Postnatal

Care for your baby

Introduction to baby and infant feeding

Whichever way you decide to feed your baby, we are here to support you. We are here to support you to make feeding time a special time when you and your baby can build a close and loving relationship ensuring your baby has the best start in life.

These pages aim to provide you with reliable and useful information to support you with feeding your baby. We also signpost to other useful websites providing lots of practical information and ideas for parents and families.

The East Kent Hospital University Foundation Trust Maternity Department is working towards becoming accredited by the Unicef Baby Friendly Initiative. We achieved our Stage One Accreditation in August 2019. 

Find out more about the Unicef Baby Friendly Initiative

Responsive breastfeeding

It's impossible to spoil a baby with too much love and attention. They have a strong need to be close to their parents and will feel safe and secure when their needs are met. Feeding and caring for your baby responsively will help you meet their needs and help you both to build a close and loving relationship.

Download this UNICEF breastfeeding leaflet

How do I know my baby is getting enough milk?

It is usual for parents to question whether they are feeding their baby enough and if they are getting all the milk the need. There are lots of signs that you can look out for to help you recognise that breastfeeding is going well.

In the first 24 hours after your baby is born, it is usual for a baby to feed about 4 times. After the first 24 hours the number of feeds should increase and a baby should be having between 8 and 12 feeds in 24 hours. Feeding should be comfortable for you and your nipples should not look squashed or pinched after a feed.

By day 5 you should be able to notice your baby swallowing milk. It is important to keep an eye on your baby’s nappies as this is a really useful guide as to whether your baby is getting enough milk. 

After the birth of your baby a member of staff will complete a feeding assessment with you and your baby. This may be repeated several times during your stay in hospital and will also be carried out when your baby is 5 days old. Below is a link to a checklist which will help you to identify if your baby is getting enough milk and a guide to how many wet and dirty nappies you might expect your baby to have. If you are concerned that your baby may not be getting enough milk then please speak to your midwife.

Expressing breast milk

Learning to hand express your breast milk during your pregnancy or in the early days is a useful skill to have. Hand expressing your colostrum may help you overcome early feeding challenges, encourage your baby to feed or help to maximise your milk supply.

We have breast pumps available on the ward should need to use one during your time in the hospital. Staff will be available to support you and ensure you have a feeding plan in place should you need to express breast milk for your baby. You may find our leaflet ‘Expressing and Handling Breast milk in the Hospital’ useful.

Feeding - breastfeeding

It's never too early to start thinking about how you're going to feed your baby. But you do not have to make up your mind until your baby is born.

Some of the benefits of breastfeeding are:

  • Your breast milk is perfectly designed for your baby

  • Breast milk protects your baby from infections and diseases

  • Breastfeeding provides health benefits for you

  • Breast milk is available for your baby whenever your baby needs it

  • Breastfeeding can build a strong emotional bond between you and your baby.

Formula milk does not provide the same protection from illness and does not give you any health benefits.

Breastfeeding is a skill that takes time to get the hang of. Lots of mums wonder if their baby's feeding well and getting enough - especially in the first few days. But once you've mastered it, you'll probably find it's the easiest and most satisfying way to feed your baby.

Apart from the fact that breast milk is tailor-made for your baby, contains vitamins and minerals and is always available, it also offers protection from certain infections and helps improve your baby's long-term health.

Breastfeeding reduces the risk of SIDS (Sudden Infant Death Syndrome), childhood diabetes and leukaemia.

We're here to provide lots of helpful information and advice on breastfeeding. If you have any breastfeeding worries or concerns, the best thing to do is speak to your midwife, health visitor or breastfeeding team.

For confidential breastfeeding information and support, call the National Breastfeeding Helpline on 0300 100 0212. Lines are open 9:30am to 9:30pm every day.

Feeding - formula feeding

If you're planning to bottle feed with expressed breast milk or infant formula, these tips will help you feed your baby and keep them safe and healthy.

If you decide to use infant formula, first infant formula (first milk) should always be the first formula you give your baby. You can use it throughout the first year.

Buying bottle feeding equipment

You'll need several bottles, teats and a bottle brush, as well as sterilising equipment, such as a cold-water steriliser, microwave or steam steriliser.

There's no evidence that 1 type of teat or bottle is better than any other. Simple bottles that are easy to wash and sterilise are probably best.

