BREAST, BOTTLE, OR BOTH — FEEDING, YOUR WAY

The first hours and days: colostrum

In the first days after birth, your body produces colostrum — a thick, concentrated fluid that is exactly what your newborn needs in those early hours. It is produced in small quantities, which is appropriate because your newborn’s stomach is very small. This is not a sign that your supply is low. It is the system working correctly.

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Milk coming in

Mature milk typically comes in between day 2 and day 5 after birth, though this varies. When it does, your breasts may feel full, firm, or tender. This is normal and usually settles within a few days as your body begins to calibrate supply toyour baby’s demand.

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How supply works

Breast milk operates on a supply-and-demand system. The more milk is removed — throughfeeding or expressing — the more your body produces. This means that in theearly weeks, frequent feeding is not a sign that something is wrong. It is how supply gets established. Most breastfeeding challenges in the early weeks have their roots here: if feeding is painful, if latch is difficult, or if feeds are being missed, supply can be affected before parents realise what is happening.

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The let-down reflex

When your baby feeds, your body releases oxytocin, which triggers the let-down reflex — the release of milk from the ducts. Some parents feel this as a tingling or rushing sensation. Others feel nothing at all. Let-down can also be triggered by hearing your baby cry, or inhibited by stress or pain. Both are normal.

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Why it can be hard

Breastfeeding is a learned skill — for you and for your baby. The fact that it is biologically natural does not mean it comes naturally to every mother and baby pair. Latch, positioning, supply, pain, and confidence all interact. Most difficulties are solvable with the right support, caught early enough.

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Sources

(1) Victora CG et al. ‘Breastfeeding in the 21st century.’ The Lancet, 2016.

(2) Lawrence RA, Lawrence RM. ‘Breastfeeding: A Guide for the MedicalProfession.’ Elsevier, 2022.

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How often will my baby want to feed?

In the first weeks, most newborns feed between 8 and 12 times in a 24-hour period — roughly every 2 to 3 hours, though this is rarely that regular in practice. Some feeds will cluster together, others will be further apart. Feeding on demand — responding to your baby’s hunger cues rather than watching the clock — is the approach most widely recommended in the early weeks, both for your baby’s nutrition and for establishing your supply (1). As babies grow, the number of feeds per day typically decreases gradually. By 3 to 4 months, many babies have settled into a more predictable rhythm, though there is wide variation between babies.

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Tracking feeds — helpful tool or source ofanxiety?

Many parents use an app to log the time, duration, and frequency of feeds, and in the early weeks this can be genuinely useful. It helps you spot patterns, gives you something concrete to report to your midwife or health visitor, and can be reassuring when everything feels uncertain. It is worth being aware, though, that for some parents tracking becomes a source of anxiety in itself — a feed that is shorter than the last one, or a gap that is longer, can feel like a problem even when it is not. If you notice that checking the app is making you more anxious rather than less, it may be worth stepping back from it. What your baby is telling you — whether they seem satisfied, settled, and growing —matters more than the numbers on the screen.

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How long should a feed last?

There is no single correct answer, and this is one of the things that surprises many new parents. A feed can last anywhere from 5 minutes to 45 minutes depending on your baby, your flow, and how hungry they are. Some babies are efficient feeders who finish quickly and are satisfied. Others feed slowly, take breaks,or use the breast for comfort as well as nutrition. Both are normal. What matters more than duration is whether your baby seems satisfied after a feed, is gaining weight well, and is producing enough wet and dirty nappies. A feed that ends in 8 minutes is not necessarily insufficient — some babies simply transfer milk very efficiently. If you are ever unsure whether your baby is getting enough, a lactation consultant can carry out a weighted feed, which measures actual milk intake directly.

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Cluster feeding

Cluster feeding is the name for periods when your baby wants to feed very frequently —sometimes almost continuously — over several hours, usually in the late afternoon or evening. It is completely normal and very common, particularly in the first weeks and during growth spurts (3). The most widely understood reason for cluster feeding is that it helps drive up milk supply ahead of a growth spurt — your baby is, in effect, placing a larger order. But cluster feeding also serves another purpose that is less often talked about: comfort and regulation. For some babies, being at the breast for extended periods helps them manage overstimulation, wind down at the end of a busy day, or simply feel settled when they are unsettled. This is particularly relevant for babies with colic. Many parents of colicky babies find that cluster feeding increases significantly during fussy periods — not because their baby is hungry, but because the breast provides warmth, closeness, and a rhythm that soothes them when nothing else does. If this is your experience, it does not mean your supply is low or that you are feeding incorrectly. It means your baby has found something that helps. Cluster feeding is tiring, and it can feel relentless inthe moment. Knowing that it is a phase — and that it usually has a developmental or comfort purpose — can make it a little easier to move through.

