When Can Switch Nursing Help With Feeding?

Switch Nursing: Supporting Milk Supply, Milk Transfer and Infant Weight Gain

Switch nursing is a breastfeeding technique that involves offering each breast more than once during a feed. It can be used when milk production needs increasing, when a baby is not maintaining active feeding or when an infant is struggling to gain weight as expected. By changing breasts when sucking and swallowing slow, the aim is to encourage renewed feeding activity, stimulate further milk ejection reflexes and support effective milk removal (Riordan and Wambach, 2016; La Leche League Canada, 2024).

Switch nursing is not simply a way to manage a baby who comes off the breast, dozes and then signals to feed again. It is a practical technique that may form part of a wider feeding plan, particularly when milk production or milk transfer needs support. Understanding when and how to use it, alongside other strategies, helps ensure that feeding advice addresses the needs of the individual feeding dyad rather than focusing solely on how long a baby remains at the breast.

What is switch nursing?

Switch nursing involves offering one breast until the baby's active sucking and swallowing slows, then offering the other breast. If active feeding slows again, the first breast can be offered once more, with further changes of side as appropriate. This may be repeated several times during a single feed, depending on the baby's response and the feeding plan (Riordan and Wambach, 2016; La Leche League Canada, 2024).

The intention is to encourage periods of active feeding rather than allowing a baby to spend a prolonged time at the breast with little effective milk transfer. Nutritive sucking is generally characterised by deeper, slower jaw movements and swallowing, whereas non-nutritive sucking tends to involve more rapid, shallow movements with less swallowing. Observing these changes can help identify when a baby may benefit from breast compressions or a change of side (Academy of Breastfeeding Medicine, 2022; University Health Network, 2020).

Changing breasts can stimulate another milk ejection reflex, providing an opportunity for the baby to resume more active sucking and swallowing. Repeated breast stimulation may also contribute to maintaining or increasing milk production when combined with effective milk removal across the day and night (Riordan and Wambach, 2016; Kent et al., 2006).

Switch nursing does not require equal feeding times on each breast, and there is no universally correct number of switches. The approach depends on the baby's feeding behaviour, milk transfer, clinical needs and the breastfeeding parent's goals.

When might switch nursing be useful?

Switch nursing may be considered when milk production needs increasing, when a baby becomes sleepy before feeding effectively, or when active sucking and swallowing reduce before sufficient milk has been transferred. It may also be incorporated into a feeding plan when an infant's weight gain is slower than expected and assessment suggests that encouraging more active feeding could help (Riordan and Wambach, 2016; University Hospitals Sussex NHS Foundation Trust, n.d.).

When milk production needs increasing, offering both breasts and returning to each side may provide additional stimulation. If a baby is becoming less active as milk flow slows, changing breasts can offer another opportunity for active feeding. Breast compressions can also be used to encourage milk flow before changing sides (La Leche League Canada, 2024).

However, frequent feeding does not automatically indicate low milk production. Cluster feeding can be part of normal infant feeding behaviour, and feeding frequency varies between babies and across the day. The significance of frequent feeding depends on the wider picture, including the baby's health, feeding effectiveness, urine output, growth and the breastfeeding parent's experience (Kent et al., 2006; Academy of Breastfeeding Medicine, 2022).

Switch nursing is therefore best understood as one technique that may support effective feeding and milk removal, rather than a solution for every unsettled feed or every concern about supply. Where feeding difficulties persist, assessment is needed to establish whether the main concern relates to milk production, milk transfer, infant feeding function or another contributing factor.

Combining switch nursing with breast compressions

Breast compressions involve gently compressing the breast while the baby is attached, with the intention of encouraging milk flow. When a baby continues sucking but swallowing slows, compression may help the baby receive more milk before changing sides. Once the baby is no longer responding to compression, offering the other breast may encourage renewed sucking and swallowing (La Leche League Canada, 2024; University Hospitals Sussex NHS Foundation Trust, n.d.).

The two techniques can be combined according to the baby's response. A caregiver may observe active feeding on the first breast, use breast compressions when swallowing slows, and then offer the other breast if the baby remains interested but is no longer feeding effectively. The sequence can be repeated as appropriate.

The aim is to support milk transfer without causing pain or turning feeding into a rigid routine. Breast compression should be comfortable, and the baby should not be forced to remain attached when no longer interested or when feeding appears difficult. Persistent difficulty maintaining attachment, coordinating sucking and swallowing or responding to milk flow warrants further assessment rather than repeated switching alone (Academy of Breastfeeding Medicine, 2022).

