Neonatal infant feeding

We will encourage and support you to express breastmilk for your baby. Breast milk is the best medicine you can give your baby. As well as staff on the unit, we have staff dedicated to breastfeeding support. They will support you in the early days with making milk for your baby and later with transitioning to breastfeeding if that’s what you want to do.

If your baby is sick or premature they probably won't be able to feed from the breast at first. Instead you'll be encouraged to express your breast milk so your baby can be fed through a tube or syringe. The earlier and the more you express, the more milk you will produce when your baby is stronger and ready to start feeding from the breast.

If this is your first time breastfeeding, it might take some time to get used to expressing. Try not to worry if it’s taking longer than you thought – it will get much easier as the days and weeks go by. And once your milk supply has been established, feeding forms a special bond between you and your baby.

Remember, your baby may only need small amounts of milk to begin with, but it's really important to be prepared for when your baby is bigger and needs more milk.

Why breastfeeding is so important in the neonatal unit - YouTube
(video with thanks to Neonatal Team NHS Lanarkshire)

The earlier you start expressing your milk the more milk you will produce. In labour ward you will be supported to hand express and shown how to use the breast pump as soon as possible after your baby is born. Ideally this will be within the first two hours.

In the early days, expressing frequently (about 8-10 times a day) will help you make enough milk for your growing baby in the days and weeks ahead. This can feel relentless at times. It should not affect your milk supply if you miss the occasional expressions.

Double pumping helps to save time and also increases your milk supply. The nurses will show you how to use the different settings on the pump and check that your breast shield fits correctly. Using the breast pump shouldn’t be sore. If you are sore or are worried about how much milk you are making ask your nurse/midwife for help with this.

Tips from other mums that have helped:

• Stay close to your baby when you are expressing. It helps with the hormones that make milk and can make it easier to have a “let down” (this is when milk comes out of your breast in bigger volumes)
• Ask the nurse to check your breast shield size on the pump. Your breasts change shape in the days and weeks after your baby is born so your shield size may change too.
• Cluster expressing. You don’t need to express every three hours to fit in 8-10 times/24 hours. It can be helpful to express two or three times closer together. This then allows you time to be with your baby, spend time with other children or eat your lunch
• Have a big drink before you go to bed. This means you will naturally wake to go to the toilet. You can then express your milk overnight. This is a really important time to express because the hormones that help you to make milk are highest at night. Lots of mums struggle overnight because they are not with their baby. Call the unit to see how your baby is doing or looking at photos or watching a video of your baby can help.
• Have a mini boo or item that smells of your baby when you are not together.
• Spending time in skin to skin contact with your baby relaxes you both and can help with milk production

Hand expressing video

How to set up an electric breast pump

How to use an electric breast pump

As soon as your baby is stable, you and your baby will really benefit from spending time in skin-to-skin contact. This is a very special time for you both and it helps to steady your baby’s heart rate and breathing and keeps them snug and warm. Skin-to-skin contact helps babies grow, reduces their stress levels and is the perfect way to soothe and calm them after a medical procedure. Skin-to-skin contact will also calm you, which can help if you have had a busy or stressful time getting to the hospital. Spending lots of time in skin-to-skin contact with your baby has been shown to shorten hospital stays.

The Parent Club website has information on breastfeeding premature and sick babies and a video on the benefits of kangaroo care contact:

• How it aids closeness and brain development
• Standing transfer video for families
• How it aids the transition to breastfeeding

Where there is not enough of mother’s own milk, and it is important that your baby receives breast milk, human milk banks can offer safe screened donor human milk as an alternative to infant formula. You can find out more from the NHSGGC Milk Bank Scotland information page.

Recipients: 

A preterm baby’s intestine is very immature and can digest and absorb breastmilk more easily than formula milk. Premature babies are fed small amounts of breastmilk to help their gut mature and the volumes fed are increased gradually. This is also true for babies who have had surgery on their gut.

• In addition to being easier to digest than formula, donor human milk contains many of the protective factors (such as immunoglobulins) which help protect premature babies from infection and are not present in formula milk.
• Necrotising Enterocolitis (NEC) is a serious gut condition which mainly affects premature babies. Babies who receive breastmilk, either mother’s own or donor, are at a significantly lower risk of developing (NEC) than those who receive formula. The reason for this remains unclear although there is evidence to support this.
• Milk banks in the UK adhere to the National Institute of Clinical Excellence Guideline (NICE) for the safe running of milk banks. This means all donor human milk from Milk Bank Scotland is rigorously screened and from a single donor ensuring full traceability.

