth talking to your doctor about.

For babies that do decide to skip crawling and show no other development delays, expert recommends climbing. Climbing is like a big kid form of crawling, with a similar reciprocal pattern of the arms and legs required. Start by encouraging a baby to climb on and off the couch, progress to steps and stairs, and work towards climbing at a playground, on a rock-climbing wall, or climbing a tree.

Expert also recommends playing games like animal walks and races (where children walk or race like an animal would) for children who have skipped crawling. Think dog, bear, rabbit, frog and lizard. They are perfect for simulating crawling and really challenge a young child’s coordination and body awareness.

Another series of activities is ‘heavy work’ activities – like pushing, pulling, loading and lifting. This could mean digging in the sand pit with a shovel, squishing big piles of play dough, ‘helping’ with the groceries or vacuuming, packing up ‘heavy’ toys such as books, tearing up cardboard, playing tug-o-war, or even play wrestling.

These activities all activate the deep receptors in the muscles and joints, something that happens naturally with the crawling process.

Drawing or painting on an upright blackboard or easel is also a good activity as it works the postural muscles around the shoulder and upper back, and gets the elbow, wrist and finger joints and muscles active – a perfect pre-writing activity.

How to child-proof your home for crawling

Now that your baby is crawling, she will soon be pulling up as she prepares to walk. This means she will be able to get to get her hands on objects that had previously been unreachable and are potentially dangerous.

And remember, even though babies are moving around fairly well on their own, they still aren’t able to follow rules about what to touch or not to touch. So it is very important to make sure your home is child-proofed so that your baby has a safe place to play and explore.

Take a walk through (or better yet, a crawl-through) your home and see what potential hazards may be at your baby’s level.

Some obvious things to take notice of:

• Electrical outlets
• Electrical cords
• Baby gates on all stairs—top and bottom
• Toilet seat locks
• Plant stands (as well as other “tippy” tables)
• Houseplants within baby’s reach
• Poisonous home cleaning supplies within baby’s reach
• Sharp corners on coffee tables and end tables
• Fragile knick-knacks that can be grabbed or knocked over

By making your baby’s environment as safe as possible, you are creating the perfect space to support her growing skills and healthy development.

What are physical developmental delays?

Physical developmental delays are when children aren’t doing activities (like rolling over, sitting without support, or walking) that other children their age are doing. Developmental delays can be a sign of a serious health condition, so it’s important to talk with your child’s pediatrician about them.

When parents first notice signs of physical developmental delays, they include worries like:

• My child doesn’t seem to be growing the way he should.
• My child seems very stiff and tight in the way she moves.
• My child is weak and limp like a rag doll.
• My child isn’t keeping up with children of the same age when they play together.
• My child seems to get tired very quickly.

If these worries sound familiar, it’s important to talk with your child’s pediatrician about signs of physical developmental delay.

If you’re worried about other developmental issues, like social, emotional, communication, or learning, visit the American Academy of Pediatrics Learn the Signs. Act Early. for free an interactive online tool that can help parents of children ages 5 and under to use when they are concerned about their child’s motor development (https://www.healthychildren.org/English/MotorDelay/Pages/default.aspx). This online tool only focuses on a child’s physical development. The tool lists physical activities by the age at which they are typically performed. If you are concerned that your child has not achieved a certain milestone or if there have been setbacks, you can click on boxes included next to activity descriptions (https://www.healthychildren.org/English/MotorDelay/Pages/default.aspx). This creates a list – with space for notes – that can be taken to the next pediatrician appointment.

Motor developmental milestones for children from baby to 5 years of age

Newborn

• Turns head easily from side to side. When lying on back, moves head one way and then another.
• Comforts self by bringing hands to face to suck on fingers or fist.
• Keeps hands mostly closed and fisted.
• Blinks at bright lights.

1 Month

• Raises head slightly off floor when lying on stomach.
• Holds head up momentarily when supported.
• Keeps hands in closed fists.
• Comforts self by sucking on fist or fingers.

