Infant Feeding
Deciding how to feed your baby is an important decision and there are many things to consider. We encourage you to learn the facts about breast/chestfeeding, as well as the use of human milk and infant formula, so your infant feeding decision is informed. We also encourage you to discuss your thoughts, feelings, concerns and questions about feeding your baby with your family and your health care provider.
Ways to feed your infant include:
- Breastfeeding: baby feeds directly from breasts (often the term used by women when feeding their infants)
- Chestfeeding: baby feeds directly from the chest (often the term used by transgender men who have chosen to have a baby and lactate)
- Human milk feeding: expressed human milk fed to infant via bottle or alternate feeding method
- Formula feeding: infant formula fed via bottle or alternate feeding method
Human milk is different than infant formula. Infant formula is a commercial product, usually cow-milk based. Both feeding options have benefits and associated risks. Speak to your health care provider about risks associated with infant feeding, and how to minimize these.
Human milk:
- Supports a baby’s growth and development
- Changes according to a baby’s nutritional needs
- Is recommended up to two years and beyond as it provides the older baby with important nutrients and some immune protection
Breast/Chestfeeding:
- Helps babies cope better with painful procedures (e.g., during immunizations)
- Provides an additional way to connect emotionally
Infant Formula:
- Increases risk of diarrhea, ear infections, chest infections, obesity, diabetes and Sudden Infant Death Syndrome (SIDS)
- Is associated with an increased risk of health concerns such as postpartum bleeding, type 2 diabetes, breast cancer, and ovarian cancer for birth parents
The Mount Sinai team seeks to make sure you have access to infant feeding information that is up-to-date, accurate and evidence-based. We will also support your decision by educating you and assisting you as much as possible when your baby arrives and while you are in hospital. Please visit the following link for more information on infant feeding decision making:
The infant feeding timeline was created to help you navigate feeding in the first 48 hours after birth. This timeline is used for education and it serves as a reminder about what is considered normal infant feeding behaviours and patterns. Your nurse will help you navigate your infant’s feeding behaviours and patterns during your hospital stay, but it is also helpful to have some understanding of these things before your baby is born. The following link provides comprehensive information on breast/chestfeeding:
Skin to Skin involves the placement of your baby in an upright position, on you or your partner’s chest with no clothing or blankets placed between the infant and the parent.
The following video provides more guidance:
Potential risk associated with infant feeding |
Reduce the potential risk by |
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Increased risk of illness with formula feeding |
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Increased risk of less responsive feeding with bottle feeding |
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Increased risk of formula contamination due to manufacturing errors, improper cleaning of equipment and/or impure water |
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Reduced human milk supply with formula and/or bottle feeding |
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Increased risk of dehydration/inadequate calories if your infant is not breast/chestfeeding effectively |
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Increased risk of dehydration/inadequate calories if your infant is not being fed the correct amounts or dilution of formula |
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Increased risk of illness from direct breast/chestfeeding when the following are considerations
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Mount Sinai seeks to support you in your infant feeding goals. The evidence tells us that there are certain steps that we can take to support your success with breast/chestfeeding. Our Promise is made up of these steps.
Baby-led latching is natural and simple and can be encouraged immediately after the baby is born. It can also be useful as your baby learns to breastfeed, if your baby is not breastfeeding well and if your nipples are sore or painful.
To encourage ‘Baby-led latching’:
- “Skin to skin care with the lactating parent will help facilitate baby led latching by encouraging the baby to be oriented to the breast/chestfeeding and ensuring the infant is within proximity of the breast/chest and by calming the infant”
- Start with a calm baby who is placed vertically with their tummy on your upper chest, between your breasts
- Be comfortable, lean back a little
- Your baby will begin to bob or peck while looking for your breast
- Support your baby’s head and neck, shoulders and bottom as they move to find the nipple
- In time, your baby will find the nipple, push their chin into the breast and reach up to the nipple with an open mouth
- It will help to continue to support the baby’s bottom, back and shoulders while this happens
- Once baby is latched, you and your baby can settle into a more comfortable position
This video shows you how baby-led latching happens in the first moments after birth.
Learning to position and latch your infant takes time, for you and your baby.
The following tips might be helpful:
- Have your baby skin to skin, close to your body
- Position your baby so the nose is at the nipple
- Allow your baby to reach up towards the nipple with an open mouth, so the head is slightly extended or tilted back
- Use the base of your hand behind the shoulders to direct the baby up to the breast
- Support the head with your fingers
- Make sure your baby’s ear, shoulder and hip are in a straight line
- Baby’s mouth will be wide open with lips flanged
These resources might be helpful to review before baby is born, and then again after baby is born.