Positioning, attachment and breast shaping

Effective positioning and attachment are important because the baby's ability to maintain a comfortable latch influences milk transfer. If a baby repeatedly slips off the breast, struggles to maintain attachment or causes persistent nipple pain, switching sides may not resolve the underlying difficulty. A feeding assessment can help identify whether positioning, attachment, oral function or another factor needs attention (Academy of Breastfeeding Medicine, 2022; NICE, 2017).

Breast shaping can support some babies to achieve an effective attachment by helping the breast fit comfortably within the baby's mouth. The approach needs to take account of the baby's position, the shape and size of the breast, nipple direction and the breastfeeding parent's comfort. Breast shaping, positioning and attachment should be considered together rather than as separate rules that every feeding dyad must follow.

For further information, see Breastfeeding Latch and Positioning and How to Improve Infant Latch: Practical Breastfeeding Support.

Where attachment remains difficult despite support, the assessment should consider the baby's feeding function and the wider clinical picture. The appearance of a lingual frenulum alone does not establish whether it is affecting feeding; assessment needs to consider tongue function, observed feeding, maternal comfort and milk transfer (NICE, 2017).

Supporting milk production

Milk production is influenced by hormonal processes and the frequency and effectiveness of milk removal. In the early postnatal period, frequent breastfeeding and effective milk removal are important in establishing production, while ongoing milk removal helps regulate production in response to the infant's needs (de Carvalho et al., 1983; Kent et al., 2006).

Where supply needs increasing, switch nursing may be one component of a plan to provide additional breast stimulation. Other measures may include responsive feeding, improving attachment, breast compressions and expressing milk. The appropriate combination depends on the reason for the supply concern and whether the baby can remove milk effectively at the breast (Academy of Breastfeeding Medicine, 2017; Academy of Breastfeeding Medicine, 2022).

It is important to distinguish between milk production and milk transfer. A breastfeeding parent may produce sufficient milk, but an infant may struggle to remove it effectively. Alternatively, the infant may feed effectively but the available milk may not meet their needs. Both situations can involve frequent feeding, yet the management approach may differ (NICE, 2017; Kent et al., 2006).

Further information is available in Increasing Breast Milk Production. This can help families understand why assessment of milk production and milk removal matters before assuming that supply is the sole explanation for feeding difficulties.

Expressing milk and flange fit

Expressing may be helpful when an infant is unable to remove sufficient milk directly from the breast, when a feed is missed or ineffective, or when additional stimulation is needed to support milk production. Expressed breast milk can also be offered to the infant when additional intake is required as part of an agreed feeding plan (Academy of Breastfeeding Medicine, 2017; Academy of Breastfeeding Medicine, 2022).

The frequency of expressing should reflect the individual circumstances, including the baby's age, feeding effectiveness, milk production and the amount of additional milk required. Where an infant is not transferring milk effectively, expressing may help protect milk production while the underlying difficulty is assessed and addressed. It should not, however, become an unnecessarily burdensome routine without consideration of the mother's recovery, sleep, emotional wellbeing and practical circumstances.

Pump choice and flange fit can affect comfort and the experience of expressing. A flange that is unsuitable for the individual breast and nipple may cause discomfort or contribute to ineffective milk removal, so assessment of fit can be valuable when expressing is painful or appears ineffective (Academy of Breastfeeding Medicine, 2022).

Families can read more in How to Express Breastmilk and Breast Pump Flange Fitting: Size, Shape, Comfort and Milk Removal.

Low weight gain: why weighing alone is not enough

When an infant's weight trajectory raises concern, weight measurements are essential for identifying the pattern of growth and monitoring whether progress is improving. However, weighing is a monitoring measure, not an intervention that addresses the cause of inadequate weight gain.

NICE recommends a clinical, developmental and social assessment when faltering growth is suspected, alongside a detailed feeding history and direct observation of feeding where appropriate. For milk-fed infants, possible contributing factors include ineffective suckling, ineffective bottle feeding, feeding patterns, the feeding environment, feeding aversion, responses to feeding cues and physical difficulties affecting feeding (NICE, 2017).

This distinction is important because a baby may feed frequently without transferring sufficient milk, while another may transfer milk effectively but have an underlying issue affecting milk production or growth. Weight measurements can demonstrate that a concern exists, but they cannot establish the cause by themselves. The assessment and feeding plan must address the factors contributing to the baby's growth trajectory (NICE, 2017).

Where weight gain is concerning, timely involvement of an appropriate healthcare professional is a priority. The urgency depends on the baby's age, clinical condition, degree of weight change and other findings. A baby who is unwell, difficult to wake, showing signs of dehydration or feeding substantially less than usual needs urgent clinical assessment rather than further attempts to manage feeding with switch nursing alone (NICE, 2017).

