Your questions on breast, bottle and mixed feeding have been answered by MAM's expert midwife, Katie Hilton

[BellaMumsnet]

Whether you’re a first time parent or have had babies before, feeding newborns and infants can raise a host of questions. Katie Hilton, MAM’s expert midwife and nurse, is here to help you find answers.

Katie is a dual qualified nurse, midwife and health visitor. Her experience has been mainly in labour delivery, postnatal and public/family health settings in hospitals and in the community. She has experience working with families in the UK, North America and Asia. Her specialist areas include infant feeding, sleep and child development. She currently practises independently as a midwife and health visitor and provides specialist advice to parents and families on behalf of the parenting press and nursery industry brands.

Here’s what MAM has to say: “Here at MAM we believe in supporting every mum on their feeding journey, whichever journey they choose. We want mums to join us in supporting each other, whether you opted for breast, bottle, or combination feeding, MAM has a solution to help parents feel confident and babies feel good. We know lots of parents end up opting for combination feeding - ie using a combination of breast and bottle feeding, whether with breastmilk or formula milk - and this can be a tricky thing to get good advice on, so if you've got any combi-feeding questions we'd love to hear them. Any question or experience shared could go on to help another mum out there.”

So whatever your question about feeding babies, if you'd like some advice please post your questions on this thread for Katie to answer. Katie will be back between the 25th January and the 5th February to answer your questions.

All who share a question on the thread below will be entered into a prize draw where one lucky Mumsnet user will win a £200 voucher for a store of their choice.

Thanks and good luck!

MNHQ

Insight Terms and Conditions apply

@FingersCrossedForAllOfUs

Some great questions here already many of which I’d like answers to as well!

I am due in April with our first baby, I am hoping to breast feed if I can and I would like to also express ideally. I’ve read that a double electric pump is a good idea but on the research I’ve done not all pumps suit all women and I often see a couple of good reviews followed by a couple of bad ones so I can’t work out which one to buy. Before spending a lot of money could you please give some tips on which pump might be best? Is there one type/model that tends to suit most women?
Thank you.

Hello @FingersCrossedForAllOfUs, thank you for your question. I always go back to the basics first when selecting a pump, so consider how often you want to pump and what your budget will be. Many women feel they need to choose between a manual and electric pump but MAM offer a 2-in-1 pump in both a single and double version. Which means you can use the pump in manual mode maybe when first starting to pump or if you have a touch of engorgement (minimal pumping to avoid overstimulation), and then you can use it in electric mode when pumping a full feed. I find if you want to pump occasionally or say once per day then the single electric is great but if you're for example going back to work and want to offer purely expressed breastmilk, and will need to pump multiple times per day, then a double electric would be more efficient.

@SayNoMor

I found that my sister in law started her DD on cow's milk at what I considered to be an early age. When is the perfect time to transition?

Hello @SayNoMor, thank you for your question. Cow's milk is not recommended until 12 months of age.

@Whytie

How do you know your babies are getting enough breast milk?

Hello @Whytie, thank you for your question. There are a number of clear indicators that a baby is getting enough breastmilk. The first would be baby's weight gain: we know that most babies lose roughly 10% of their birth weight, which is totally normal and is part of them adapting to life outside of the womb. Most babies regain their birth weight by around 10 days of age; some tend to be slower than others but as long as your midwife or health visitor can see baby is getting towards there, they will be happy. The next indicator would be 6-8 heavy wet nappies and 2-3 dirty nappies in a 24 hour period. Baby should have good muscle tone, good skin colour and be generally active, alert and content after a feed. You can also feel the little soft spots on baby's head (fontanelles). Baby will have 2, one which is a diamond shape towards the front of the head and a small triangular one towards the back of the head (don't worry, these eventually close up!). If baby is dehydrated these will be sunken.

@mophia

Is combi-feeding necessary? What brands are best, especially if you come from a family with allergies?

Hello @mophia, thank you for your question. Combi-feeding is not necessary, it is totally a parent's choice. I would always tell parents about the benefits of breastfeeding and would never withhold information if a family asked me how to combi-feed. Some parents choose to combi-feed for a variety of reasons, which is totally personal to them. You can combi-feed with either expressed breastmilk or formula.