- Video: Breastfeeding in the First Hours (Stanford University)
- Videos: Latch, Swallows, Compressions (International Breastfeeding Centre)
- Video: Breastfeeding Positions (Healthy Families BC)
- Toronto Public Health: Learning to Breastfeed
- A Video on Breastfeeding Positions (Healthy Families BC)
- Breastfeeding Protocol: Positioning and Latching (Breastfeeding Resources Ontario)
Putting the infant to breast/chest as soon as possible is the best way to initiate breast/chestfeeding. If the infant cannot/does not latch, then hand expression can help stimulate milk supply.
If you’re interested in expressing milk before your baby is born, please speak to your care team. For more information on Antenatal Hand Expression, see this pamphlet.
Hand expression of breast milk is a technique that is valuable for every new breastfeeding mother to learn. In addition to feeding your baby at the breast, hand expression of breast milk has been shown to increase milk production. It can also be very helpful when a breast is very full. A small amount of hand expression from a full breast can assist a baby to latch more successfully.
Learning the skill of hand expression early in your breastfeeding experience can allow for better availability of colostrum in the first days because the breast pump may not easily collect this thicker, stickier version of breast milk. Colostrum is low in fat, and high in carbohydrates, protein, and antibodies to help keep your baby healthy. Colostrum is extremely easy to digest, it is low in volume (measurable in teaspoons rather than ounces), but high in concentrated nutrition for the newborn. Colostrum has a laxative effect on the baby, helping him pass his early stools, which aids in the excretion of excess bilirubin and helps prevent jaundice.
- Video: How to Hand Express Colostrum and Breast milk (Stanford University)
- Video: Hand Expressing Breastmilk (Healthy Families BC)
Your expressed breast milk offers many important benefits and is especially important if your baby is born prematurely or is sick. If you are separated from your infant, and you plan to breastfeed, we encourage early hand expression of breast milk.
The research tells us that hand expression should begin within 1 hour of the birth and continue regularly, every 3 hours or so, for the first 24 hours. You will also be encouraged to do regular breast pumping at intervals similar to the timing a baby may feed if going to the breast. It is also okay to hand express or pump as well as feed your baby at the breast with the goal of increasing milk supply. It is usually advised that you breastfeed first and then pump or hand express, collecting your expressed breast milk to supplement the feed at the breast. Hand expression is an effective means of expressing milk, boosting milk supply and collecting milk for an infant. Ask your labour and delivery and your postpartum nurse to help you with hand expression.
Expressing human milk with a pump
Another way to express your milk is to use a pump. When considering whether to purchase or borrow a pump, it is important to know there are some pumps should not be shared. Please visit the following link for more information on making a safe pump choice:
Before making a purchase it is advised that you check with a lactation consultant to determine what type of pump will meet your individual needs.
You can rent or purchase a pump at a number of locations, including Mount Sinai at the Sinai Shop. You will need to also purchase a single-use collection kit. Sterile Kits (for immediate use) can be purchased online at the link above, or in person at the Baby Shop (Monday to Friday 10am to 4:30pm) or in PNAC (Monday to Sunday 10am to 4pm).
If you are pumping for a late preterm or a preterm infant, a hospital-grade electric breast pump is recommended if you are pumping for a baby with special needs, such as a premature infant or a baby who is unable to breastfeed. If you are pumping milk for a baby in the NICU, please see the following links for more information:
- Breastfeeding Your Early Preterm Baby (Best Start)
- Breastfeeding Your Late Preterm Baby (Best Start)
Points to remember when using a pump:
- Pump each breast for no longer than 30 minutes. Double pumping (both breasts at the same time) will save time and often yields more milk.