An International Board Certified Lactation Consultant (IBCLC) can provide specialist lactation and infant-feeding assessment, including observation of feeding, assessment of milk transfer and support with milk production, expressing and supplementation. The IBCLC can contribute to a feeding plan alongside the GP, health visitor, midwife or paediatric team, according to the baby's clinical needs. Medical assessment remains necessary where illness, dehydration or another health concern needs to be investigated (NICE, 2017; Academy of Breastfeeding Medicine, 2022).

The baby's health and adequate nutritional intake must come first. Increasing milk production may be an important part of the plan, particularly where continued breastfeeding is a family goal, but it must not delay ensuring that the infant receives sufficient milk. The plan may include switch nursing, breast compressions, improving attachment, expressing and providing additional milk where clinically indicated. Follow-up should evaluate whether the plan is meeting the baby's nutritional needs and whether the factors contributing to the concern are improving, alongside weight monitoring at intervals appropriate to the clinical situation (NICE, 2017; Kellams et al., 2017).

For more information about specialist feeding support, see What is an IBCLC? Feeding Support Explained.

Expressed milk, supplementation and supplemental nursing systems

Where an infant needs additional milk, the feeding plan should identify how their nutritional requirements will be met while the underlying difficulty is investigated and addressed. Depending on the clinical circumstances, this may involve expressed breast milk, donor human milk where available and appropriate, or infant formula. Supplementation decisions should be based on an assessment of the individual infant rather than a single finding in isolation (Kellams et al., 2017).

Providing additional milk does not automatically mean breastfeeding must end. Where maintaining breastfeeding is important to the family, the plan may include continuing to offer the breast when appropriate, expressing to support milk production and reviewing the approach as feeding effectiveness and growth improve. The infant's immediate nutritional needs must remain central to these decisions (Kellams et al., 2017; NICE, 2017).

A supplemental nursing system (SNS) delivers additional milk through a fine tube positioned alongside the nipple, allowing the baby to receive milk while feeding at the breast. For some feeding dyads, this can be an option for providing additional milk while maintaining opportunities for direct breastfeeding and breast stimulation. Suitability depends on the baby's feeding ability, the amount of milk required and whether the system can be used reliably and safely with appropriate guidance (La Leche League Great Britain, n.d.; Kellams et al., 2017).

An SNS should not be selected simply because an infant has a low weight trajectory. Assessment needs to establish whether the baby can feed effectively at the breast, whether the system is practical for the family and whether the baby's nutritional needs can be met using that method. Other alternative feeding methods may be more appropriate in some circumstances (Kellams et al., 2017).

Further information is available in Alternative Feeding Methods for Babies, which discusses different approaches to providing milk when feeding directly at the breast is insufficient or not possible.

Supporting maternal mental health during feeding difficulties

Breastfeeding difficulties can affect emotional wellbeing, particularly when a mother is worried about milk production, feels that her baby is not satisfied after feeding or is receiving repeated advice to change how she feeds. When an infant is not gaining weight as expected, the responsibility of ensuring adequate intake can add to anxiety, exhaustion and feelings of uncertainty. Frequent feeding, expressing, monitoring intake and attending additional appointments can also become physically and emotionally demanding (World Health Organization, 2022; NICE, 2017).

Support should recognise the mother's experience alongside the baby's feeding needs. Reassurance alone may not be sufficient when feeding remains difficult or there are unresolved concerns about milk transfer or weight gain. Clear explanations, an achievable feeding plan, appropriate clinical follow-up and consistent communication between healthcare professionals can help reduce uncertainty and ensure that responsibility for resolving the difficulty does not rest entirely on the mother (World Health Organization, 2022).

Switch nursing and other breastfeeding techniques should be offered when appropriate to the feeding assessment, rather than becoming additional tasks that a mother feels she must perform perfectly. Where expressing, supplementation or other feeding methods are needed, these should be discussed sensitively, taking account of the mother's circumstances, feeding goals and emotional wellbeing. Supporting the baby's nutritional needs and supporting the mother's mental health are complementary priorities (World Health Organization, 2022; Kellams et al., 2017).

Healthcare professionals should remain alert to signs of significant distress, anxiety or low mood and facilitate access to appropriate perinatal mental-health support when needed. The World Health Organization recommends psychosocial interventions to help prevent postnatal depression and anxiety and emphasises the importance of supportive, respectful postnatal care (World Health Organization, 2022). A compassionate approach acknowledges that feeding experiences can be emotionally complex and that seeking help is not a sign of failure.

When feeding difficulties persist

Persistent feeding difficulties may involve several contributing factors, including positioning and attachment, maternal comfort, milk production, infant alertness, oral function, coordination, underlying illness or other clinical and environmental influences. NICE recommends considering a range of possible factors when assessing faltering growth, rather than assuming that one explanation accounts for every feeding difficulty (NICE, 2017).

