The Basics: Overview

Breastfeeding (also known as nursing) is very healthy for you and your baby. Breast milk is the only food or liquid your baby needs for about the first 6 months after birth.

At about 6 months, you’ll start to feed your baby other foods in addition to breast milk. Experts recommend continuing to breastfeed your baby for at least the first 12 months — and for as long as you want after that.

Breastfeeding is natural, but that doesn’t mean it’s always easy. You and your baby may need practice — and almost all moms need a little help, especially in the beginning. The good news is that it gets easier with time.

To get ready to breastfeed:

• Talk to your doctor or midwife about breastfeeding.
• Make a plan for after your baby is born.

Once your baby is born:

• Let your doctor or midwife know you want skin-to-skin contact with your baby right away.
• Nurse whenever your baby is hungry.
• Ask for help if breastfeeding is difficult.

The Basics: Age Guidelines

Does my newborn need any other foods?

No. Until your baby is about 6 months old, they only need your breast milk. In fact, giving babies things like rice cereal or baby food too early can keep them from getting the nutrients they need from breast milk.

Most babies are ready for solid foods between ages 4 and 6 months — don’t start giving your baby solid foods before age 4 months.

Here are some guidelines to help make sure your baby gets the nutrition they need.

Birth to about age 6 months:

• Feed your baby breast milk or formula (no juice, cow's milk, solid foods, or water)
• Give your baby any vitamins, minerals, or medicine that your doctor recommends
• Ask your doctor if your baby needs a vitamin D supplement

About ages 6 months to 12 months:

• Keep breastfeeding your baby
• Introduce your baby to a variety of new foods, including foods high in iron and zinc — like fortified infant cereal, meat, seafood, and beans

Age 12 months and older:

• Continue to breastfeed as long as it feels right for you and your baby
• Keep adding new foods to your baby's diet

The Basics: Health Benefits

What are the benefits of breastfeeding?

Breastfeeding gives you and your baby time to be close, get to know each other, and bond. Breastfeeding is a healthy choice for both moms and babies.

Benefits for your baby

Breast milk:

• Is the best source of nutrition for most babies
• Changes to meet your baby's nutritional needs as she grows
• Helps protect your baby from infection and illness
• May lower your baby’s risk of overweight, obesity, and asthma
• Is easier for babies to digest than formula

Benefits for you

Breastfeeding may help protect you from:

• Ovarian and breast cancer
• High blood pressure
• Type 2 diabetes

Breastfeeding can also help lower your baby's risk of sudden infant death syndrome (SIDS).

The Basics: Common Questions

If you are worried about breastfeeding, you aren't alone.

It's normal to have concerns about breastfeeding! The information below may help answer some of your questions.

My baby really doesn't need other food or liquid for the first 6 months?

Right. Your breast milk is made just for your baby — it’s the best form of nutrition in the first 6 months of life. Giving babies formula or other food or liquid can cause them to gain weight too fast, which can lead to health problems later.

Also, when your baby eats cereal or formula instead of breast milk, your body gets a signal that your milk isn’t needed and starts to make less milk. The more your baby nurses, the more milk your body makes.

Will my baby be able to sleep through the night without other foods?

Your baby may wake up to nurse — but that’s normal. Many moms worry that their babies won't be full enough to sleep through the night with only breast milk. Actually, in the first couple of months, babies need to nurse every few hours, even at night — they aren't supposed to sleep through the night.

If I breastfeed, will I be the only one who can feed my baby?

Not necessarily. Many moms think they won't get a break if they breastfeed. But you can learn how to pump and store breast milk so your baby can eat when you’re not there.

And just because you’re leaving the house doesn’t mean someone else has to feed your baby. You can get a baby sling or carrier to make going out with your baby easier. With practice, you may be able to breastfeed in the carrier.

Take Action: Get Help

After you start breastfeeding, it's normal to have lots of questions. Here are some tips and resources to help you breastfeed.

Talk to your doctor or midwife about breastfeeding.

While you are pregnant, tell your doctor or midwife that you plan to breastfeed. Ask what kind of support is available to help you learn what you need to know.

