Breastfeeding Basics: From Positions to Schedules

The amount of information available on how to breastfeed successfully can seem overwhelming at times. We recommend finding a trusted source that provides evidence-based information and techniques for you to trial, and using what works for you. If you are experiencing difficulty then it’s a good idea to get a second opinion - contact the Karitane Careline, your child and family health nurse, the Australian Breastfeeding Association or a private lactation consultant.

The World Health Organisation endorses exclusive breastfeeding beginning one hour after birth until six months of age. From there, add nutritious, complementary foods while continuing to breastfeed, until your child turns two.

The latch your baby develops with your breast is key to successful breastfeeding. Your baby is hardwired to breastfeed and will instinctively find your breast within the first hour after birth.

Getting a good attachment to your breast may be challenging. Finding a method that works for both of you makes all the difference to your success. Generally, the way your baby latches and your position don’t really matter, as long as you are not experiencing pain and your baby is comfortable and receiving enough milk.

Here are a few tips on getting a good latch:

Your baby should be held close, unwrapped and well supported
Make sure your baby faces you and is tucked in close to your body
Position your baby’s nose and top lip in line with your nipple
Move your baby toward your breast
Encourage your baby’s mouth to open by teasing with your outer nipple and bring your baby to your breast
Ensure your baby gets a good mouthful of your nipple

Once attached, your baby will have a short, initial burst of sucking, then slow to an even rhythm, with deep jaw movements. As your child continues, pauses may occur. Don’t worry - this is a normal aspect of feeding. Pause frequency may increase as the feed continues. Eventually, your baby will stop feeding by coming off the breast themselves.

If you experience pain during the feed, and/or the pain doesn’t settle after a few sucks, you’ll need to help your baby learn how to latch more successfully. Gently break the seal of their mouth on your nipple by using a clean finger at the corner of your child’s mouth to detach. Once your baby’s mouth is off the breast, help them reattach.

Karitane Tip: If you experience any pain while feeding, it is vital to detach your baby from the breast.

Baby-led attachment is another latching method. It involves allowing your baby to follow their natural instincts to find your breast and attach at will. This method works best soon after birth – however, it can also be introduced a few weeks later. This video demonstrates successful baby-led attachment (sourced from Raising Children).

Some tips:

Trust your baby to find your breast
Look for cues that your baby is hungry
Skin to skin contact is helpful
Pick a warm place where you feel comfortable
Use pillows for support
Keep calm
Place your baby on your chest, between breasts
Support your baby’s shoulders and bottom
Only support your baby’s head as necessary
Support your baby’s thighs and back while they position themselves to latch

Karitane Tip: Feeding within the first hour of life helps get your breastfeeding experience off to a good start. While pregnant, it is helpful to have a chat to your midwife or doctor to implement this into your birthing plan.

For more information on breast attachment, visit the Australian Breastfeeding Association.

In the early weeks your baby will try to communicate their needs. As you get to know each other better, you’ll begin to understand these cues.

Babies are ‘wired’ to look for food when hungry, and feeding times can vary greatly. On average, newborns feed every 2-3 hours – so if your baby starts to fuss and hasn’t been fed in the last few hours, checking their appetite is a good start. It’s normal to feed a newborn baby 6-12 times per day.

Karitane Tip: Your baby’s hunger cues are the best indicator for when to feed. Going by a set time period doesn’t take your baby’s individual needs into consideration.

Hunger cues include:

Sucking noises
Opening mouth
Turning towards breast or bottle
Sucking fingers and/or fist
Crying
Being unsettled

Sometimes your baby just wants to feed for comfort. This reassurance is fine when your baby is very distressed as it can be calming in these situations.

The following videos demonstrate some baby hunger signs (Sourced from Raising Children).

As your baby grows, you’ll notice they are able to latch more independently with increased sucking efficiency – which means that they can feed for a shorter time, but with the same satisfaction. At around three to four months, you may also notice your baby becomes easily distracted, and detaches and attaches several times during the feed. This is more prone to happen in new and/or stimulating environments, like a shopping centre.

Around this time babies also generally reduce breastfeeds over 24 hours. At this point, it is common for babies to feed every 3-4 hours – including overnight feeds. Remember to keep looking for hunger cues as an appropriate indicator of when to offer the breast.

Karitane Tip: We recommend giving your baby only breast milk or formula for the first six months, as these contain all the nutrients your child needs. To cater to your baby’s growing development, you can begin to introduce solids around this six-month period. For more information on solids, read more here.

When assessing whether your baby is actually hungry or not, it’s important to consider other things your baby might be trying to express. Look at your baby’s growth, development, sleep routine, activity, health and environment, to determine whether your baby is really hungry, tired or needs changing.

Every baby is unique and will therefore grow a little differently. However, you may find it helpful to have your baby’s head length and weight checked and recorded at regular intervals. Your child and family health nurse can do this for you, during regular child health checks. You’ll find a copy of their growth percentile chart in the Blue Book.

Your baby’s weight will vary significantly as your breastfeeding routine is established over time. All babies experience greater periods of hunger at certain times, so your baby may increase feeds to change your milk supply at these times of growth. Look for these additional hunger cues and feed to your baby’s demand.