2 Months

• Holds head up and begins to push up with arms when lying on stomach.
• Makes smoother movements with arms and legs.
• Moves both arms and both legs equally well.
• Brings hands to mouth.

3 Months

• Lifts head and chest when lying on stomach.
• Moves arms and legs easily and vigorously.
• Shows improved head control.

4 Months

• Holds head steady without support.
• Grabs and shakes toys, brings hands to mouth.
• Pushes down on legs when feet are placed on a hard surface.
• Pushes up to elbows when lying on stomach.
• Rocks from side to side and may roll over from tummy to back.

6 Months

• Rolls over in both directions.
• Begins to sit with a little help.
• Supports weight on both legs when standing, and might bounce.
• Rocks back and forth on hands and knees, may crawl backward before moving forward.

9 Months

• Gets in and out of sitting position, and sits well without support.
  Creeps or crawls.
• Pulls to stand and stands, holding on.
• Begins to take steps while holding on to furniture (cruising).

12 Months

• Pulls to stand and walks holding on to furniture.
• Gets into sitting position without help.
• Begins to stand alone.
• Begins to take steps alone.

18 Months

• Walks alone, and begins to run and walk up steps.
• Walks backward pulling toy.
• Feeds self with spoon and drinks with cup.
• Helps dress and undress self.

2 Years

• Kicks a ball forward.
• Throws a ball overhand.
• Walks up and down stairs holding on.
• Stands on tiptoes.
• Begins to run.
• Climbs on and off furniture without help.
• Puts simple puzzles together.

3 Years

• Climbs and runs well.
• Walks up and down stairs, with one foot on each step.
• Jumps with both feet, and may hop on one foot.
• Pedals tricycle or three-wheel bike.

4 Years

• Catches a bounced ball most of the time.
• Hops and stands on one foot for a few seconds.
• Pours beverages, cuts with supervision and mashes own food.

5 Years

• Hops and may be able to skip.
• Does somersaults.
• Uses a fork and spoon, and sometimes a table knife.
• Stands on one foot for at least 10 seconds.
• Uses the toilet independently.
• Swings and climbs.

If my child isn’t doing activities by a certain age, does that mean he or she has a physical developmental delay?

Probably not, but it’s important to find out for sure. Usually a child who is late doing certain activities will catch up to other children. But sometimes developing late is the sign of a health condition. Spotting these signs and finding the health condition as early as possible will help your child get the care he or she needs to grow and develop.

My child was born prematurely (before 37 weeks of pregnancy). Do I need to wait until he’s older to worry about physical developmental delays?

If your child was born prematurely, it’s important to know that your child may develop later than other children of the same age. For example, if your child was born 2 months early, he may be 14 months old before he meets the milestones for a 12 month old born at term. Talk to your child’s pediatrician about what to expect from your child’s physical development.

How babies learn to crawl

A baby’s first jump forward might actually be a scoot backward. As babies figure out how to do that arm-leg-arm-leg crawling movement, they sometimes go backward first, and then learn how to crawl forward. So, for a while, babies might cry in frustration as they somehow finds themselves scooting away from the very object or person they are so determined to reach.

The process of learning to crawl differs among babies as they work out a way to move that is unique to them. Some ways babies learn to move:

• The “I’ll Have the Usual”: This is the classic crawl—alternating hand on one side and knee on the other to go, go, go.
• The “Crab”: Just like at the beach, the “crab” bends one knee and extends the opposite leg to scoot forward.
• The “Commando”: This crawler lies flat on her belly and drags herself forward using her arms.
• The “Rolling Wonder”: Who needs to crawl when rolling gets me where I need to go?
• The “Take It in Stride” Kid: Some children skip crawling and go right to walking. No time to waste—here I come.

There’s no right or wrong way to crawl. As long as a baby is making progress in his ability to use his body to get around, that’s what is important.

When do babies sit up?

Babies must be able to hold their heads up without support and have enough upper body strength before being able to sit up on their own. Babies often can hold their heads up around 2 months, and begin to push up with their arms while lying on their stomachs.

