Formula and pumped breastmilk side by side. Note that the formula is of uniform consistency and color, while the expressed breast milk exhibits properties of an organic solution by separating into a layer of fat at the top (the "creamline"), followed by the milk, and then a watery blue-colored layer at the bottom. Expressed milk Manual breast pump A mother may express her milk (remove milk from breasts) for storage and later use. Expression may occur manually with hand expression, or by using a breast pump. Mothers express milk for multiple reasons. Expressing breast milk can maintain a mother's milk supply when she and her child are apart. A sick baby who is unable to nurse can take expressed milk through a nasogastric tube. Some babies are unable or unwilling to nurse. Maternal breastmilk is the food of choice for premature babies; these infants may be fed maternal milk through tubes, supplemental nursing systems, bottles, spoons or cups until they develop satisfactory ability to suck and swallow breast milk. Some women donate expressed breast milk (EBM) to others, either directly or through a milk bank. This allows mothers who cannot breastfeed to give their baby the benefits of breast milk. While informally-shared breastmilk does carry the nutritional benefits of breastmilk, this breastmilk is most often not pasteurized or screened, and thus carries with it the risk of transmitting diseases or medications that are unsafe for infants. Parents considering directed or informal milk sharing should discuss this option with their doctor, and they should be familiar with the donors medical history and milk handling practices. use of informally-shared (unscreened, not pasteurized) milk from an anonymous donor is discouraged by the academy of<unk>  Medicine. Babies feed differently with artificial nipples than from a breast. With the breast, the infant's tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth. Drinking from a bottle takes less effort and the milk may come more rapidly, potentially causing the baby to lose desire for the breast. This is often referred to as nipple confusion or nipple preference. While some infants do experience this preference for the bottle, many infants do not and will be able to alternate between bottle and breast without issue. "Exclusively expressing" and "exclusively pumping" are terms for a mother who exclusively feeds her baby expressed milk. Exclusively pumping is poorly studied in the literature, especially in recent years. However, from available evidence, it appears to be fairly uncommon, with only approximately 7% of study participants reporting exclusive pumping. Storage of Expressed Breastmilk Breastmilk may be stored for various amounts of time depending on storage temperature and conditions. The content and quality of expressed milk changes over time as it is stored, particularly when frozen. For example, there is a decrease in the ability of breastmilk to kill bacteria when it is stored in the refrigerator for more than 48 hours. Additionally, the quantity of fat, protein, and calories in breastmilk decreases when the milk is frozen for more than 3 months. While several components of breastmilk change over time, inflammatory factors (cytokines) and maternal antibodies, and growth factors are thought to be stable for at least 6 months when the breastmilk is frozen. Storage guidelines, according to the CDC, La Leche League International and the Academy of<unk>  Medicine, are noted in the table below. +Storage of Expressed Breastmilk Storage Location Optimal Storage Time Acceptable Storage Time Source Countertop 4 hours 8 hours Insulated bag with icepack 24 hours Refrigerator 4 days 5 days Freezer compartment of minifridge 2 weeks Standard Freezer 6 months 12 months Deep Freezer (usually separate from refrigerator) 6–12 months Breastmilk Storage Containers Expressed breastmilk can be stored in freezer storage bags, containers made specifically for breastmilk, a supplemental nursing system, or a bottle ready for use. Parents should avoid using storage containers which contain bisphenol A (BPA). Additionally, use of polyethylene containers have been shown to decrease the immune benefits of breastmilk, including its ability to kill bacteria and the maternal antibodies it contains, by up to 60%. Shared nursing It is not only the mother who may breastfeed her child. She may hire another woman to do so (a wet nurse), or she may share childcare with another mother (cross-nursing). Both of these were common throughout history. It remains popular in some developing nations, including those in Africa, for more than one woman to breastfeed a child. Shared<unk>  is a risk factor for HIV infection in infants. Shared nursing can sometimes provoke negative social reactions in the English-speaking world. Tandem nursing It is possible for a mother to continue<unk>  an older sibling while also<unk>  a new baby; this is called tandem nursing. During the late stages of pregnancy, the milk changes to colostrum. While some children continue to breastfeed even with this change, others may wean. Most mothers can produce enough milk for tandem nursing, but the new baby should be nursed first for at least the first few days after delivery to ensure that it receives enough colostrum.<unk>  triplets or larger broods is a challenge given babies' varying appetites. Breasts can respond to the demand and produce larger milk quantities; mothers have breastfed triplets successfully. File:Breastfeeding newborn twins.Newborn twins being breastfed File:Breastfeeding 2 year old twins.Woman breastfeeds 2 year old twins whilst reading them a book. File:Tandem<unk>  toddler and baby.Woman tandem nurses an infant and a toddler. Re-lactation and induced lactation Re-lactation is the process of restarting<unk> . In developing countries, mothers may restart<unk>  after a weaning as part of an oral rehydration treatment for diarrhea. In developed countries, re-lactation is common after early medical problems are resolved, or because a mother changes her mind about<unk> . Re-lactation is most easily accomplished with a newborn or with a baby that was previously<unk> ; if the baby was initially bottle-fed, the baby may refuse to suckle. If the mother has recently stopped<unk> , she is more likely to be able to re-establish her milk supply, and more likely to have an adequate supply. Although some women successfully re-lactate after months-long interruptions, success is higher for shorter interruptions. Techniques to promote lactation use frequent attempts to breastfeed, extensive skin-to-skin contact with the baby, and frequent, long pumping sessions. Suckling may be encouraged with a tube filled with infant formula, so that the baby associates suckling at the breast with food. A dropper or syringe without the needle may be used to place milk onto the breast while the baby suckles. The mother should allow the infant to suckle at least ten times during 24 hours, and more times if he or she is interested. These times can include every two hours, whenever the baby seems interested, longer at each breast, and when the baby is sleepy when he or she might suckle more readily. In keeping with increasing contact between mother and child, including increasing skin-to-skin contact, grandmothers should pull back and help in other ways. Later on, grandmothers can again provide more direct care for the infant. These techniques require the mother's commitment over a period of weeks or months. However, even when lactation is established, the supply may not be large enough to breastfeed exclusively. A supportive social environment improves the likelihood of success. As the mother's milk production increases, other feeding can decrease. Parents and other family members should watch the baby's weight gain and urine output to assess nutritional adequacy. A WHO manual for physicians and senior health workers citing a 1992 source states: "If a baby has been<unk>  sometimes, the breastmilk supply increases in a few days. If a baby has stopped<unk> , it may take 1-2 weeks or more before much breastmilk comes." Induced lactation, also called adoptive lactation, is the process of starting<unk>  in a woman who did not give birth. This usually requires the adoptive mother to take hormones and other drugs to stimulate breast development and promote milk production. In some cultures,<unk>  an adoptive child creates milk kinship that builds community bonds across class and other hierarchal bonds.
Breastfeeding
Human–animal breastfeeding
Infant formula
Breast milk
Home birth
Parenteral nutrition
Dieting
Infant bathing