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Sources

(1) Victora CG et al. ‘Breastfeeding in the 21st century.’ The Lancet, 2016.

(3) KentJC et al. ‘Volume and frequency of breastfeedings and fat content of breastmilk throughout the day.’ Pediatrics, 2006.

Latch difficulties

A poor latch is the most common root cause of breastfeeding pain and supply problems. When a baby latches shallowly — taking only the nipple rather than a good portion of the areola — it causes pain for the mother and means the baby cannot effectively transfer milk. Signs of a poor latch include nipple pain during or after feeds, a clicking sound while feeding, or a baby who feeds frequently but seems unsatisfied. A lactation consultant can assess latch directly and make adjustments that often resolve pain within days.

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Nipple shape

Some mothers find that breastfeeding is difficult in the early days simply because of nipple shape. Flat or short nipples — where the nipple does not protrude much naturally — can make it harder for a newborn to latch deeply, particularly in the first days when both mother and baby are still learning. What often happens is that the baby’s sucking action gradually draws the nipple out over time. Ther epeated suction stretches the tissue in a way that nothing else quite replicates, and many mothers find that what was genuinely difficult in the first week becomes much easier by week two or three, without any intervention. This is not something that is widely talked about — which means many mothers assume the difficulty is permanent when it is not. In the meantime, a few approaches can help. Hand-expressing or using a pump for a minute or two before a feed can help draw the nipple out before your baby latches. Nipple shields —thin silicone covers that give a baby more to latch onto — can also bridge the gap in the early days, though they work best when used with guidance from a lactation consultant, who can help you use them in a way that does not affect your supply.

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Nipple pain and soreness

Some tenderness in the first days is normal as your body adjusts. Persistent or sharp pain —especially pain that continues throughout a feed or between feeds — is not something you have to accept. It is almost always a sign that something can be improved, most often latch or positioning.

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Engorgement

When milk comes in — usually between day 2 and day 5 — your breasts may become very full, firm,and tender. This happens because milk is accumulating in the ducts faster than it is being removed, and the surrounding tissue swells with increased blood flow and fluid as your body ramps up production. The ducts can become compressed, which makes it harder for milk to flow freely — and harder for your baby to latch onto a taut, unyielding breast. One cause that is easy to overlook is a bra that is too tight. External pressure on the breast tissue can compress the milk ducts in exactly the same way, preventing milk from draining properly and triggering or worsening engorgement. If you are experiencing engorgement, it is worth checking that your bra — including at night — is not pressing into the breast tissue at any point. The most effective solution is to remove milk from the breast. Feeding your baby on demand is the first response — latching your baby directly to the breast drains the ducts, relieves the pressure, and signals to your body to begin calibrating supply. If your baby is struggling to latch onto a very full breast, gently hand - expressing or using a pump for a short time before a feed can soften the breast enough to help. If engorgement is severe or persists beyond a few days, a lactation consultant can guide you through safe relief strategies.

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Low milk supply — perceived and actual

Concerns about milk supply are among the most common reasons parents stop breastfeeding earlier than they planned. It is worth knowing that genuine low supply — wherethe body cannot produce enough milk — is actually uncommon (5). What is much more common is perceived low supply: a baby who feeds frequently, is fussy, or is going through a growth spurt, and a parent who understandably interprets this as not having enough milk. A lactation consultant can assess whether supply is genuinely a concern and help you distinguish between the two.

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Mastitis

Mastitis is an inflammation of the breast tissue, usually caused by milk not draining properly, and it affects around 10% of breastfeeding mothers (4). It causel ocalised pain, redness, swelling, and often flu-like symptoms. Continuing to feed or express from the affected breast is usually recommended to keep milk moving. If symptoms do not improve within 12 to 24 hours, or if you develop a fever, see your GP — mastitis can sometimes require antibiotic treatment.

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Tongue tie

Tongue tie —where the strip of tissue connecting the under side of the tongue to the floor of the mouth is shorter or tighter than usual — can significantly affect a baby’s ability to latch effectively. It is not always obvious and is frequently missed in routine newborn checks. If latch is consistently painful despite adjustments, or if your baby struggles to feed efficiently, it is worth asking for a tongue tie assessment. A lactation consultant can identify the signs and refer you to an appropriate practitioner.