Making up bottles for your baby

Make sure you sterilise bottles and teats until your baby is at least 12 months old. Wash your hands thoroughly before handling sterilised bottle and teats.

If you're using infant formula, follow the instructions on the packaging carefully when you make up the feed.

How to bottle feed your baby

Bottle feeding is a chance to feel close to your baby and get to know and bond with them. Babies will feel more secure if most feeds are given by you, your partner or their main caregiver.

Make sure you're sitting comfortably with your baby close to you. Hold your baby in a semi-upright position for bottle feeds. Support their head so they can breathe and swallow comfortably.

Brush the teat against your baby's lips and when they open their mouth wide let them draw in the teat. 

Never leave your baby alone to feed with a propped-up bottle as they may choke on the milk.

Gently place the teat into the baby’s mouth. Keep the bottle in a horizontal position (just slightly tipped). This will allow the milk to flow steadily and help prevent your baby from taking in air.

If the teat goes flat while you're feeding, pull gently on the corner of your baby's mouth to release the suction.

If the teat gets blocked, replace it with another sterile teat.

All babies are different. Your baby will know how much milk they need. Some want to feed more often than others. Just follow your baby's lead.

Feed your baby when they seem hungry and do not worry if they do not finish the bottle.

Your baby may take short breaks during a feed and may sometimes need to burp. When your baby has had enough milk, hold them upright and gently rub or pat their back to bring up any wind.

Only make up the feed when needed – one feed at a time.

Formula feeding in hospital

Please where possible bring in single use bottles of ready-made formula with single use teats.

We do have a limited number of sterilisers that can be set up next to your bed during your stay should you need to bring in larger bottles of ready-made formula and your own bottles. If you do need to do this, please ensure you bring in a bottle brush and washing up liquid so you are able to wash your bottles correctly. Staff have access to a milk fridge where excess ready-made formula can be stored.

Before you are discharged home staff will be able to discuss with you how to safely prepare powdered formula milk in your own home. Please don’t hesitate to ask staff if you have any questions regarding bottle feeding before you go home.

Help with bottle feeding

Talk to your midwife, health visitor or other mothers who have bottle fed if you need help and support.

You'll find the phone number for your health visitor in your baby's personal health record (red book).

Tongue tie

Sometimes when a baby struggles to feed or if feeding is making you sore it can be identified as being caused by a tongue tie.

Firstly you need to be seen by a feeding specialist who will give you help and information to improve the feeding. Your midwife or health visitor can refer you to the specialist service.

If the specialist feels that a tongue tie division could help they will refer your baby for a procedure called a frenulotomy. This is to give the tongue more movement which can help improve feeding.

We are able to treat babies up to 12 weeks of age.

If you have been referred for a tongue tie or would like more information please download this leaflet.

Information to support feeding after a tongue tie procedure.

Occasionally a baby may not want to feed following a tongue tie procedure, there are several things you can try.

Get yourself a warm drink and try to relax, place your baby in skin to skin contact with a blanket over you both.

Lay back in a comfortable, supported, semi-reclining position with your baby lying on you, with their whole front in contact with your body. This position often stimulates a baby’s instinct to attach and suckle well. It’s also easier for you to watch for signs of your baby stirring and enables you to gently encourage feeding.

It is hard for babies to latch if they are crying, especially if they are also learning what their newly released tongue can now do. You can try these suggestions:

  • Sing and talk calmly

  • Hold him against your shoulder if he doesn’t like to be held near the breast

  • Keep the environment peaceful

  • If you have a sling try placing him in the sling and having a walk.

For breastfed babies try expressing some milk. If you haven’t got access to a pump many mothers find hand expressing as efficient. Here is a video on how to express milk to show you how if you haven’t tried before.

Your expressed milk can be offered by spoon if your baby does not take a bottle. Once baby is calm offer the breast again.

If you were using nipple shields try them again, you can work towards stopping using them with the support of your Lactation specialist.

If you are bottle-feeding and your baby will not take a bottle try the calming techniques above.

When you offer the bottle, try paced bottle feeding, shown in this paced bottle feeding video.

For a baby over 2 months you can use infant paracetamol (Calpol) if your baby is very distressed. You need to follow the manufacturer’s instructions for dosage.

If your baby remains distressed and not feeding after a few hours you should ring NHS 111.

