Where possible breastmilk should be the feed of choice for all infants
International guidance recommends that breastmilk should be the preferred choice of feed for infants, with current guidelines from the World-Health-Organisation (WHO) stating infants should be exclusively breastfed for the first 6 months-of-life and in combination with complementary food until 2 years-of-life (1-3). Breastmilk confers many advantages to infants and mothers as well as promoting the formation of the parental bond (4), as well as being associated with a reduction in healthcare costs by improving the health of both mothers and children (5). Low breast feeding rates are associated with increased morbidity and mortality amongst infants and mothers (1-3) and the use of infants formula is associated with an increased risk of four childhood illnesses; namely gastrointestinal infection, lower respiratory tract infection and acute otitis media in infants, in addition to maternal breast cancer (5).
For infants who require an acute admission to hospital a number of factors impact on the ability to continue breastfeeding in a hospital setting including; modes of feeding, maternal stress/ anxiety, as well as access to support and equipment. Health care professional attitude towards breastfeeding may not always be supportive or conflicting advice may be given (6, 7).
The Baby Friendly Initiative aims to promote and protect breastfeeding in newborns providing ten principles. For infants requiring admission during infancy, the 10 steps can be further adapted (Table 1).
Principles to promote, protect and support breastfeeding during a hospital admission in infancy
10 Steps for successful breastfeeding during a hospital admission (adapted from WHO/UNICEF 10 steps to successful breastfeeding) (7, 8)
- Have a written breastfeeding policy specific to a Children’s Hospital or Paediatric ward environment, which is regularly discussed and communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Encourage all parents who are breastfeeding their infants about the benefits of continuing to breastfeeding for as long as possible.
- Help mothers to sustain breastfeeding by providing access to breastfeeding expressing equipment or private areas in which to breastfeed.
- Show mothers how to breastfeed following medical procedures e.g. cardiac surgery, and how to maintain lactation even if they should be separated from their infants.
- Encourage non-nutritive sucking and positive touch to help maintain infants feeding skills during periods of non oral feeding
- Provide nourishment to breastfeeding mothers and practise rooming-in allowing mothers and infants to remain together – 24 hours a day.
- Encourage breastfeeding on demand or expressing of breastmilk at least 5 times per day.
- Foster the establishment of health care professionals breastfeeding champions who can support mothers during a hospital admission and following discharge from the hospital or clinic.
- Encourage the training and transference of knowledge around supporting breastfeeding to all health care staff.
- Koletzko B PB, Uauy R, editor. Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines 2014.
- BDA. Breastfeeding Policy Statement 2018 24th February 2018.
- Royal College of Paediatrics and Child Health. Position statement Breastfeeding 2018.
- Kair LR, Flaherman VJ, Newby KA, Colaizy TT. The experience of breastfeeding the late preterm infant: a qualitative study. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine. 2015;10(2):102-6.
- Pokhrel S, Quigley MA, Fox-Rushby J, McCormick F, Williams A, Trueman P, et al. Potential economic impacts from improving breastfeeding rates in the UK. Archives of disease in childhood. 2015;100(4):334-40.
- Heilbronner C RE, Hadchouel A et al. Breastfeeding disruption during hospitalisation for bronchiolitis in children: a telephone survey. BMJ Paediatrics Open. 2017.
- Marino LV, Kidd CS, Davies NJ, Thomas PC, Williams SW, Beattie RM. Survey of healthcare professional and parental experience in accessing support for breastfeeding during an acute hospital admission. Acta paediatrica (Oslo, Norway : 1992). 2019;108(1):175-7.
- WHO. Baby Friendly Iniative 10 Steps to Successful Breastfeeding. 2018.