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Sources

(4) Gatti L. ‘Maternal perceptions of insufficient milk supply inbreastfeeding.’ Journal of Nursing Scholarship, 2008.

(5) AmirLH. ‘Mastitis.’ BMJ Clinical Evidence, 2014.

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Early support matters most‍

The window between birth and around two weeks is when most breastfeeding difficulties either resolve or become entrenched. Latch problems that are identified and addressed in the first week rarely become the reason someone stops feeding. The same problems left unaddressed for a month are much harder to turn around — not impossible, but harder. If something is not working, seeking support early is the single most effective thing you can do.

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Positioning and latch adjustments

Many breastfeeding difficulties are positional. Small adjustments — to how you hold your baby, the angle of feeding, or the way you bring your baby to the breast — can make a significant difference to both comfort and milk transfer. This is something a lactation consultant can assess and guide in person, in a way that online resources or written guides often cannot.

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A note on your wellbeing

Struggling with breastfeeding is genuinely hard — not just physically but emotionally. If feeding is painful, if you are not sleeping, if you feel anxious every time your baby wants to feed, that matters. Your mental health is not separate from your breastfeeding experience — it is part of it.

Whatever you decide about how to feed your baby, that decision is yours to make. Breastfeeding is a choice, and so is stopping. If you decide to stop — for any reason, at any point — you do not need to justify it to anyone. A postnatal wellbeing coach can support you through that transition if you need it.

What to rule out first

If you or your baby seem unwell — fever, significant weightloss, signs of infection — always see your GP or midwife before focusing on breastfeeding adjustments. Medical issues need to be addressed first.

Sources:

(1) Victora CG et al. 'Breastfeeding in the 21st century.' The Lancet, 2016. thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7

There is no single right way to feed a baby

Parents arrive at bottle feeding by many different routes. Some plan it from the start. Some move to it when breastfeeding turns out to be painful, unsustainable, or simply not what they want. Some combine breast and bottle. Some bottle feed because of low supply, a medical issue, returning to work, sharing feeds with a partner, adoption, or because it protects their own mental health. Every one of these is a legitimate reason, and none of them requires an explanation to anyone. What matters is that your baby is fed, growing, and close to you.

Formula or expressed milk — both count

Bottle feedingcovers two things: infant formula, and breast milk that has been expressed andgiven by bottle. Many parents use a mix of the two. Expressed breast milk letssomeone else share feeds while your baby still receives your milk; infant formulais a complete, regulated source of nutrition designed to meet a baby’s needs inthe first year. Whichever you use, the practical skills — how you prepare,hold, and pace a bottle — are largely the same, and the next cards walk throughthem.

Letting go of the guilt

A great deal of distress around infant feedingcomes not from the feeding itself but from the feeling of having fallen shortof a plan. If that is where you are, the simple truth is this: a feed that issafe and that you can keep up is good parenting — not second best. Your babygets the same closeness, eye contact, and comfort at the bottle as at thebreast.

Which formula does my baby need?

For almost all babies, a standard infant formula (usually whey-based) is the only formula needed for the entire first year, until they move on to cow’s milk as a main drink at around 12 months. Brands are more similar than their marketing suggests, all meeting the same compositional rules, so there is rarely a reason to switch between them. Specialist formulas — for example for cow’s milk allergy or reflux — should only be used on the advice of your GP, health visitor, or paediatrician, not chosen independently.

Why preparation matters

Powderedformula is not a sterile product — the powder itself can occasionally containbacteria such as Cronobacter. Making feeds up with water that is hot enoughkills these bacteria, which is why the standard guidance is to prepare eachfeed with freshly boiled water that has cooled for no more than around half anhour, so it is still hot (around 70°C / not below). The made-up feed is thencooled quickly — holding the bottle under running cold water — until it is bodytemperature, tested by dripping a little on the inside of your wrist (6).

Always followthe instructions on the packaging and the current guidance of your nationalhealth authority, as the precise method and temperatures are set locally. Measurethe powder with the scoop provided, levelled off, and never add extra powder orextra water. Too much powder can leave your baby dehydrated or constipated; toolittle means they are not getting enough nourishment.

Make up feeds fresh, one at a time

Make up each feed fresh, when your baby needsit — that is the safest approach. If you do need to prepare ahead (for nightfeeds, say, or while you are out), follow your local guidance: cool the feedquickly, keep it at the back of the fridge, and throw away anything kept longerthan the recommended time. At the end of a feed, discard any milk left in thebottle rather than saving it — once your baby has fed, bacteria from theirmouth get into the milk.