Babies tend to grow according to their percentile. This expected weight gain table offers a general guide to growth rates.

Aged 0 - 3 months gain 150 - 200g / week
Aged 3 - 6 months gain 100 - 150g / week
Aged 6 - 12 months gain 70 - 90g / week
Birth - 1 year should be 2 - 3 x birth weight
1 - 2 years gain 2 - 3kg / year (40 - 50g / week)
2 - 5 years gain 2kg / year

Your baby’s development influences when and how often a feed is offered. As your child grows, you’ll find they begin to attach and breastfeed with more ease. Breast milk should remain the primary source of nutrition before solid foods are introduced at six months. At this stage water may be introduced in small amounts, for thirst only.

At Karitane, we’ve found promoting a feed, then play, and then sleep helps you determine your baby’s hunger and sleep cues more easily. Not feeding when they’re due to be sleeping also helps your child learn to sleep more independently over time.

Additionally, you’ll find daily activity helps reduce snack feeding – promoting better, healthier feed and sleep patterns. Activity for infants up to one year is typically floor play, including tummy time and time smiling and talking with mum and dad.

Feeding and sleeping work closely together. Too little sleep can make it hard to feed well, just as too little food affects sleeping patterns. Over the first few weeks, you’ll experience some trial and error when it comes to these. Don’t be discouraged. It takes time to get know your baby.

Babies find it difficult to regulate their own body temperature, so your baby can easily overheat with overdressing, multiple blankets, room heating and/or hot weather. This increases their need for extra fluids. If your baby is under six months, this may mean additional feeding.

If your baby is too hot, they may wake for more feeds or fluid overnight. If your baby is too cold, they may expend more energy to stay warm, and demand more feeds to sustain this energy. As a general rule for hot weather, dress your child in one item less than you’re wearing. In the cold, add one layer extra.

Karitane Tip: There is also no evidence to support maintaining a specific room temperature, or any specific bedding configuration (number of blankets required) as this depends on a number of factors, such as what your baby is wearing, whether it is summer or winter, and whether there is heating or cooling within the room where your baby is sleeping.

Sourced from Red Nose: Room Temperature.

When deciding whether your baby is getting enough out of their feed, it’s useful to remember every child is different. No two babies have the same appetite. Instead of focusing on each individual feed, try to consider the feeds over the whole day. There will be times of the day where you will feel your baby has had a good feed and other times of the day where your baby might have had a short feed or been fussy.

Contentment:

If your child seems generally content after a feed, this is a cue of satisfaction. You may notice your baby also appears more alert and active when awake. Remember, in the early months it’s normal for your baby to experience one or two unsettled periods a day, and they may want to feed more often – so don’t be worried if this occurs.

Output:

Urine: Your baby will have six or more wet nappies over the course of 24 hours. Healthy urine is a clear, pale yellow. Should the urine darken, seek medical advice.

Stools: Your baby’s bowel movements are soft, and occur many times in the first 6-8 weeks. If your baby is also taking formula, stool (poo) frequency and consistency can be firmer and less regular (every 1-2 days on average). Once solid foods are introduced, colour, texture and frequency often change as your baby adjusts to the new diet.

Karitane Tip: If you notice firm, pebble-like stools, difficulty passing stools, crying when passing stools, or bleeding when passing stools, seek medical advice.

For more information on breastfeeding, download a copy of Breastfeeding your Baby by the NSW Ministry of Health.

If you experience challenges with feeding, don’t be afraid to reach out. There are many avenues available to you.

Karitane Careline (1300 CARING | 1300 227 464)

Karitane provides feeding support through our free careline. Should you reach us out of hours, an experienced child and family health nurse will phone back within 24 hours, between 12.30pm – 9pm / 11pm – 6am Monday to Thursday, or 9am – 3.30pm Friday to Saturday.

Karitane emails

Don’t hesitate to email KRTNE-OnlineEnquiries@health.nsw.gov.au if you have any feeding questions.

Friends and family

If you’re lucky to have generous friends and family offering to help, request assistance in practical ways. They can help by making meals, doing laundry, hosting play dates, preparing snack boxes, and offering emotional support.

Child and family health nurses

Registered child and family health nurses are qualified in child and family health, and are trained to support parents with feeding issues.

Your local community health centre

Local family health centres are a great place to seek help with feeding. Many centres offer drop-in feeding clinics and/or appointments for difficulties.

www.healthdirect.gov.au l 1800 022 222

Australian Breastfeeding Association

The ABA is a non-profit organisation run by other breastfeeding mums. Their breastfeeding helpline is staffed by trained volunteers, and is available seven days a week.

1800 MUM 2 MUM | 1800 686 268

Lactation consultant

A trained breastfeeding specialist can provide support and advice, often in a clinical or home setting. Free lactation consultations are available from a child and family health centre. Private consultations will incur a fee. To find a consultant, ask your family doctor or search online.

Your local feeding clinic

Many large hospitals house specialist feeding clinics. These are often required after oral surgery, feeding tubes, oral trauma, medical conditions or interfering feeding behaviours. Ask your family doctor for a referral.