@salemaxo

Is there such a thing as over feeding when it comes to combi-feeding?

Hello @salemaxo, thank you for your question. Ideally when a baby is being fed with a bottle a paced responsive feeding technique should be used. Using this technique you remain responsive to your baby's cues and needs. If baby at any point shows signs of having had enough by either falling asleep, turning away from the bottle or pushing the bottle away then it's important to stop feeding, regardless of how much baby has taken during the feed. If you continued to feed baby then there is a risk of over-feeding. However most babies who have taken too much will bring the feed back up.

@alshareif

What advice would you give to women who are not able to produce as much breast milk?

Hello @alshareif, thank you for your question. So firstly it's important to establish if you do truly have low milk supply. One of the best ways of identifying this is through baby's weight gain. We know that most babies lose roughly 10% of their birth weight, which is totally normal and is just part of them adapting to life outside of your womb. Most babies regain this weight by 10 days of age, although some are a little slower than others. As long as your midwife/health visitor can see baby is getting towards that weight, they'll be happy. Along with good weight gain we should also see roughly 6-8 heavy wet nappies and 2-3 dirty nappies in a 24 hour period. Baby should be alert, and have good muscle tone, good skin colour and be generally content after a feed. If we don't see these things then it can be indicative of a low milk supply. Get someone to check baby's positioning and latch in case this is the cause. Try to feed baby at least every 2-3 hours day and night, with lots of skin to skin. You can do something known as 'switch feeding', in which you would switch breasts every 5 minutes for a total of 20 minutes. You might consider starting to pump between feeds to boost your supply. To help your supply use a warm compress over the breasts both before and during pumping, use breast massage again before and after, and ensure you're well hydrated as dehydration can lead to low milk supply, so perhaps keep a glass of water at the side of you whilst pumping.

KatieHiltonMAM please stop telling mums that loosing roughly 10% of their birthweight is normal. In many areas this is enough for babies to be readmitted to hospital in some areas. Many babies loose far less than this.

"Hello @SayNoMor, thank you for your question. Cow's milk is not recommended until 12 months of age."

KatieHiltonMAM for goodness sake get your facts straight, cows milk is not recommended as a main drink before 12m but can be used as part of meals.

I was thinking the same @Bert2e 🙄 we definitely need more mums trying to express milk for their baby's weetabix they've been incorrectly told they can't use cows milk.

@SpamIAm or buying expensive formula because they think they need to and feeling that they don't have enough milk when they try to express and can't get much out and therefore buying formula so that their milk supply does dwindle. THIS is what happens when you ask someone to answer questions about bf who has a clear conflict of interest. KatieHiltonMAM how do you justify answering questions on bf when you do not uphold the WHO code yourself? And could you tell us what qualifications you have that make you an expert in this field?

@zindeggeh

I know this isn't related to breastfeeding per se, but do you think dummies affect a babies feeding habits?

Hello @zindeggeh, thank you for your question. Soothers and feeding are a difficult topic because we know that a baby settled to sleep with a soother has a reduced risk of SIDS, but then it can sometimes interfere with establishing breastfeeding. I think it has to be a personal choice as a family, but most breastfeeding parents will choose to delay using a soother until their breastfeeding is established at 6-8 weeks of age.

@uggpug

Interested to know if it's normal to be able to breastfeed but not pump much? I always struggled to get much from a pump e.g. when I went back to work. Any tips for improving pumping supply and when to start pumping?

Hello @uggpug, thank you for your question. Try to pump at the same time each day. First thing in the morning is a particularly good time as your body makes more milk in the morning. Ensure you're well hydrated, as dehydration can lead to a low milk supply. Keep to a consistent routine of pumping. Use a warm cloth on your breasts before pumping and do a little hand massage.

@Octoblockswim12345678swim

I'm struggling to get my five month old to take any kind of milk from a bottle. So far he's been EBF. Are there any tips you can share as to how best to encourage him to take a bottle? Time of day, person, trying when he's really hungry or not too hungry etc. I don't know what to do for the best. I'm just aiming for one bottle a day. Thanks

Hello @Octoblockswim12345678swim, thank you for your question. This is a common issue many families experience, have you tried using a paced responsive feeding technique? I would recommend watching a video of the technique. The technique allows baby to feed in a similar way to feeding at the breast and really assists in the continuation of breastfeeding.

