WHO and UNICEF recommend starting breastfeeding within the first hour after birth, exclusive breastfeeding for six months, and continued breastfeeding with complementary foods up to two years or beyond. Breastfeeding protects babies against diarrhoea, pneumonia and other infections, and lowers the mother’s risk of breast and ovarian cancer. Yet globally, fewer than half of infants under six months are exclusively breastfed. Skilled, practical support from nurses and midwives makes a big difference.
The first hour
- Place the baby skin-to-skin on the mother’s chest immediately after birth, and keep them together.
- Let the baby find the breast, and offer help if needed.
- Avoid giving water, glucose water or formula unless medically indicated. Colostrum, the first milk, is all a healthy term baby needs.
- After a caesarean section, start skin-to-skin and breastfeeding as soon as the mother is able.
Positioning and attachment
Good positioning: baby’s head and body in a straight line, facing the breast, close to the mother, with the whole body supported.
Signs of good attachment (latch):
- Mouth wide open.
- Lower lip turned out.
- Chin touching the breast.
- More areola visible above the baby’s mouth than below.
- Slow, deep sucks with pauses, and audible swallowing.
- No pain for the mother after the first few sucks.
How often, and is the baby getting enough?
- Feed on demand, 8–12 times in 24 hours in the early weeks, including at night.
- Early hunger cues: rooting, sucking on hands, stirring. Crying is a late cue.
- Signs of enough milk: 6 or more wet nappies a day from about day 5, yellow stools, and steady weight gain. Most babies lose some weight in the first days and regain birth weight by about 2 weeks.
Common problems
| Problem | Likely cause | What helps |
|---|---|---|
| Sore or cracked nipples | Poor attachment (most common) | Correct the latch; apply a little expressed milk after feeds; check for tongue-tie or thrush |
| Engorgement (hard, full, painful breasts, day 3–5) | Milk coming in, infrequent feeding | Frequent feeds, hand expression to soften the areola before latching, cold compresses after feeds |
| Blocked duct | Milk not draining well from one area | Keep feeding, gentle massage, vary positions, avoid tight clothing |
| Mastitis (red, hot, painful area, fever, flu-like) | Inflammation, sometimes infection | Keep breastfeeding, rest, fluids, pain relief; see a health worker, antibiotics may be needed |
| “Not enough milk” | Often a perception; sometimes infrequent feeding or poor latch | Check wet nappies and weight; feed more often; correct attachment; reassure |
Hand expression
Teach every mother to hand express. It helps with engorgement, feeding small or sick babies, and storing milk. Wash hands, place the thumb and fingers about 2–3 cm from the nipple, press back towards the chest, then compress and release rhythmically, rotating around the breast. Expressed milk can be stored at room temperature for a few hours, in a fridge for several days, or frozen, following local guidance.
Special situations
- HIV: WHO recommends that mothers with HIV on effective ART breastfeed, with adherence support. See our HIV care guide.
- Medicines: most medicines are compatible with breastfeeding; check with a pharmacist rather than advising women to stop.
- Small or preterm babies: see our kangaroo mother care guide.
- Returning to work: help mothers plan expressing and storage; advocate for workplace breastfeeding breaks, including for nurses themselves.
The Code
The International Code of Marketing of Breast-milk Substitutes restricts the promotion of formula in health facilities. Health workers should not distribute free formula samples or promotional materials. When formula is medically needed, give clear, unbiased information on safe preparation.
Based on WHO/UNICEF infant and young child feeding recommendations, the Baby-friendly Hospital Initiative and WHO guidance on breastfeeding and HIV. Educational content.