- Pumping should not be uncomfortable and should not hurt
- Make sure your nipple is placed in the centre of the flange
- Begin pumping six hours after birth if your infant has not/cannot latch. In this case, hand expression can begin one hour after birth, and can happen with pumping as advised by the Lactation consultant
- If you and your baby are separated - double pump every two to three hours for 30 minutes (up to eight times a day)
- If you have a low supply and your baby is breast/chestfeeding, but requires supplementation, double pump for 10-15 minutes after each feed
These links may provide additional information on pumping and milk storage:
- Pumping Breast Milk – Everything You Need to Know! (New Mom Collective)
- Establishing and maintaining milk supply when baby is not breastfeeding (Kelly Mom)
- Pumping and storing breastmilk (Women's Health)
- Pumping milk (La Leche League)
- Breastfeeding Matters – An Important Guide to Breastfeeding for Women and their Families (Best Start)
- How to safely store breast milk (Cindy and Jana)
Expressed breast milk is the optimum choice for supplementation of the breastfeeding infant. Your expressed breast milk should always be refrigerated and given to your infant when they are ready to begin feeds. If there is not enough breast milk, your team will discuss with you what options might be available.
Clusterfeeding is part of the normal pattern a baby has in the first days after birth. Following the initial quiet alert stage in the first two or three hours after birth, baby goes into a deep sleep to help recover from labour. This period of deep sleep is followed by increased wakefulness and increased nursing demands. This is called "clusterfeeding." Clusterfeeding is often interpreted as an indication "that baby is not getting any milk or is getting an insufficient amount" of milk. Research has shown that this is a time in the early postpartum period, when mothers will resort to using supplemental formula. Clusterfeeding is not a medical indication for formula supplementation.
Some important points to remember:
- Clusterfeeding usually occurs 24 to 48 hour after birth
- This is a normal reaction to reduction of colostrum and brown fat reserves baby has made during pregnancy
- The neurological system of a healthy, full term newborn is immature at birth and is somewhat disorganized in its behaviours. Baby seeks comfort and familiarity and breastfeeding offers this
- Prolactin is the hormone responsible for making milk. It is at its highest levels at night and increases with more frequent feeding. Night feeds are particularly important to establish the milk supply and to increase milk volumes
Allowing baby to feed as much as possible at the breast during this time period of clusterfeeding will help the more mature milk to come in, will comfort baby and will positively influence future milk production. If parents become exhausted in this period of time, feeding mom’s own expressed milk is the first line of defense.
One of the reasons parents feel they need to introduce formula when they are breastfeeding is because they think they do not have enough milk for their growing infant.
The Best Start “Breastfeeding Your Baby Poster” is a guide that outlines the signs that feeding is going well, and can be a source of reassurance when you are feeling uncertain.
Watch the following videos to hear more about how you know you have enough milk, or how you can increase your supply.
- Video: Is Your Baby Getting Enough Milk (Global Health Media)
- Video: Increasing Your Milk Supply (Global Health Media)
How do you safely supplement a breastfeeding baby?
If a baby requires supplementing, our first advice is to use mom’s own milk to do so. Hand expression and /or pumping can assist you in collecting your own milk to supplement your baby. Using formula when you are breastfeeding your baby can be a very difficult decision. These resources may also be helpful in making this decision:
- Video: Alternative Feeding Methods for Newborns (Healthy Families BC)
- Article: All About Supplementing (Healthy Families BC)
- Article: What You Need to Know About Supplementing Your Baby With Formula (Healthy Families BC)
The use of formula is sometimes medically indicated when your milk is not enough in volume for your baby. Extra breast milk or formula may also be indicated for medical reasons such as:
- Low blood sugar (glucose) levels
- Jaundice treatments (if the baby is too sleepy to feed well at the breast)
- Meconium stools continue after the fourth day
- Late preterm baby who is not feeding well at the breast
- Excessive weight loss (despite frequent, effective feeds)
- Mother’s milk has not increased by the fourth day
- Dehydration (not enough wet diapers)
Ask your nurse or lactation consultant about supplementing your infant. Above all, your infant must be fed. We want you to be informed so that you can make the best decisions for your infant, but you may also find it helpful to get the opinion and support of experts.
Recommended volumes for supplementing
The chart below is a guide for supplementing your infant’s feed:
Age |
Per feed ml |
---|---|
The first 24 hours |
2-10 ml |
24 to 48 hours |
5-15 ml |
48 to 72 hours |
15-30 ml |
72 to 96 hours |
30-60 ml |
More information about a baby’s stomach capacity in the early days can be found here.
When is a bottle needed?
Paced bottle feeding is a method of feeding your baby that mimics breastfeeding. It is also known as ‘Baby-led bottle feeding’ and is a method of feeding that can help minimize the negative impact bottle feeding may have on the baby who is also breastfeeding or trying to breastfeed. It is an acceptable method of supplementing breastfeeding when volumes of expressed milk or formula that are recommended exceed what might be reasonable to feed by cup or spoon.