The team looking after your baby will discuss the benefits of donor milk. We have a Frequently Asked Questions sheet which you can read and you will have an opportunity to ask any questions.

If you agree to your baby receiving donor milk, you will be asked to complete a consent form. This also helps us to track which milk your baby receives for future reference.

We do very occasionally provide donor milk for babies receiving care in other wards or at home. You can find out more from the NHSGGC Milk Bank Scotland information page.

Donors:

Donating your breastmilk is one of the most precious gifts that you can offer. Donated breastmilk helps to save the lives of premature and sick babies whose mothers are unable, for many reasons, to provide them with sufficient breastmilk of their own. If you have breast milk that is surplus to your own baby’s needs, you may be able to donate it. We don’t have a limit on how old your baby is when you donate. We can also take stored milk that is less than 90 days old.

You can contact us via milkbank@ggc.scot.nhs.uk or through UKAMB: Find A Milk Bank - Baby Milk Bank Near You, Nationwide Breast Milk (ukamb.org) or our local NHS website: NHSGGC : Contact Form

There is a screening process which we can do by email or post. We send you a pack to complete which includes questions about your medical history, lifestyle and diet. Once this is returned, we ask you to get a blood sample taken at your GP Practice and returned to the milk bank for screening.

We provide everything you need for this and bottles and labels for freezing your milk at home. If you already have a stock of milk in breastmilk bags, your milk bank may accept this, although the fat in the milk is not released from breastmilk bags as well as it is from milk bank bottles. Premature babies rely on high-fat milk to grow, and the bottles milk banks use are designed to increase the available fat as much as possible.

You can find out more at the NHSGGC Milk Bank Scotland Donor page. We will also arrange collection of your frozen milk by our Glasgow Children’s Hospital Charity Volunteers.

You can donate milk if you:

• are breast feeding or expressing for your own baby
• are and remain in good health
• are able to commit to a period of donating or make a once off donation of around 3 litres
• take thyroxine, asthma inhalers or the mini pill

You cannot donate milk if you:

• or anyone in your house smokes or vapes even if outside
• take certain medications including anti-depressants, sedatives, medication for blood pressure, domperidone. Please contact the milk bank to discuss medications you take routinely. You can also find more information on drugs at https://ukamb.org/medication-and-donating-breastmilk-2/

If you had a tattoo, piercing or blood transfusion in the last 4 months, you could still donate but we would need to delay your blood tests.

If you would like more information about donation or to get a donor pack please use the Contact Us form on the NHSGGC Milk Bank Scotland page and we will get back to as soon as we can.

Feeding your baby is a very special time. After all your effort expressing, it can be the perfect reward when your baby begins to feed directly from you. Learning how to feed a baby in the neonatal unit is a new experience for most families. We will help you to learn how your baby communicates with you about feeding and how to recognise their cues.

You can begin to practise how to hold your baby for feeding long before they are able to fully breastfeed. Holding your baby in skin-to-skin contact will help you to notice early feeding cues (opening their mouth, poking their tongue out, turning toward your breast). Letting them lick and nuzzle at your breast (after you have expressed) is a good way of helping your baby get to know the shape of your breast and smell of your milk. Even after your baby has had a first breastfeed, it can still take time for them to be fully breastfeeding, so it is best to take each day or even each feed at a time.

Tips to help get breastfeeding off to a good start:

• Try to get as comfy as possible.
• Hold your baby close (skin-to-skin contact is perfect) and calm and reassure them by talking gently
• Make sure baby’s nose and toes are facing the same way so they don’t have to twist their head to feed
• Support your baby’s neck so that they can still move their head to reach up for the nipple
• Express a little milk on your nipple and let baby lick this
• Encourage baby to open their mouth by gently rubbing your nipple above their top lip
• When their mouth is wide open, bring baby closer so that your nipple reaches back into their mouth

You will feel a drawing sensation as baby begins to feed, but it should not be painful. Look and listen to your baby and notice if they are swallowing, as this will tell you that they are getting your milk. If your baby doesn’t seem comfortable, try changing the way you hold them. Ask the nurses to help you find a position that suits you both.

This video from Parent Club explains how to recognise if your baby is well attached at the breast

Learning to feed is an important milestone for your baby. Most full term babies are able to feed right from birth but preterm babies or sick babies may need special help as they learn to feed. Cue based feeding means that we use your baby’s cues to help us to know when your baby is ready to start feeding, and how to progress their feeding. During the feed we will also watch for cues that tell us when baby wants to stop feeding.