Ready-to-feed and sterilising

Ready-to-feed liquid formula is sterile untilit is opened, which makes it a safe, convenient choice for newborns or when youare out. It simply costs more than powder.

Whatever you use, sterilise bottles and teatsfor at least the first 12 months. Wash them thoroughly first, then sterilise bycold-water steriliser, steam, or boiling, following the maker's instructions.

Sources

(6) WHO / FAO. ‘Safe preparation, storage and handling of powdered infantformula: guidelines.’ Geneva, 2007.

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Paced bottle feeding

Paced feeding lets your baby set the rhythm, much as they would at the breast. Hold them fairly upright rather than flat on their back, and keep the bottle close to horizontal with a slow-flow teat, so the milk comes slowly and your baby has to draw it out rather than having it pour in. Brush the teat against their lips and let them take it in themselves, rather than pushing it into the mouth. Then pause now and then, let them have breaks, and switch sides halfway through. Feeding this way reduces overfeeding, wind, and the gulping and milk-refusalth at a fast flow can cause (8).

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Follow your baby’s cues, not the line on the bottle

Responsivefeeding applies just as much to the bottle as to the breast. Watch for hungercues — rooting, hands to mouth, stirring — and offer the bottle before cryingsets in. Just as importantly, watch for fullness: turning away, slowing down,relaxing the hands, or pushing the teat out. If your baby shows these signs,the feed is finished, even if milk remains. Never force a baby to drain abottle. Babies who are allowed to stop when full are better at regulating theirown appetite.

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Hold your baby close

Hold your babyin your arms to feed, rather than propping the bottle and leaving them to it.Propping is a choking risk, because the milk keeps flowing even after your babystops sucking (9). It also misses the closeness that feeding is for: stayclose, make eye contact, talk to them, and have some feeds skin-to-skin. Bottlefeeding is an ideal moment for a partner to share feeds and build their ownbond with the baby.

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Winding

Bottle-fedbabies often take in a little more air, so a pause to wind partway through andagain at the end can help — hold your baby upright against your shoulder or sitthem supported on your lap and gently rub or pat their back. Some babies needit, some barely do.

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How much, how often?

In the earlydays newborns take small amounts frequently, and this settles over the firstweeks. As a very rough guide, from a few weeks old many babies take in theregion of 150–200 ml per kilogram of body weight across a day, spread overseveral feeds — but appetite varies enormously between babies and from feed tofeed, and this is a guide, not a target. Feed responsively rather than imposinga rigid schedule, and let weight gain and nappies, not a fixed number ofmillilitres, tell you whether your baby is thriving. Your health visitor cancheck against growth charts if you are unsure.

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Sources

(8) NHS Start4Life.‘Bottle feeding advice.’ nhs.uk

(9) US Centers for Disease Control andPrevention. "About Feeding From a Bottle." Available at https://www.cdc.gov/infant-toddler-nutrition/bottle-feeding/index.html(the American Academy of Pediatrics gives the same advice).

Combination feeding

Combination (or 'mixed') feeding — some breastfeeds and some bottles of formula or expressed milk — is common and entirely workable. It can be a way to keep breastfeeding while sharing feeds, easing back to work, or simply getting more rest. The main thing to understand is the effect on supply: because breast milk works on supply and demand, every breastfeed replaced by a bottle is a little less stimulation, and supply gradually adjusts downward. That is fine if it is what you want; if you want to keep your supply up, expressing at the times a bottle replaces a feed helps maintain it. Because changing the balance of feeds affects supply in ways that are not always easy to predict, it is worth setting the mix up with a lactation consultant — getting it wrong in either directioncan leave you with too little milk, or uncomfortably engorged.

Introducing a bottle

If breastfeeding is going well and you want to protect it, many find it easiest to wait until it is comfortably established — often between 4 to 6 weeks post partum — before introducing regular bottles, though there is no rigid rule and some babies take a bottle easily from early on. Some babies refuse a bottle at first, especially from the parent they usually breastfeed with. It can help if someone else offers it, if you are out of the room, if the baby is calm rather than ravenous, and if you try feeding in a different position or with a different teat. Paced feeding (Card 7) tends to make the switch smoother in both directions.

Expressing and pumping

Expressing — by hand, or with a manual or electric pump — lets you build up a store of breast milk for bottle feeds, ease fullness, or keep your suppl ygoing when you are apart from your baby. Some mothers express now and then, others feed their baby entirely on expressed milk, known as exclusive pumping —demanding, but a completely valid way to give breast milk. Electric pumps in particular are worth getting right: pumping more than your baby actually needs signals your body to make more, which can tip you into over supply and engorgement, and from there into blocked ducts or mastitis. A lactation consultant can help you set up a routine that fits your supply and your life —how often to pump, for how long, and how to scale it back safely if you find you are making too much.