NIPE checks / first checks

All parents are offered a thorough physical examination for their baby within 72 hours of giving birth.

The examination includes screening tests to find out if your baby has any problems with their eyes, heart, hips and, in boys, testicles (testes).

What is the newborn physical examination?

The newborn physical examination is usually carried out in hospital before you go home.

Sometimes it's done at a hospital or community clinic, GP surgery, children's centre or at home. Ideally, both parents should be there when the examination is done.

The healthcare professional doing the examination should explain what it involves. This could be a doctor, midwife, nurse or health visitor who's been trained to do the examination.

Some parts of the examination may be a bit uncomfortable for your baby, but it will not cause them any pain. The aim is to spot any problems early so treatment can be started as soon as possible. Usually, nothing of concern is found.

If the healthcare professional doing the examination does find a possible problem, they may refer your baby for more tests.

You'll be offered another physical examination for your baby at 6 to 8 weeks, as some of the conditions it screens for can take a while to develop.

This 2nd examination is usually done at your GP surgery.

How is the newborn physical examination done?

The healthcare professional will give your baby a thorough physical examination.

They'll also ask you questions about how your baby is feeding, how alert they are, and about their general wellbeing.

Your baby will need to be undressed for part of the examination.

During the examination, the healthcare professional will also:

  • Look into your baby's eyes with a special torch to check how their eyes look and move

  • Listen to your baby's heart to check their heart sounds

  • Examine their hips to check the joints

  • Examine baby boys to see if their testicles have descended into the scrotum.

What does the newborn physical examination check for?

The examination includes an overall physical check, plus 4 different screening tests.

Eyes

The health professional will check the appearance and movement of your baby's eyes.

They're looking for cataracts, which is a clouding of the transparent lens inside the eye, and other conditions.
About 2 or 3 in 10,000 babies are born with cataracts in one or both eyes that need treatment.

But the examination cannot tell you how well your baby can see.

Heart

The healthcare professional will check your baby's heart. This is done by observing your baby, feeling your baby's pulses, and listening to their heart with a stethoscope.

Sometimes heart murmurs are picked up. A heart murmur is where the heartbeat has an extra or unusual sound caused by a disturbed blood flow through the heart.

Heart murmurs are common in babies. The heart is normal in almost all cases where a murmur is heard.

But about 8 in 1,000 babies have congenital heart disease that needs treatment.

Hips

Some newborns have hip joints that are not formed properly. This is known as developmental dysplasia of the hip (DDH).

Left untreated, DDH can cause a limp or joint problems.

About 1 or 2 in 1,000 babies have hip problems that need to be treated.

Testicles

Baby boys are checked to make sure their testicles are in the right place.

During pregnancy, the testicles form inside the baby's body. They may not drop down into the scrotum until a few months after birth.

Around 2 to 6 in 100 baby boys have testicles that descend partially or not at all.

This needs to be treated to prevent possible problems later in life, such as reduced fertility.

Does my baby have to have the examination?

The aim of the examination is to identify any of the problems early so treatment can be started as soon as possible.

It's strongly recommended for your baby, but not compulsory.

You can decide to have your baby examined and screened for any or all of the conditions.

The healthcare professional who does the examination will give you the results straight away and if your baby needs to be referred for more tests, they'll discuss this with you there and then, too.

The results will be recorded in your baby's personal child health record (red book). You'll need to keep this safe and have it to hand whenever your baby sees a healthcare professional.

If you have any concerns, you can discuss them with your midwife or the healthcare professional who does the examination.

NHS services for new parents

Registering your baby with a GP

Register your baby with your GP as early as possible in case you need their help.

You can contact your GP at any time, whether it's for you or your child.

If you move, register with a new GP close to you as soon as possible.

If your baby is not yet registered with a GP but needs to see one, you can receive emergency treatment from any GP surgery.

Find a GP

How your health visitor can help

A health visitor will usually visit you at home for the first time around 10 days after your baby is born. Until then you'll be cared for by local midwives.

A health visitor is a qualified nurse or midwife who has had extra training. They're there to help you, your family and your new baby stay healthy.

Your health visitor can visit you at home, or you can see them at your child health clinic, GP surgery or health centre, depending on where they're based.

Talk to your health visitor if you’re struggling with your mental health. They can give you advice and suggest where to find help.

