Breastmilk may have longer term health benefits like reducing the risk of becoming overweight or obese and developing noncommunicable diseases, such as diabetes, cardiovascular disease and certain cancers later in life. Breastmilk protects newborns from getting sick and also helps protect them throughout their infancy and childhood. It is particularly effective against infectious diseases because it strengthens the immune system by directly transferring antibodies from the mother. Breastfeeding is also an integral part of the reproductive process with important implications for the health of mothers.
Defining exclusive breastfeeding
Exclusive breastfeeding means no other food or drink, not even water, except breastmilk (including milk expressed or from a wet nurse) for the first 6 months of life, with the exception of rehydration solution (ORS), drops and syrups (vitamins, minerals and medicines).
Predominant breastfeeding is not the same as exclusive breastfeeding. Predominant breastfeeding means that the infant's predominant source of nourishment has been breastmilk (including milk expressed or from a wet nurse as the predominant source of nourishment). In addition, the infant may also have received liquids (water and water-based drinks, fruit juice) ritual fluids and ORS, drops or syrups (vitamins, minerals and medicines). WHO and UNICEF recommend exclusively breastfeeding infants for the first 6 months of life.
The optimal duration of breastfeeding (WHO and UNICEF recommendations)
Initiate breastfeeding within 1 hour of the birth.
Exclusively breastfeed your infants for the first 6 months of their life to achieve optimal growth, development and health.
Unrestricted exclusive breastfeeding results in ample milk production.
If you are severely ill or suffer from complications that prevent you from caring for your infant or continuing direct breastfeeding, express milk to safely provide breastmilk to your infant.
If you are too unwell to breastfeed or express breastmilk, you should explore the possibility of relactation (restarting breastfeeding after a gap), wet nursing (another woman breastfeeding or caring for your child), or using donor human milk. Which approach to use will depend on cultural context, acceptability to you, and service availability.
It is possible for mothers to exclusively breastfeed from birth. Nevertheless, a small number of health conditions of the infant or the mother may justify recommending that she does not breastfeed temporarily or permanently. These conditions, which affect very few mothers or infants, are listed below together with some health conditions of the mother that, although serious, are not medical reasons for using breast-milk substitutes. If you are considering not breastfeeding or stopping breastfeeding, the benefits of breastfeeding should be weighed against the risks posed by the presence of the specific conditions listed.
WHO and UNICEF recommend
Infant conditions
According to WHO/UNICEF, infants who should not receive breastmilk or any other milk except specialized formula include:
infants with classic galactosemia: a special galactose-free formula is needed;
infants with maple syrup urine disease: a special formula free of leucine, isoleucine and valine is needed;
infants with phenylketonuria: a special phenylalanine-free formula is needed (some breastfeeding is possible, under careful monitoring).
Infants for whom breastmilk remains the best feeding option but who may need other food in addition to breastmilk for a limited period include:
infants born weighing less than 1500 g (very low birth weight);
infants born at less than 32 weeks of gestational age (very pre-term);
newborn infants who are at risk of hypoglycaemia by virtue of impaired metabolic adaptation or increased glucose demand (such as those who are preterm, small for gestational age or who have experienced significant intrapartum hypoxic/ischaemic stress, those who are ill and those whose mothers are diabetic) if their blood sugar fails to respond to optimal breastfeeding or breast-milk feeding.
Maternal conditions
According to WHO/UNICEF, mothers who are affected by any of the conditions mentioned below may avoid or temporarily avoid breastfeeding. They should also receive treatment for their condition according to standard guidelines.
A condition that may justify permanent avoidance of breastfeeding is HIV infection. Explore the possibility of wet nursing (another woman breastfeeding or caring for your child), or using donor human milk if any of these methods of replacement feeding are acceptable, feasible, affordable, sustainable or safe for you.
Maternal conditions that may justify temporary avoidance of breastfeeding include:
severe illness that prevents a mother from caring for her infant, for example sepsis;
herpes simplex virus type 1 (HSV-1): direct contact between lesions on the mother’s breasts and the infant’s mouth should be avoided until all active lesions have disappeared.
Medications that may justify temporary avoidance of breastfeeding include:
sedating psychotherapeutic drugs, anti-epileptic drugs and opioids and their combinations which may cause side-effects, such as drowsiness and respiratory depression, and are better avoided if a safer alternative is available;
radioactive iodine-131 which is better avoided given that safer alternatives are available – a mother can resume breastfeeding about 2 months after taking this substance;
excessive use of topical iodine or iodophors (e.g. povidone-iodine), especially on open wounds or mucous membranes, which can result in thyroid suppression or electrolyte abnormalities in the breastfed infant and should be avoided;
cytotoxic chemotherapy which requires that a mother stops breastfeeding during therapy.