If you have a health condition or take any medicines, ask if it's okay for you to breastfeed. Keep in mind that most conditions and medicines won't keep you from breastfeeding.

Get help from a breastfeeding specialist.

Many hospitals and doctor's offices have breastfeeding specialists called lactation counselors or consultants. They can answer your questions about breastfeeding and help you get started.

Your doctor or midwife may refer you to a lactation counselor.

Get help from another mom.

Breastfeeding peer counselors are moms who breastfed their own babies and learned how to help other women start breastfeeding. Ask your doctor or midwife how to find a peer counselor near you.

Take Action: Cost and Insurance

What about cost?

Under the Affordable Care Act, health insurance plans must cover counseling and breastfeeding supplies for pregnant and nursing women. Depending on your insurance plan, you may be able to get help with breastfeeding at no cost to you. Check with your insurance company to find out more.

If you don't have insurance, you may still be able to get free or low-cost help with breastfeeding:

• Get connected with free or low-cost services in your state by calling 1-800-311-BABY (1-800-311-2229)
• Find a health center near you and ask about breastfeeding support

Learn more about WIC.

WIC (Women, Infants, and Children) is a government program that can help you get healthy food for yourself and your baby. WIC offers breastfeeding support, too. Ask your doctor or midwife how to sign up for this no-cost program.

Take Action: Make a Plan

Make a plan for after your baby is born.

By pumping breast milk, you can provide food for your baby when you're apart. A lactation counselor can help you learn to pump and store breast milk.

If you plan to go back to work after your baby's birth, talk to your supervisor ahead of time about where you can pump and store breast milk at work. Most employers are now required by law to give you time and a place to pump milk at your job.

Take Action: Breastfeeding Tips

Get close to your baby right away.

Tell your doctor, midwife, or nurse that you want to hold your baby skin-to-skin right after you give birth – and that you want to breastfeed within 1 hour. This will help you and your baby get off to a good start with breastfeeding.

At first, your milk will be yellow. This is called colostrum, and it’s very good for your baby. Your regular milk will come in after a few days, and your breasts will feel full.

Nurse whenever your baby shows signs of hunger.

Newborn babies need to nurse often — about every 2 hours. Nursing often is also important for you, because it tells your body to make enough milk.

Watch your baby for signs of hunger, like:

• Moving their head from side to side (called rooting)
• Moving their fists to their mouth
• Being more alert
• Acting fussy

Take Action: Vitamin D, Iron, and Zinc

Give your baby vitamin D.

Vitamin D helps babies grow healthy bones. Breast milk doesn’t have enough vitamin D in it — so if you breastfeed your baby, you need to give them a vitamin D supplement. Start giving your baby a supplement with 400 IU (international units) per day of vitamin D soon after birth. Talk to your baby’s doctor about making sure your baby gets enough vitamin D.

Talk to your baby’s doctor about iron.

Iron helps your baby’s brain develop, and breast milk may not have enough iron in it. When your baby starts eating solid foods at about 6 months, include foods with iron like meats, seafood, and iron-fortified infant cereals. Some babies may need to take iron supplements before age 6 months — ask your baby’s doctor if they need iron supplements.

Introduce foods with zinc.

It’s also important for your baby to get enough zinc. At about 6 months, start introducing foods with zinc like meats, beans, and zinc-fortified infant cereals.

Take Action: Breastfeeding Problems

Ask for help if breastfeeding is difficult.

Breastfeeding is new for you and your baby, so it'll take time and practice. It's okay to ask for help.

Breastfeeding shouldn't hurt.

You may think breastfeeding is a little uncomfortable at first, but it’s not normal for breastfeeding to be painful. If you have pain or any other problems during breastfeeding, talk to your doctor, nurse, or lactation counselor.

Ask for help so that you and your baby can enjoy breastfeeding.

The benefits of breastfeeding for mothers of multiples and their babies are the same as for all mothers and babies — possibly greater, since many multiples are born early. The idea of breastfeeding more than one baby may seem overwhelming at first! But many moms of multiples find breastfeeding easier than other feeding methods, because there is nothing to prepare. Many mothers successfully breastfeed more than one baby even after going back to work.