They may also be able to put you in touch with groups where you can meet other parents.

Child health clinics

Child health clinics are run by health visitors and GPs. They offer regular baby health and development reviews and vaccinations.

You can also talk about any problems to do with your child, but if your child is ill and likely to need treatment, see your GP.

Some child health clinics also run parent and baby, breastfeeding, and peer support groups.

Bobble hat system

Within one hour of birth, the bobble hat assessment tool and care plan will be completed and the correct hat will be put onto your baby. This lets staff know what level of care the baby will need. 

  • Green bobble hats; these are for babies who have been fed at delivery and have no risk factors.

  • Amber bobble hats; these are for things such as complicated deliveries, multiple births, where feeding hasn't been established and for babies of people who are taking specific medications. 

  • Red bobble hats; these are babies who might need extra care. For example premature babies, babies who are underweight, babies who are on certain antibiotics or babies of diabetic women on medication. 

Safe sleep

Any parent will recognise the difficulties of not getting enough sleep and life with a newborn is one of those times when sleep deprivation is usually at its worst. Getting enough sleep is essential for both physical and mental wellbeing, but how can you make sure that your baby is safe when they’re asleep?

Sudden Infant Death Syndrome (or SIDS) is something that worries many parents, but there are many ways that you can reduce the risk to your baby. Following safe sleep guidance is one of the best ways to do this.

Safe sleeping

It is safest for your baby to sleep in the same room as you do for the first six months at least, ensuring the room is smoke free.

The safest position for your baby to sleep on is their back - which is different to what a lot of our parents and grandparents were taught. Place your baby with his or her feet at the bottom of the cot, especially if you are using a blanket to keep them warm. This stops them being able to wriggle underneath the blanket too far and obstructing their mouth and nose. Only tuck their blanket in at shoulder height and ensure they don’t sleep with anything near their face. Hats and any jewellery, like teething necklaces or dummy savers/clips should be removed for sleep.

Where should my baby sleep?

Choosing a cot can be one of the most exciting parts of preparing for a baby’s arrival, as well as selecting beautiful clothes. But what should you know about safety?

You may wish to use a side-car style cot which allows you to care for your baby at night without having to get up.

Make sure you buy a cot that is safety tested and CE marked. It’s fine to buy a second-hand cot if you want to, but make sure you buy a new mattress, as laying your baby to sleep on a used mattress can be a safety hazard. Mattresses should be firm and a good fit without any gaps at the edges. There should never be anything else in the cot with your baby. Cot bumpers and soft toys can be a suffocation hazard, so only use these for decorative purposes.

Many parents have found that bedside cots, often known as co-sleepers or sidecar cots, are a great solution for keeping babies safe and close to them without bed-sharing. These are usually attached to the bed and are especially useful if you are breastfeeding.

However, other parents prefer to share their bed with their baby. This can allow for getting more sleep as a breastfeeding parent. It is important to follow safe sleep advice if you plan to bed-share. Preparing in this way can help tired parents to avoid the danger of falling asleep with your baby on a sofa or armchair.

Public Health England have teamed up with UNICEF, Basis and The Lullaby Trust to provide updated and agreed information on safe sleep for babies.

How to register the birth

You must register your baby's birth within 42 days of them being born. You will need to go to the area where your baby was born to register the birth.

Once you have your baby's birth certificate, you can register them with your GP surgery. You may be able to use your baby's NHS number if your baby becomes unwell before you have their birth certificate. Speak to your surgery for advice.

Find out more about how to register the birth of your baby in Kent.

ICON normal infant behaviour team

The ICON campaign

A baby’s cry can be upsetting and frustrating. It is designed to get your attention and you may be worried that something is wrong with your baby. Your baby may start to cry more frequently at about 2 weeks of age. The crying may get more frequent and last longer during the next few weeks, hitting a peak at about 6 to 8 weeks.

Every baby is different, but after about 8 weeks, babies start to cry less and less each week.

ICON advises parents and carers that:

  • Infant crying is normal

  • Comfort methods may help soothe your baby

  • It’s ok to walk away briefly, if you have checked the baby is safe

  • You should never, ever shake or hurt a baby

  • Speak to someone if you need support such as your family, friends, Midwife, GP or Health Visitor.

For more information and advice, go to the ICON guide website.