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If feeding is affected by the breastfeeding/chestfeeding baby or child's illness then the mother/parent will need advice on managing the breasts/chest. A sudden reduction in breastfeeding/chestfeeding puts the parent at risk of discomfort and mastitis, particularly in an exclusively breastfed/chestfed baby. If they are in discomfort the mother/parent should express, whether by hand or pump. They may also wish to get milk to give to the baby by another route, for example nasogastric tube. Those who are not used to expressing may find it difficult to get 'let down' (milk ejection) - they can be advised to warm the breast/chest and look at pictures/videos of the baby or smell the baby. If the baby can feed a little bit then the mother/parent could continue to express after a brief feed.

All children's wards should have electric pumps for loan. See a video on hand expressing technique here. Note that if the mother/parent's milk supply is precarious (for example the baby has faltering growth or exclusive breastfeeding/chestfeeding hasn't been fully established in the first few weeks of life) and the baby isn't feeding, the mother/parent should be advised to express 8-10 times a day to maintain and build their supply. If the supply is well established (baby growing well on exclusive breastfeeding/chestfeeding, more than a few weeks old) then they just need to express as much as required to relieve discomfort and get whatever milk volume they desire.

Also remember that NICE Guidance on care in the first 2 months of life recommends that 

  • Breastfeeding/chestfeeding support should be made available regardless of the location of care

  • Healthcare professionals should have sufficient time, as a priority, to give support to a mother/parent and baby during initiation and continuation of breastfeeding/chestfeeding

So if your department admits young babies, it needs to have staff available with the time and expertise to give feeding support to their families

Have a look at Sarah's story of breastfeeding a baby undergoing surgery

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