Mothers in our study often worried about whether their child would get enough to drink and eat whilst separated from them. In this guide we provide some information on solids and providing expressed breastmilk or formula to your child whilst separated.
It is recommended that breastmilk or infant formula milk is the main source of nutrition / drink until the child is 12 months.1 Children are typically ready to be introduced to solids around 6 months. From 12 months children can have cow’s (or alternative to) milk as a drink. Therefore if your child is under 12 months they may need expressed breastmilk or formula whist separated from you. After 12 months children can often manage on solid food, drinks of tap water. However, there is variation across children, which may depend on the age of the child, how they have taken to solids, and how long you are separated for. Some children under 12 months may manage without expressed milk or formula and have just solid food and water. They then may make up milk feeds when you are together. Whilst some over 12 months may require expressed milk and/or formula whilst separated. If you are concerned about your child’s solid or milk intake speak to your health visitor, GP or breastfeeding support service.
Introducing Solids
From around 6 months, children can start eating normal family foods, although children still need most of their calories/nutrition from breastmilk or infant formula milk until 12 months. The NHS1 provides useful resources on introducing solids, and we signpost to further resources in Mother Guide 14. The NHS states there are 3 clear signs which, when they appear together from around 6 months of age, show your baby is ready for their first solid foods alongside breastmilk or formula milk. They’ll be able to:
- stay in a sitting position and hold their head steady
- coordinate their eyes, hands and mouth so they can look at the food, pick it up and put it in their mouth by themselves
- swallow food (rather than spit it back out)
Responsive and Paced Bottle Feeding
If your child is given milk (expressed breastmilk or formula) in a bottle it is recommended to use responsive and paced bottle feeding2,3 which will help you find the right portion size for your child. Responsive feeding refers to offering milk based on feeding cues. Paced bottle feeding gives your child more control by using breaks to pace the feeds. A useful video on paced bottle feeding: https://youtu.be/OGPm5SpLxXY?si=oSLdH0Vyid95s0Am
How much milk to give?
If your child is given expressed breastmilk or formula whilst separated from you, you may wonder how much to provide/offer, especially if you are used to feeding on demand. As discussed above it is recommended that children are fed responsively and when bottle fed a paced bottle feeding method is used. As a guide, from about 4/5 weeks old babies take more or less the same amount of breastmilk per day till 6 months old then they typically take LESS (one they start eating supplementary family foods). A research study (reviewing other studies)3 suggests among children who were exclusively breastfed for 6 months, the average breastmilk intake at 6 months was 729ml per day and at 12 months was 593ml per day. Milk intake will vary across children. Whereas infant formula volumes do continue to go up as babies grow and formula feeds are generally larger and less frequent4.
If offering expressed breastmilk a rough calculation is to offer 30ml for every hour you are apart with a maximum feed volume of 120ml-150ml. But again children vary in their milk intake. If offering formula, first steps nutrition trust make excellent research-based resources about formula and baby foods, including how to safely make up formula feeds. Their guide to infant formula milks5 provides information on suggested intake ranges and number of feeds, based on age and weight. Again the recommendation is to be guided by your child and follow responsive feeding recommendations.
A note on avoiding the top up trap
When introducing formula to a breastfed child, many parents worry about falling into what is commonly referred to as the top-up trap. This term describes a cycle where supplementing with formula unintentionally leads to reduced breastfeeding, which then decreases breastmilk supply and increases dependence on formula. Suggestions to avoid this include:
- When breastfeeding – work on getting a good latch
- Maximise the feed
- Watch for active feeding: see 2-4 minutes of this video – https://globalhealthmedia.org/portfolio-items/is-your-baby-getting-enough-milk/ – for some good examples of the movement one should look for (of your baby’s chin and throat) to help you decide whether your baby is drinking well.
- Once “active feeding” slows you might like to try breast compressions: this video – https://youtube/TCauJNqkirU?feature=share – explains how.
References
- https://www.nhs.uk/baby/weaning-and-feeding/babys-first-solid-foods/
- https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/bottle-feeding-resources/infant-formula-responsive-bottle-feeding-guide-for-parents/
- https://www.nhs.uk/start-for-life/baby/feeding-your-baby/bottle-feeding/bottle-feeding-your-baby/feeding-on-demand/
- Rios-Leyvraz, M., & Yao, Q. (2023). The volume of breast milk intake in infants and young children: a systematic review and meta-analysis. Breastfeeding Medicine, 18(3), 188-197.
- First Steps Nutrition Trust, (2024) Infant milks: A simple guide to infant formula, follow-on formula and other infant milks, Available from: https://www.firststepsnutrition.org/parents-carers