At 4 months, a baby typically can hold his/her head steady without support, and at 6 months, he/she begins to sit with a little help. At 9 months he/she sits well without support, and gets in and out of a sitting position but may require help. At 12 months, he/she gets into the sitting position without help.

Tummy time helps strengthen the upper body and neck muscles that your baby needs to sit up. Around 6 months, encourage sitting up by helping your baby to sit or support him/her with pillows to allow him/her to look around.

When do babies roll over?

Babies start rolling over as early as 4 months old. They will rock from side to side, a motion that is the foundation for rolling over. They may also roll over from tummy to back. At 6 months old, babies will typically roll over in both directions. It’s common for babies to roll over from tummy to back for a month or two before rolling over from their back to front.

To encourage rolling over, place your baby on a blanket on the floor with a toy or book to one side near him/her to reach toward with her arms.

When do baby teeth start

Babies are usually born with 20 baby teeth (also known as primary teeth, milk teeth or deciduous teeth). Baby teeth start to come through the gums at about 6 months and all the teeth have usually appeared by the time the baby is 2 to 3 years of age. This process is called teething. Baby teeth will fall out at various times during childhood.

Table 1: General guide of when baby teeth appear

Tooth type	Age
Central incisors	6 to 10 months
Lateral incisors	10 to 16 months
Canine	17 to 23 months
1st baby molar	14 to 18 months
2nd baby molar	23 to 31 months

Babies are born with the following teeth:

• 4 second molars
• 4 first molars
• 4 canine teeth
• 4 lateral incisors
• 4 central incisors.

There is one set on each side of the upper jaw, and one on each side of the lower jaw.

Baby teeth help your child to chew food easily and to pronounce words properly. They are also needed to hold a place in the jaw for the permanent teeth to come through later.

It is important to keep baby teeth clean. This will protect against infection, cavities and pain. Decayed baby teeth can damage the permanent teeth underneath.

Your child’s jaw will continue to grow and permanent teeth will start to replace the baby teeth when the child is around age 6.

The outer covering of baby teeth is made of thinner enamel than the enamel of permanent teeth and this makes the baby teeth look whiter. It also means they are more likely to get tooth decay.

Baby teeth also have shorter and different shaped roots from permanent teeth, making it easier for the roots to dissolve later and to allow space for permanent teeth to grow underneath them.

Babies can be quite uncomfortable when they are teething. Try chilled (not frozen) teething rings, wash cloths or dummies to ease the pain.

Usually teething doesn’t cause children too much discomfort, however, many parents can tell when their baby is teething. Babies may show signs of discomfort in the area where the tooth is coming in, the gums around the tooth may be swollen and tender, and the baby may drool a lot more than usual.

Parents can help ease teething pain by massaging their baby’s gums with clean fingers, offering solid, not liquid-filled, teething rings, or a clean frozen or wet washcloth. If you offer a teething biscuit, make sure to watch your baby while he or she is eating it. Chunks can break off easily and can lead to choking. Also, these biscuits are not very nutritious and most contain sugar and salt.

A baby’s body temperature may slightly rise when teething; however, according to a 2016 study in Pediatrics ¹⁾, a true fever (temperature over 100.4 ° Fahrenheit or 38 ° Celsius) is not associated with teething and is actually a sign of an illness or infection that may require treatment. If your baby is clearly uncomfortable, talk with your pediatrician about giving a weight-appropriate dose of acetaminophen (e.g., Tylenol) or if over 6 months, ibuprofen (e.g., Advil, Motrin). Make sure to ask your pediatrician for the right dose in milliliters (mL) based on your child’s age and weight.

DO NOT use teething tablets, gels with benzocaine, homeopathic teething gels or tablets, or amber teething necklaces.

Stay away from teething tablets that contain the plant poison belladonna and gels with benzocaine. Belladonna and benzocaine are marketed to numb your child’s pain, but the FDA has issued warnings ²⁾ against both due to potential side effects.

In addition, amber teething necklaces are not recommended. Necklaces placed around an infant’s neck can pose a strangulation risk or be a potential choking hazard. There is also no research to support the necklace’s effectiveness.