Storing breast milk safely

Freshly expressed breast milk keeps for a few hours at room temperature, several days in the fridge (at the back, where it is coldest), and several months in the freezer. Defrost it in the fridge, use it within about a day once thawed, and never refreeze it. The exact times vary between national guidelines, so follow your local health authority's storage chart, and label everything with the date.

Returning to work

Many parents combine expressed milk and formula around a return to work. A few things makethe transition easier: build up a small frozen store in advance, offer the occasional bottle beforehand so it is familiar, and express once during the working day to keep your supply steady. There is no need to choose breast or bottle — whatever keeps you and your baby going is the right answer.

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International Board Certified Lactation Consultants (IBCLCs) - The most qualified breastfeeding specialists available. They can assess latch, positioning, milk transfer, and supply, identify tongue tie, and support you through most breastfeeding challenges with a personalized plan.

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Breast feeding counsellors - Trained supporters who can provide guidance, reassurance, and practical help, particularly in the early weeks. They work alongside IBCLCs and are often a good first point of contact.

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Postnatal wellbeing coaches - If the emotional weight of breastfeeding is affecting you, a postnatal wellbeing coach can provide support for your mental health and help you navigate the decisions ahead, whatever they are.

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Q  How do I know if my baby is getting enough milk?

The most reliable signs are weight gain and nappy output — not the length of feeds, or how your breasts feel. In the first days, wet nappies increase with each day of life: at least one on day one, two on day two, three on day three. From around day five, most babies have at least six wet nappies in 24 hours, plus two to three dirty ones. Your midwife or health visitor will monitor weight, but if you are ever unsure between check-ups, a lactation consultant can assess a feed in person and, if needed, do a weighted feed to measure exactly how much milk your baby takes — as a one-off check, not a daily habit. ‍

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Q  Is breastfeeding supposed to hurt?

Some tenderness in the very first days is common. Persistent pain — pain that is sharp, that continues after a feed ends, or that is making you dread feeding — is not something you have to accept. It is almost always asign that something can be adjusted, and a lactation consultant can usually identify the cause in a single session.

Q  How often should my newborn be feeding?

Most newborns feed between 8 and 12 times in 24 hours in the early weeks. This can feel relentless, but frequent feeding is how supply get sestablished. If your baby is feeding significantly less than this and seems sleepy or difficult to rouse, speak to your midwife or health visitor.

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Q  Which formula should I choose?

A standardfirst infant formula is suitable for the whole first year, and the brands arefar more alike than the packaging implies, so there is rarely any need toswitch. You do not need follow-on or ‘hungry baby’ milks. Only use a specialistformula — for allergy or reflux, for example — on the advice of a healthprofessional.

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Q  Is it safe to make up a bottle in advance?

Freshly made upeach time is safest, because powdered formula is not sterile and is made safeby preparing it with hot water. If you must prepare ahead, follow your nationalhealth authority’s guidance on cooling quickly and storing at the back of thefridge, and discard anything kept too long or left over after a feed.

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Q  Will giving a bottle ruin breastfeeding?

Not on its own.Plenty of families combine breast and bottle successfully. The thing to watchis supply: each breastfeed replaced by a bottle is slightly less stimulation,so if you want to protect your supply, express around the feeds you replace. Alactation consultant can help you set up combination feeding so it lasts.

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Q  My baby refuses the bottle — what can I do?

This is common,especially early on. It often helps if someone other than the breastfeedingparent offers it, if you are out of the room, if your baby is calm rather thanvery hungry, and if you try a different teat, position, or milk temperature.Paced feeding usually makes the bottle more acceptable. If it stays difficult,a feeding specialist can help.

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 Q  What if I decide to stop breastfeeding?

That is your decision to make, at any point, for any reason. If you stop because it was not working or because it was affecting your wellbeing, that is enough of a reason. Weaning should be done gradually where possible to reduce the risk of engorgement and mastitis — a lactation consultant can guide you through this safely if you need support.

Q  Can I breastfeed if I am on medication?

Many medications are compatible with breastfeeding, including some that are commonly assumed not to be. Always checkwith your GP or pharmacist rather than stopping breastfeeding based on a medication alone. The LactMed database, maintained by the US National Libraryof Medicine, is a reliable reference for medication safety during breastfeeding.