Being prepared

It will help to learn as much as you can about breastfeeding during your pregnancy. Before the babies are born, you can:

• Take a breastfeeding class
• Find internet and print resources for parents of multiples
• Join a support group for parents of multiples through your doctor, hospital, local breastfeeding center, or La Leche League International
• Let your doctor and family members know that you plan to breastfeed
• Find a lactation consultant who has experience with multiples before your babies are born so that you know where to get help

Many twin and multiple babies are smaller or born premature.

Making enough milk

Most mothers can make plenty of milk for twins. Many mothers exclusively breastfeed or express their milk for triplets or quadruplets. Keep these tips in mind:

• Breastfeeding soon and often after birth is helpful for multiples the same way it is for one baby. The more milk that is removed from your breasts, the more milk your body will make.
• If your babies are born early, double pumping (pumping both breasts at the same time) can help you make more milk.
• The doctor's weight checks can tell you whether your babies are getting enough breastmilk.
• It helps to have each baby feed from both breasts. You can "assign" a breast to each baby for a feeding and switch at the next feeding. Or you can assign a breast to each baby for a day and switch the next day. Switching sides helps keep milk production up if one baby isn't eating as well as the other baby. It also gives babies a different view to stimulate their eyes.

Breastfeeding during your next pregnancy is not usually dangerous to you, your breastfeeding child, or your new developing baby. Your child may decide to wean (stop breastfeeding) on his or her own because of changes in the amount and flavor of your milk. Your doctor also may advise you, or you may want, to wean your baby if:

• You have any problems in your pregnancy, such as uterine pain or bleeding
• You have a history of preterm labor
• Pregnancy hormones make breastfeeding uncomfortable
• Your growing belly makes breastfeeding difficult

Your child will need additional food and drink, especially if he or she stops breastfeeding. You will probably make less milk during pregnancy, especially after your 20th week.

If you keep nursing your child after your baby is born, feed your newborn first to make sure he or she gets the colostrum. Once you are making more milk, you can decide how you can best meet everyone's needs, but stay aware of your new baby's needs for you and your milk.

You may want to ask your partner to help you by taking care of one child while you are breastfeeding. Also, you will need more fluids, healthy foods, and rest, because you are taking care of yourself and two small children.

Yes, but the amount of milk your breasts will make will depend on how your surgery was done, where your incisions were, and the reasons for your surgery. Women who had incisions in the fold under the breast are less likely to have problems making milk than women who had incisions around or across the areola, which can cut into milk ducts and nerves. Women who have had breast implants usually are able to breastfeed.

If you ever had surgery on your breasts for any reason, talk with a lactation consultant. If you are planning to have breast surgery, talk with your surgeon about ways he or she can save as much of the breast tissue and milk ducts as possible.

Maybe. Many mothers who adopt can breastfeed their babies with some help. You may need to supplement your breastmilk with donated breastmilk from a milk bank or with infant formula. But some adoptive mothers can breastfeed exclusively, especially if they have been pregnant in the past.

If you plan to adopt and want to breastfeed, talk with your doctor and a lactation consultant. They can help you decide the best way to try to establish a milk supply for your new baby. Options include:

• Pumping every three hours around the clock for two to three weeks before your baby arrives
• Waiting until the baby arrives and starting to breastfeed
• Using devices such as a supplemental nursing system or a lactation aid. This can help make sure that your baby gets enough nutrition and that your breasts are stimulated to make milk at the same time.

Maybe. You can try breastfeeding (or returning to breastfeeding) after your baby is older. This process is called relactation. It may take weeks or even longer to get a full supply of milk, so you will need to continue to supplement your baby's diet with formula.

Talk with your doctor and a lactation consultant. They can help you decide the best way to try to rebuild your milk supply. Options include:

• Pumping every three hours to stimulate your milk supply.
• Give your baby skin-to-skin time to encourage the transition from the bottle to the breast.
• Using devices such as a supplemental nursing system or a lactation aid. This can help ensure that your baby gets enough nutrition and that your breasts are stimulated to make milk at the same time.