A lingual frenulum may be relevant to feeding function in some infants, but its appearance alone cannot establish whether it is affecting feeding. Assessment should consider tongue function, observed feeding, maternal comfort, milk transfer and the baby's wider clinical picture (NICE, 2017).

Where a baby repeatedly falls asleep before feeding effectively, struggles to maintain attachment, has difficulty coordinating sucking and swallowing or continues to gain weight inadequately, further assessment is more important than repeatedly changing breasts in the hope that the problem will resolve. The appropriate feeding strategy should follow the assessment and be reviewed according to the baby's response (Academy of Breastfeeding Medicine, 2022; NICE, 2017).

For professionals supporting feeding dyads, documenting the presenting concern, observed feeding behaviour, parental comfort, agreed feeding plan and review arrangements can support continuity of care. This also helps ensure that a technique is reviewed when it is not meeting the baby's needs, rather than continuing without evidence of improvement (Academy of Breastfeeding Medicine, 2022).

The role of switch nursing in a wider feeding plan

Switch nursing can be a useful technique for encouraging active feeding and providing additional breast stimulation. It may be considered when milk production needs increasing or when a baby becomes less active at the breast before feeding effectively. It can be combined with breast compressions, effective positioning and attachment, breast shaping and expressing where appropriate (Riordan and Wambach, 2016; La Leche League Canada, 2024).

However, the aim is not to keep a baby at the breast for as long as possible or to increase the number of switches without considering the outcome. The important questions are whether the baby is transferring milk effectively, receiving adequate nutrition, maintaining hydration and growing as expected (NICE, 2017; Academy of Breastfeeding Medicine, 2022).

When weight gain is concerning, weighing provides information about progress, but the feeding plan must address the factors contributing to the concern. Specialist infant-feeding support and appropriate healthcare involvement can help families understand what is happening, protect the baby's health and support milk production where needed. The mother's emotional wellbeing also deserves attention throughout this process (NICE, 2017; World Health Organization, 2022).

The most useful feeding strategy is one that meets the baby's nutritional needs, supports the family's feeding goals and is reviewed according to the response of the individual feeding dyad.

References

Academy of Breastfeeding Medicine (2017) ‘ABM Clinical Protocol #3: Supplementary feedings in the healthy term breastfed neonate, revised 2017’, Breastfeeding Medicine, 12(3), pp. 188–198. doi: 10.1089/bfm.2017.29038.ajk.

Academy of Breastfeeding Medicine (2022) ‘Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for birth hospitalization discharge of breastfeeding dyads, revised 2022’, Breastfeeding Medicine, 17(3), pp. 197–206. doi: 10.1089/bfm.2022.29203.aeh.

de Carvalho, M., Robertson, S., Merkatz, R. and Klaus, M. (1983) ‘Effect of frequent breastfeeding on early milk production and infant weight gain’, Pediatrics, 72(3), pp. 307–311.

Kellams, A., Harrel, C., Omage, S., Gregory, C. and Rosen-Carole, C. (2017) ‘ABM Clinical Protocol #3: Supplementary feedings in the healthy term breastfed neonate, revised 2017’, Breastfeeding Medicine, 12(3), pp. 188–198. doi: 10.1089/bfm.2017.29038.ajk.

Kent, J.C., Mitoulas, L.R., Cregan, M.D., Ramsay, D.T., Doherty, D.A. and Hartmann, P.E. (2006) ‘Volume and frequency of breastfeedings and fat content of breast milk throughout the day’, Pediatrics, 117(3), pp. e387–e395. doi: 10.1542/peds.2005-1417.

La Leche League Canada (2024) Breast compressions and switch nursing. Available at: https://www.lllc.ca/breast-compressions-and-switch-nursing.

La Leche League Great Britain (n.d.) Relactation and induced lactation. Available at: https://laleche.org.uk/relactation-induced-lactation/.

National Institute for Health and Care Excellence (NICE) (2017) Faltering growth: recognition and management of faltering growth in children. NICE guideline NG75. Available at: https://www.nice.org.uk/guidance/ng75.

Riordan, J. and Wambach, K. (2016) Breastfeeding and human lactation. 5th edn. Burlington, MA: Jones & Bartlett Learning.

University Hospitals Sussex NHS Foundation Trust (n.d.) Helping your breastfed baby to get all the milk they need. Available at: https://www.uhsussex.nhs.uk/resources/helping-your-breastfed-baby-to-get-all-the-milk-they-need-2/.

World Health Organization (2022) WHO recommendations on maternal and newborn care for a positive postnatal experience. Geneva: World Health Organization. Available at: https://www.who.int/publications/i/item/9789240045989.

World Health Organization (2022) WHO guide for integration of perinatal mental health in maternal and child health services. Geneva: World Health Organization. Available at: https://www.who.int/publications/i/item/9789240057142.