Many children, however, will have no problems at all when their teeth come in.

Figure 1. Baby teeth

How many baby teeth?

Babies are usually born with 20 baby teeth.

What order do baby teeth come in?

The teeth in the center of the bottom jaw (the lower central incisors) often come through first, sometime between 4 months and 10 months.

Each baby is different so don’t worry if your baby’s teeth appear earlier or later. Talk to your dentist if you are worried.

Most babies will develop teeth between 6 and 12 months.

There is a wide range of variability of when a first tooth may appear—some babies may not have any teeth by their first birthday! Around 3 months of age, babies will begin exploring the world with their mouth and have increased saliva and start to put their hands in their mouth. Many parents question whether or not this means that their baby is teething, but a first tooth usually appears around 6 months old. Typically, the first teeth to come in are almost always the lower front teeth (the lower central incisors), and most children will usually have all of their baby teeth by age 3.

Figure 2. Baby teeth coming in order

Abbreviations: mos = age in months; yrs = age in years

How to care for baby teeth

Baby teeth can start to decay as soon as they appear in the mouth. Frequent exposure to sugary liquids can destroy baby teeth.

You should wipe your baby’s gums with a wet facecloth or a clean gauze pad after each feed. You can brush your baby’s first tooth as soon as it appears with a soft toothbrush and a little water.

Fluoride should be added to your child’s diet at 6 months of age. Fluoride is a mineral that helps prevent tooth decay by hardening the enamel of teeth. The good news is that fluoride is often added to tap water. Give your baby a few ounces of water in a sippy or straw cup when you begin him or her on solid foods (about 6 months of age). The American Academy of Pediatrics, along with the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC), agree that water fluoridation is a safe and effective way to prevent tooth decay. Speak with your pediatrician to see if your tap water contains fluoride or whether your child needs fluoride supplements. Fluoride is not typically found in most bottled water.

According to the American Dental Association, it is safe to use fluoridated water to mix infant formula. The risk if mixing infant formula with fluoridated water is mild fluorosis (see below for more information on this condition). However, if you have concerns about this, talk with your pediatrician or dentist.

Older children should be supervised while they are cleaning their teeth. Children over 18 months can use a pea-sized amount of children’s low-fluoride toothpaste and should be taught not to swallow it. They should rinse with water after brushing.

To reduce the risk of tooth decay:

• never allow your baby to fall asleep with a bottle containing milk, formula, fruit juice or sweetened liquid
• don’t dip a dummy in sugar or honey
• clean the dummy before you give it to your baby
• visit your dentist by about 12 months.

If you are worried about your baby’s tooth development, call your dentist.

What if we live in a community where the water is not fluoridated? What can we do?

Check with your local water utility agency to find out if your water has fluoride in it. If it doesn’t, ask your pediatrician or dentist if your child is at HIGH risk for dental caries (also known as tooth decay or a cavity). He or she may recommend you buy fluoridated water or give you a prescription for fluoride drops or tablets for your child.

How else can my child get fluoride?

There are many sources of fluoride. Fluoridated water and toothpaste are the most common. It is also found in many foods and beverages. So making sure your child eats a balanced diet with plenty of calcium and vitamin D is a great way to keep teeth healthy. Your dentist or pediatrician may also recommend a topical fluoride treatment during well child or dental visits at various stages of your child’s development.

When should my child start using fluoride toothpaste?

The American Academy of Pediatrics and the American Dental Association recommend using a “smear” of toothpaste (the size of a grain of rice) on children once the first tooth appears and until your child is 3, especially after the last drink or food of the day. Once your child has turned 3, the American Academy of Pediatrics, the American Dental Association (ADA), and the American Academy of Pediatric Dentistry recommenda pea-sized amount can be used. When your child is able, teach him or her to spit out the excess toothpaste. It is best if you put the toothpaste on the toothbrush until your child is about age 6. Parents should monitor and assist their child while brushing until he or she is around 7 or 8 years old. When your child can write his or her name well, he or she also has the ability to brush well.