@lauren987

Do I need to buy new bottles for baby number 2 or can I reuse?

Hello @lauren987, thank you for your question. It really depends on the condition of your bottles. If they are still in good condition then you can just buy new teats.

@Sarah84848484

I worked my way up the test sizes from 1-4... why can’t you start a baby straight away on size 4?

Hello @Sarah84848484, thank you for your question. The teat numbers relate to the speed of the flow of milk. So a stage 1 would be slow flow, which is suitable for a newborn baby. You would then move onto a stage 2, medium flow, around 8-12 weeks of age, and finally a stage 3, which is fast flow, around 6 months of age.

"ensure you're well hydrated as dehydration can lead to low milk supply, so perhaps keep a glass of water at the side of you whilst pumping."

@KatieHiltonMAM please can you show where you get the evidence to support this statement? Nancy Mohrbacher in 2010 states "Contrary to popular belief, drinking more fluids is not associated with greater milk production." Some studies show excess fluid consumption actually reduces milk production (Illingworth RS, Kilpatrick B. Lactation and fluid intake. Lancet. 1953;2:1175. Lawrence (2005 ed, p. 326)) and several other studies show no effect on milk production. Please do share references to the contrary if you have them.

Sorry complete ref for the Lawrence paper: Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. Philadelphia, Pennsylvania: Mosby, 2005: 325-326.

We know that most babies lose roughly 10% of their birth weight,

Some babies lose weight, anything up to 8% is considered normal.

And it's rarely a low supply, more often a milk transfer issue.

Or midwives suggesting supplementary feeding with EBM or AF rather than spending time dealing with the real issues.

So we've had the dehydration thing which had been addressed and evidence posted, the misleading cows milk advice, recommending a certain brand of pump and we've had saying that losing up to 10% of body weight being normal. Which it isn't. It might be common to lose weight but that doesn't make it normal and the whole clinical picture including maternal factors and labour and birth need to be taken into account.

Please, please nobody use these answers for advice.

Use first steps nutrition, unicef, videos on things like the baby buddy app or global health media.

@ruqiya1965 no offence but you don't need to understand why anyone else doesn't want to breastfeed. It's not your business is it? I found your comment a bit rude and unnecessary. Nobody should have to justify themselves based on who they choose to feed their baby.
I exclusively formula fed. I always knew I never wanted to even try breastfeeding or expressing, so I didn't. It wasn't for me at all. I never liked the idea of it and I'd just always known that no matter what I'd never even try it. It was my decision and I've never once regretted it.
Fed is best, how is irrelevant.

How do you know your babies are getting enough breast milk?

The next indicator would be 6-8 heavy wet nappies and 2-3 dirty nappies in a 24 hour period.

Surely this depends on age of baby? Day one 6-8wet nappies is a little optimistic.

Also colour of stool is significant here and not mentioned.

'Aptamil' is suppose to be closest to breastmilk I am told. I have breastfed 5 children and believe in giving breast as much as possible during the first year. All the powdered milks should be is backup and for supplementing. I think some people just fuss to much about breast/ bottle etc.....and stress out other people new to feeding. Chill and baby will chill with you. If your baby is the one to fuss, it could be birthtrauma and a trip to a chiropractor could help sort any issues with spine. Also a homeopath can help with anything else. Babies have been born for milions of years and we managed fine before these so called healthvisitors came along telling mothers how to do things. All they do is stress mothers out about silly things and most of them have no children of their own but 'learnt' thru books!

I use 'NUK first choice' as the teat is shaped after a mums nipple. My children all loved them.

@honeybee Aptimil had a very successful and very against the law advertising campaign that said they were closest to breastmilk and unfortunately this myth still persists they are not. Nobody's formula is closest to breastmilk. All artificial milks contain the same basic nutrients. Anything else is just advertising. There is no evidence base to fully support the claims that anything else added to their milks is beneficial. If it were proven to be beneficial then it would need to be added to all milks.

Again, first steps nutrition is the place to go for accurate and brilliantly helpful information about what is in formula milk and comparing brands.