Paced bottle feeding is also the recommended method of feeding if you choose to exclusively formula feed by bottle.
The following video can help you learn how to pace bottle feed your baby:
- Video: How to Bottle Feed Your Baby (Region of Peel)
- Video: Paced Bottle Feeding
Using Formula
It is important to know how to safely prepare and store formula as well as how to sterilize bottles and equipment. It is important to note that powdered formulas are not considered sterile, and can be subject to contamination recalls. We encourage our patients to consider using the premixed liquid formula or the concentrated liquid formula in the first two months of life. In addition to good hand hygiene and proper sterilizing of equipment when preparing formula, we encourage parents to always follow the package directions for reconstituting formula.
These resources are helpful for any parent who is considering formula for full feeds or as a supplement:
- Booklet: Infant Formula: What You Need to Know (Best Start)
- Video: Safely Preparing Infant Formula (Best Start)
- Article: Getting Ready to Make Formula (Best Start)
- Article: How to prepare ready-to-feed formula for healthy babies (Best Start)
- Article: How to prepare concentrated liquid formula for healthy babies (Best Start)
- Article: How to prepare powdered formula for healthy babies (Best Start)
- Article: How to bottle feed your baby and transport formula (Best Start)
Why is breast milk important for preterm babies?
Breast milk is the ideal food for all babies and vital for preterm babies. A mother’s milk is especially suited to her own baby.
Your colostrum and breast milk are unique to your baby. Your breast milk adapts to meet the needs of your baby and changes over time.
Preterm breast milk is very important for:
- Growth and development and is especially suited to the needs of preterm babies
- Providing protein for brain growth
- Providing antibodies to protect preterm babies from infection
Babies who are not breastfed are at a higher risk for:
- Ear infections
- Lung and breathing issues
- Diarrhea
- Diabetes
- Overweight and obesity
- Some childhood cancers
- Sudden Infant Death Syndrome
An early preterm baby may need extra nourishment to support their growth needs. This may include adding human milk fortifier, nutrients and/or fat to the expressed breast milk. Although preterm babies may not be able to breastfeed in the beginning, skin-to-skin contact and breast milk are very important for them. Until premature babies are able to feed directly from the breast, mothers can express and pump their milk to feed to their baby.
The evidence tells us that there are certain steps that we can take to support your success. Our Promise made up of these steps, has been modified to acknowledge the very specific challenges that a parent might have when feeding a baby in the NICU.
You will have access to a Lactation Consultant with specialized knowledge in initiating and maintain a milk supply and encouraging a preterm baby to the breast when they are ready.
For information on pumping milk for a baby in the NICU, please refer to the “Hand Expression and Pumping” section
These resources are helpful for feeding your baby in the NICU:
- Video: Feeding your baby in the NICU (Children’s Healthcare Canada)
- Video: Expecting to breastfeed your premature baby (First Droplets)
- Booklet: Breastfeeding your early preterm baby (Best Start)
Our Postnatal Ambulatory Clinic (PNAC) is staffed by a team of registered nurse/lactation consultants who provide breast/chest/human milk feeding support services to Mount Sinai patients.
Once you go home with your infant, you may require additional breastfeeding support.
After discharge, get help with your breast/chestfeeding if:
- You are supplementing your breast/chestfeeding infant with formula
- You have sore nipples
- You have blocked ducts that are not relieved by frequent feeding, hand expression or pumping
- You have a fever or you are generally not feeling well
- You are using a lactation device or nipple shield
- Your infant is sleeping through feeds, not waking for feeds at least every four hours, not peeing or pooping enough, is jaundiced or is not gaining appropriate weight
There can be many circumstances that influence your breast/chestfeeding success. It is important to be patient with yourself, your body and your infant and it is ok, and encouraged, that you seek help if you need it. To determine if breast/chestfeeding is going well, this poster may help you monitor how breast/chestfeeding is progressing with your baby.
These resources may also be helpful for breast/chestfeeding:
- Mount Sinai Hospital, Postnatal Ambulatory Clinic, 416-586-4800 ext. 7409
- Best start resources
- Breastfeeding Online
- La Leche League
- Telehealth: 1-866-797-0000, 110 languages and direct TTY number 1-866-797-0007
- Toronto Public Health services
- Toronto Public Health Information
In-Patient Education
Helpful breastfeeding education class to guide you