To start with your baby may only manage to suck small amounts so the rest will be given through the feeding tube.

Cue based feeding also helps us keep track of how well your baby is feeding (the quality of feeding), and how your baby’s feeding is progressing.

Cues are your baby’s way of talking to us. Your baby talks to us through changes in his or her behaviour - facial expressions, breathing, posture, movement and wakefulness.

Your baby’s cues and medical needs help guide the feeding and will change as your baby learns and grows. The amount your baby sucks is important, but the quality of feeding is more important. A successful feed is a safe and enjoyable experience for both baby and parents, and one that matches your baby’s individual stage of development

Feeding Readiness Scale and When to Stop The Feeding Readiness Scale is used to assess what your baby’s feeding cues mean, and to know when it is right to offer your baby a suck feed. We will show you how to match your baby’s cues to a score. The feeding cues are assessed before each feed.

The score will tell you whether baby should be offered a feed or should have their milk through their feeding tube. The scores are 1-5. If baby scores a 4 or 5 then it is safe to offer baby a suck feed. A score of 1, 2, or 3 tells us that baby should be given their milk through the feeding tube. There will always be a nurse to guide you.

It is important to respond to baby’s cues and allow them to suck, even in the early stages when they may only suck for a short time. They are telling us that they are only ready for a short feed - they stop when their need is satisfied or they become tired but it is important that they are given the opportunity to suck when they are ready.

We will also show you how to recognise cues and signs that will tell us when to stop feeding. It is very important that you do not to try to encourage your baby to feed when they are showing STOP signs. Encouraging can tire baby and they will not enjoy feeding. It may cause them to be reluctant to suck at the next feeding time and can delay baby’s progress. The Scale Charts are on the wall so that you can easily see and refer to them. You will also find them attached to the cots and incubators. The cues and scoring will mean the same whether your choice is to breast or formula feeding.

The things you do to help your baby feed well are important

You and your baby’s team will work together to find the best way to feed your baby. Babies in neonatal nurseries may need extra help as they learn to feed. Your baby may need a feeding tube, special feeding position or extra help to breathe comfortably during feeding.

Your baby will guide the pace at which feeding progresses. Babies are individuals and show their unique personality from birth, this means that some babies will show feeding cues early and some babies will show cues later. The timing of your baby’s cues will not delay your baby being ready for home.

It is important to hold your baby close to you when breast or bottle feeding. Spending long periods of cuddling your baby, particularly skin-to-skin holding (also known as Kangaroo Care) has short and long term benefits for both baby and you. We encourage you to be with your baby as much as possible. Please ask about how we can best support you to do this.

We firmly believe that you are the most constant influence in your baby’s life and that your role as a parent is a very significant one at all stages of your baby’s journey. Being with your baby at feeding times is important for progressing to suck feeding. Staff will always available to help you.

• Responsive feeding
• Home NG feeding programme
• Assessing effective feeding
• Post discharge support

We have breast pumps available for you to use when you are with your baby on the neonatal unit. We also have a stock of pumps which you can use at home when you are not at the hospital. These are exactly the same as the pumps you will use in hospital. You can have this pump for the full time your baby is in hospital. The only exception would be if your baby gets moved to a hospital which is nearer home for you and no longer in GGC.

Before lending you a pump we will ask you to fill out a form with your contact details and sign a contract saying you agree to return the pump when your baby is discharge. Please ask your nurse if you need a breast pump while your baby is in the neonatal unit.

Every week we have breastfeeding peer supporters from NCT who come to the unit. They have had lots of additional training to support you with expressing and breastfeeding your sick or preterm baby.

Ask your nurse what day the peer supporter is normally on the unit.

If you want to contact them at any point during your stay you can sign up for the service by texting:

FEED to 82222

One of the peer supporters will get back to you usually within 24 hours. They can then offer you support at your baby’s bedside or via a virtual appointment on attend anywhere. We have tablets available to support virtual appointments if you don’t have access to a smart phone.

Breastfeeding support nurses

All of the nurses on the unit have been trained to support you with feeding your baby on the neonatal unit. We have also have staff on the unit who have dedicated time to support expressing and breastfeeding. Ask your nurse if you would like to speak to one of them.

Other places to look for support:

• Parent Club
• The Breastfeeding Network
• Infant feeding advisors:
  Gillian Bowker
  Email: gillian.bowker@ggc.scot.nhs.uk
• Glasgow Breastfeeding Buddies Neonatal Support Group