Breastfeeding of the normal new born

For feeding of the LBW/ premature infant see Feeding)

Benefits of breastfeeding - babies who are exclusively breastfed for 6 months will get the greatest health benefits and disease prevention.

Colostrum (first yellowish milk after delivery)– this will meet the needs of the baby in the first few days after birth.

Discomfort for the mother at the start of breast feeds in the first few days is not uncommon, but this should not persist.

A baby may have a variable feeding pattern, at least over the first few days, as the baby takes small amounts of colostrum and then takes increasingly larger feeds as the milk supply comes in.

When the milk supply is established, a baby will generally feed every 2–3 hours, but this will vary between babies and, if the baby is healthy, his/ her individual pattern should be respected.

Empty both breasts at each feed.

How to assess Breast-feeding

Ask mother if the infant has breastfed in the previous hour?

If infant has not fed in the previous hour, ask the mother to put her infant to the breast and assess for the following:

  1. First assess the position
  2. Then assess the attachment
  3. Then assess the sucking

1. Position

Observe the breastfeed for 4 minutes

Signs of good positioning:

Baby’s body is well supported.
The head, neck and the body of the baby are kept in the same plane. Entire body of the baby faces the mother. Baby’s abdomen touches mother’s abdomen

2. Attachment

Signs of good attachment:

Chin touching breast
Mouth wide open
Lower lip turned outward
More areola above than below the mouth

Poor attachment results in painful nipples → Breast milk not removed effectively thus causing breast engorgement → poor milk supply hence baby is not satisfied and irritable → breast produces less milk resulting in a frustrated baby who refuses to suck→ poor weight gain

3. Check for baby's sucking

Effective sucking is when the infant shows slow deep sucks, sometimes pausing.
If not sucking well, then look for ulcers or white patches in the mouth (thrush).

Key facts for providers and mothers/ guardians - Breast feeding

  1. If breastfeeding is not progressing, support and assistance with positioning and attachment on the breast should be provided
  2. If nipple pain persists after repositioning, consider evaluation for thrush or cracks.
  3. If signs and symptoms of engorgement are present, the mother should be encouraged to:
    • Wear a well-fitting bra or binder.
    • Feed frequently, including prolonged breastfeeding from the affected breast
    • Massage breasts and if necessary, hand express milk
    • Take analgesia if necessary.
  4. If signs and symptoms of mastitis are present a woman should be advised to:
    • Continue breastfeeding and/or hand expression to ensure effective milk removal
    • Gently massage the breast to relieve any blockage
    • Seek assistance with positioning and attachment
    • Take analgesia compatible with breastfeeding, for example paracetamol
    • Increase her fluid intake.

If signs and symptoms of mastitis persist more than several hours the mother should contact her healthcare provider and may require antibiotic treatment.
If the baby is not taking sufficient milk directly from the breast and supplementary feeds are necessary, expressed breast milk should be given by a cup or spoon (Supplementation not recommended).