Breastfeeding – Strong Evidence Supporting “Breast is Best”


There are several advantages of breastfeeding, and fortunately, it is available worldwide!

Here are some advantages:

1) Nutrition: optimal for the needs of the baby in terms of nutrients, vitamins and minerals

2) Immunity: provides passive immunity, particularly in colostrum within the first few days.

3) Reduced incidence of infectious diseases such as bacterial meningitis, bacteremia, diarrhea, UTI, OM and respiratory illnesses, thereby reducing hospitalizations.

4) Reduction in incidence of NEC in preterm babies
5) Possible reduction in risk of SIDS (sudden infant death syndrome)

6) Increase in IQ possible

7) Protection from allergen exposure

8) Reduction in obesity possible

9) Bonding between mother and infant, which can have developmental implications (emotional and cognitive) for baby

10) Convenient, accessible and affordable, no sterilization required

Benefits to mother:

1) post partum ovulation suppression and weight loss
2) decrease in breast and ovarian cancer

Barriers to breastfeeding include:

1) Cultural/social limitations. Mothers may feel conscious, and therefore early designated rooms should be made available, and there are also nursing scarves feeding for public use. Early education regarding the importance of breastfeeding is also important to promote societal acceptance.


2) Maternal breast milk let down – can try several measures, including herbal: Blessed Thistle + Fenugreek (should be taken together), and prescription (domperidone). Remember, the more frequently the baby breastfeeds and mother pumps, the increase in the milk production due to signals sent to the brain. Think of it like, “if you don’t use it, you lose it”

3) Technique – there may be benefit from involving a lactation consultant. The baby should be making swallowing sounds. The following website is a great resource, providing tips for optimization of breastfeeding:

4) Anatomical causes, such as tongue tie (anterior and/or posterior tongue tie, which can inhibit the infant’s ability to create adequate seal and sucking ability. In this case, they may need to be reviewed by a doctor to assess for the benefit of releasing the tongue tie. There is a Canadian Paediatric Society statement on ankyloglossia.

There are also some circumstances where it is not recommended, for example in developed countries, when the mother has a communicable infection such as HIV, as there are are alternatives. In the developing nations, given inaccessibility to alternative methods of providing nutrition, breastfeeding may still be encouraged.

Contraindications in Canada include (CPS Statement):

1) HIV positive (recommended to formula feed)
2) Cytotoxic chemotherapy in mothers
3) Radioactive isotopes or radiation therapy
4) Galactosemia – no breastmilk! Indication for soy based milk
5) PKU: breastfeed to supplement low phenylalanine formula + strict monitoring of levels
6) Limit alcoholic beverages as they pass into breast milk. Motherisk and LactMed for further information regarding drug safety and breastfeeding.
7) Limit and quit smoking – but continue breastfeeding as it may mitigate the negative effects of smoking
8) Continue breastfeeding even in physiologic jaundice and breast milk jaundice. Assess latch, teach appropriate skills and monitor feeding closely. May need to refer to lactation consultant.

The Canadian Paediatric Society has a policy statement on Breastfeeding also, promoting the Baby Friendly Initiative started by WHO and UNICEF in 1991. The goal is to improve breastfeeding initiation and adherence.

Recommendation: Breastfeed for the first 6 months of life, and then supplement accordingly following this, up to 2 years of life and beyond. Of note, breastfeeding can be tapered at 4 months (subsequent CPS statement), with early introduction of complementary foods.

TEN STEPS TO SUCCESSFUL BREASTFEEDING (the Innocenti Declaration and the WHO International Code of Marketing of Breastmilk Substitutes):

1) Have a written breastfeeding policy that is routinely communicated to all healthcare providers and volunteers

2) Ensure all health care providers have the knowledge and skills necessary to implement the breastfeeding policy

3) Inform pregnant women and their families about the importance and process of breastfeeding

4) Place babies in uninterrupted skin-to-skin contact with their mothers immediately following birth for at least an hour or until completion of the first feeding or as long as the mother wishes: encourage mothers to recognize when their baby is ready to feed, offering help as needed.

5) Assist mothers to breastfeed and maintain lactation should they face challenges including separation from their infants

6) Support mothers to exclusively breastfeed for the first six months, unless supplements are medically indicated

7) Facilitate 24h rooming in for all mother-infant-dyads: mothers and infants remain together.

8) Encourage baby led or cue based breastfeeding. Encourage sustained breastfeeding beyond six months with appropriate introduction of complementary foods

9) Support mothers to feed and care for their breastfeeding babies without the use of artificial teats or pacifiers (dummies or soothers).

10) Provide seamless transition among the services provided by the hospital, community health services and peer support programs. Apply principles of primary health care and population health to support the continuum of care, and implement strategies that affect the broad determinations that will improve breastfeeding outcomes.

Introducing any food or drink before it is nutritionally required can interfere with breastfeeding!

Also, although pacifiers may reduce risk of SIDS, consider introducing them after successful breastfeeding is established to prevent “nipple confusion”. In the NICU, they may use it as suck training and for soothing/pain relief.

Skin-to-skin (kangaroo care) within the first half hour of life is recommended, even if not expected to breastfeed.

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