If you can't breastfeed and still want to give your baby human milk, you may want to consider a human milk bank. A human milk bank can give you fresh donor human milk if you have a prescription from your doctor. Many steps are taken to make sure the milk is safe.

Some reasons you may want or need a human milk bank include:

• You are unable to breastfeed because:
  • Your baby was born premature (before 37 weeks of pregnancy)
  • Your baby has other health problems
  • You take certain medicines that are dangerous for babies and can be passed to your baby in your breastmilk, such as anxiety medicine, birth control with estrogen, or certain migraine medicines
  • You have a specific illness (such as HIV or active tuberculosis) that means you should not breastfeed
  • You get radiation therapy, though some therapies may mean only a brief pause in breastfeeding
• Your baby isn't doing well on formula because of allergies or intolerance

Some mothers give extra breastmilk directly to parents of babies in need. This is called "casual sharing." But this milk has not been tested in a lab like milk at a human milk bank has. The Food and Drug Administration recommends against feeding your baby breastmilk that you get either directly from other women or through the Internet.

You can find a human milk bank through the Human Milk Banking Association of North America (HMBANA). To find out whether your insurance will cover the cost of the milk, call your insurance company or ask your doctor. If your insurance company does not cover the cost of the milk, talk with the milk bank to find out whether payment can be made later on or how to get help with the payments.

While human milk provides the most complete form of nutrition for infants, including premature and sick newborns, there are rare exceptions when human milk or breastfeeding is not recommended.

Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants

Physicians should make case-by-case assessments to determine whether a woman’s environmental exposure, her own medical condition, or the medical condition of the infant warrants her to interrupt, stop, or never start breastfeeding.

Mothers should NOT breastfeed or feed expressed breast milk to their infants if

• Infant is diagnosed with classic galactosemia, a rare genetic metabolic disorder
• Mother is infected with the human immunodeficiency virus (HIV) (Note: recommendations about breastfeeding and HIV may be different in other countries)
• Mother is infected with human T-cell lymphotropic virus type I or type II (HTLV – 1/2)
• Mother is using an illicit street drug, such as PCP (phencyclidine) or cocaine1 (Exception: Narcotic-dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection and other illicit drugs can breastfeed)
• Mother has suspected or confirmed Ebola virus disease

Mothers should temporarily NOT breastfeed and should NOT feed expressed breast milk to their infants if

• Mother is infected with untreated brucellosis
• Mother is taking certain medications
• The mother is undergoing diagnostic imaging with radiopharmaceuticals
• Mother has an active herpes simplex virus (HSV) infection with lesions present on the breast (Note: Mothers can breastfeed directly from the unaffected breast if lesions on the affected breast are covered completely to avoid transmission)

Mothers may be able to resume breastfeeding after consulting with a physician to determine when their breast milk is safe for their infant. These mothers should be provided with lactation support to learn how to maintain milk production and feed their infants with pasteurized donor human milk or formula while temporarily not breastfeeding.

Mothers should temporarily NOT breastfeed, but CAN feed expressed breast milk if

• Mother has untreated, active tuberculosis
  (Note: The mother may resume breastfeeding once she has been treated appropriately for 2 weeks and is documented to be no longer contagious)
• Mother has active varicella (chicken pox) infection that developed within the 5 days prior to delivery to the 2 days following delivery

Airborne and contact precautions may require temporary separation of the mother and infant, during which time expressed breast milk should be given to the infant by another care provider. Mothers should be able to resume breastfeeding after consulting with a physician to determine when there is no longer a risk of spreading infection. These mothers should be provided with lactation support to learn how to maintain milk production while not breastfeeding and/or while expressing their milk.

Are medications safe to take while breastfeeding?

Few medications are contraindicated while breastfeeding. Although many medications do pass into breast milk, most have no known adverse effect on milk supply or on infant well-being. However, healthcare providers should always weigh the risks and benefits when prescribing medications to breastfeeding mothers.