Maternal conditions during which breastfeeding can still continue, although health problems may be a concern, include:
breast abscess: breastfeeding should continue on the unaffected breast; feeding from the affected breast can resume once treatment has started;
hepatitis B: infants should be given hepatitis B vaccine, within the first 48 hours or as soon as possible thereafter;
hepatitis C;
mastitis: if breastfeeding is very painful, milk must be removed by expression to prevent progression of the condition;
tuberculosis: mother and baby should be managed according to national tuberculosis guidelines.
substance use: maternal use of nicotine, alcohol, ecstasy, amphetamines, cocaine and related stimulants has been demonstrated to have harmful effects on breastfed babies, and alcohol, opioids, benzodiazepines and cannabis can cause sedation in both the mother and the baby.
Mothers should be encouraged not to use these substances, and given help and support to abstain from using.
Benefits of breast feeding
- Breastmilk provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life.
- Breastfeeding reduces the risk of acute infections such as diarrhoea, pneumonia, ear infection, Haemophilus influenzae, meningitis and urinary tract infection.
- It also protects against chronic conditions in the future such as type I diabetes, ulcerative colitis, and Crohn’s disease.
- Breastfeeding during infancy is associated with lower mean blood pressure and total serum cholesterol.
- Breastfed children perform better on intelligence tests, are less likely to be overweight or obese and less prone to type 2 diabetes during adolescence and adult life.
- Women who breastfeed also have a reduced risk of breast and ovarian cancers.
- Breastfeeding delays the return of a woman’s fertility and reduces the risks of post-partum haemorrhage, pre-menopausal breast cancer and ovarian cancer.
Complementary feeding at 6 months
© SPRINGAt 6 months of age, an infant’s need for energy and nutrients starts to exceed what is provided by breastmilk, and complementary foods are necessary to meet those needs. An infant of this age is also developmentally ready for other foods. Introduce nutritionally adequate and safe complementary foods while continuing to breastfeed for up to 2 years of age or beyond. If complementary foods are not introduced around the age of 6 months, or if they are given inappropriately, an infant’s growth may falter.
Initially, infants should receive complementary foods 2 to 3 times a day between 6 and 8 months and increase to 3 to 4 times daily between 9 and 11 months and 12 to 24 months.
Additional nutritious snacks should also be offered 1 to 2 times per day for ages 12 to 24 months, as desired.
Gradually increase food consistency and variety as the infant gets older, adapting to the infant’s requirements and abilities.
Infants can eat pureed, mashed and semi-solid foods beginning at 6 months.
By 8 months, most infants can also eat “finger foods” (snacks that can be eaten by children alone).
By 12 months, most children can eat the same types of foods as consumed by the rest of the family, while keeping in mind the need for nutrient-dense foods, including animal-sourced foods like meat, poultry, fish, eggs and dairy products.
Avoid foods in a form that may cause choking, such as whole grapes or raw carrots.
Avoid giving drinks with low nutrient value, such as tea, coffee and sugary soft drinks.
Limit the amount of juice offered, to avoid displacing more nutrient-rich foods.
Recommendations for health facilities and their staff
Inappropriate marketing of breast-milk substitutes continues to undermine efforts to improve breastfeeding rates and duration worldwide. If you are providing maternity and newborn services, you should not promote breastmilk substitutes, feeding bottles, teats, pacifiers or dummies in any part of your facilities, or by any of your staff. Enable mothers and infants to remain together and practise skin-to-skin contact, and rooming-in throughout the day and night, especially straight after birth during initiation of breastfeeding.
Exclusive breastfeeding to 6 months is still infrequent. However, more women could be encouraged to exclusively breastfeed their child for the first 6 months if lactation support was available. Provide adequate social and nutritional support to lactating women. Maximize the number of infants exclusively breastfed at 6 months by addressing these potential problems:
the nutritional status of pregnant and lactating mothers;
micronutrient status of infants living in areas with high prevalence of deficiencies such as iron, zinc, and vitamin A; and
the routine primary health care of individual infants, including assessment of growth and of clinical signs of micronutrient deficiencies.
Counselling and psychosocial support
If you have questions or concerns about breastfeeding and complementary feeding, feel overwhelmed or stressed, seek breastfeeding counselling, basic psychosocial support, or practical feeding support, you may be able to get support from appropriately trained health care professionals and also community-based lay and peer breastfeeding counsellors.
You may also access our mental health and psychosocial support platform. The platform offers basic psychological support to help you better manage the psychosocial difficulties you might be experiencing. It provides general information about stress and how it affects us and suggests exercises for you to deal with stress. The platform also provides general information about problems caused by substance use, and how it affects us and suggests the ways to deal with these problems. It also provides contact information for mental health professionals in the 22 countries of WHO’s Eastern Mediterranean Region who you may wish to talk to.
Related links
Acceptable medical reasons for use of breast-milk substitutes
Global strategy on infant and young child feeding
Guideline: Counselling of women to improve breastfeeding practices
Infant and young child feeding list of publications
Mental health and psychosocial support platform
Nutrient adequacy of exclusive breastfeeding for the term infant during the first 6 months of life
The optimal duration of exclusive breastfeeding
The World Health Organization's infant feeding recommendation