Breastfeeding offers many benefits to your baby. Breast milk contains the right balance of nutrients to help your infant grow into a strong and healthy toddler. Some of the nutrients in breast milk also help protect your infant against some common childhood illnesses and infections. It may also help your health. Certain types of cancer may occur less often in mothers who have breastfed their babies.

Women who don't have health problems should try to give their babies breast milk for at least the first six months of life. Most women with health problems can breastfeed. There are rare exceptions when women are advised not to breastfeed because they have certain illnesses. Some medicines, illegal drugs, and alcohol can also pass through the breast milk and cause harm to your baby. Check with your health care provider if you have concerns about whether you should breastfeed.

If you are having problems with breastfeeding, contact a lactation consultant.

What are the benefits of breastfeeding?

Breastfeeding is good for both infants and mothers. Breast milk is the best source of nutrition for most infants. As an infant grows, breast milk changes to meet the infant’s nutritional needs. Breastfeeding can also help protect the infant and mother against some short- and long-term illnesses and diseases:

Benefits to Infants

Infants who are breastfed have a lower risk of:

• Asthma.
• Obesity.
• Type 1 diabetes.
• Severe lower respiratory disease.
• Acute otitis media (ear infections).
• Sudden infant death syndrome (SIDS).
• Gastrointestinal infections (diarrhea/vomiting).
• Necrotizing enterocolitis (NEC) for preterm infants.

Benefit to Mothers

Mothers who breastfeed their infants have a lower risk of:

• Breast cancer.
• Ovarian cancer.
• Type 2 diabetes.
• High blood pressure.

When should a mother avoid breastfeeding (contraindications)?

Breast milk provides the best nutrition for most infants, including premature and sick newborns. However, there are rare exceptions when breast milk or breastfeeding is not recommended. Learn more about contraindications to breastfeeding.

Only a few medications are contraindicated (not recommended) while breastfeeding. Although many medications do pass into breast milk, most have little or no effect on milk supply or on an infant’s well-being. However, health care providers should always weigh the risks and benefits when prescribing medications to breastfeeding mothers.

How is growth assessed for breastfed infants?

In the United States, the World Health Organization (WHO) Growth Standard Charts are recommended for use with both breastfed and formula-fed infants and children, from birth to 2 years of age, to monitor growth. The WHO growth charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and were still breastfeeding at 12 months. The WHO growth charts establish the growth of the breastfed infant as the norm for growth and are the standards for how children should grow when provided optimal conditions. Clinicians should be aware that healthy breastfed infants typically gain weight faster than formula-fed infants in the first few months of life but then gain weight more slowly for the remainder of infancy, even after complementary foods are introduced.

For children older than 2 years (2 to 19 years of age) CDC and the American Academy of Pediatrics recommend that health care providers use the CDC Growth Reference Charts.

How long should a mother breastfeed?

The American Academy of Pediatrics recommends that infants be exclusively breastfed for about the first 6 months with continued breastfeeding along with introducing appropriate complementary foods for 1 year or longer. WHO also recommends exclusive breastfeeding up to 6 months of age with continued breastfeeding along with appropriate complementary foods up to 2 years of age or longer.

Mothers should be encouraged to breastfeed their children for at least 1 year. The longer an infant is breastfed, the greater the protection from certain illnesses and long-term diseases. The more months or years a woman breastfeeds (combined breastfeeding of all her children), the greater the benefits to her health as well.

The American Academy of Pediatrics recommends that children be introduced to foods other than breast milk or infant formula when they are about 6 months old.

What can happen if someone else’s breast milk is given to another child?

Very few illnesses are transmitted via breast milk.

Are special precautions needed for handling breast milk?

CDC does not list human breast milk as a body fluid to which universal precautions apply. Occupational exposure to human breast milk has not been shown to lead to transmission of HIV or Hepatitis B infection. However, because human breast milk has been implicated in transmitting HIV from mother to infant, gloves may be worn as a precaution by health care workers who are frequently exposed to breast milk (e.g., people working in human milk banks (defined below)).

Where can mothers find more information about preparation and storage of breast milk?

CDC has guidelines for proper storage and preparation of breast milk to maintain the safety and quality of expressed breast milk for the health of the baby.

What are human milk banks?

Human milk banks are a service established for the purpose of collecting milk from donors and processing, screening, storing, and distributing donated milk to meet the specific needs of individuals for whom human milk is prescribed by licensed health care providers. When possible, human milk banks also serve healthy infants who have been adopted or are not able to get their own mother’s milk.

Milk banks accept donations directly at their deposit sites or they can arrange for safe, overnight transportation of human milk at no cost to the donor. Learn more about donating to a milk bank by visiting the Human Milk Banking Association of North America (HMBANA).

Is it safe for families to buy breast milk on the internet?

The American Academy of Pediatrics and the Food and Drug Administration recommend avoiding Internet-based milk sharing sites and instead recommend contacting milk banks. Research has demonstrated that some milk samples sold online have been contaminated with a range of bacteria.

Nonprofit donor human milk banks, where processed human milk comes from screened donors, have a long safety record in North America. All member banks of the Human Milk Banking Association of North America (HMBANA) must operate under specific evidence-based guidelines that require extensive testing and processing procedures as well as self-reported health information and a health statement from both the donor’s health care provider and the infant’s health care provider. Because most of the milk from milk banks is given to hospitalized and fragile infants, milk banks may not have enough to serve healthy infants at all times.

What legal rights do breastfeeding mothers have?

Breastfeeding Laws

• All 50 states, the District of Columbia, Puerto Rico and the Virgin Islands have laws that specifically allow women to breastfeed in any public or private location. Visit the National Conference of State Legislatures to learn more about federal and state laws that protect and support breastfeeding.

Workplace Laws

• The “Break Time for Nursing Mothers Provision” of the Patient Protection and Affordable Care Act (ACA) requires employers to support breastfeeding mothers to express breast milk for 1 year after each child’s birth by providing mothers with reasonable break time and a private, non-bathroom space to express their breast milk. Visit the United States Department of Labor to learn more.

Travel Laws

• Air travelers are permitted by the Transportation Security Administration (TSA) to bring breast milk, formula, and juice in excess of 3.4 ounces in their carry-on baggage and it does not need to fit within a quart size bag. Ice packs, freezer packs, and other accessories needed to keep the liquid cool are also allowed in carry-on bags. All liquids and partially frozen accessories are subject to being screened by X-ray. TSA is required by the Bottles and Breastfeeding Equipment Screening Act (BABES act) to provide ongoing training to ensure TSA staff receive consistent training related to traveling with breast milk, formula, and infant feeding equipment. Visit the TSA to learn more about traveling with breast milk, formula, and juice.

How can a mother continue to provide breast milk to her infant after returning to work or school?

Being prepared for returning to work or school can help a mother ease the transition and continue to breastfeed after her maternity leave is over. The Office on Women’s Health has information for making this transition easier.

When a mother is away from her infant, she can pump or hand express her breast milk so that her infant can drink breast milk from a bottle. Mothers can visit CDC’s Infant and Toddler Nutrition website to learn more about pumping breast milk.

Mothers who are expressing their breast milk should visit the CDC’s Proper Storage and Preparation of Breast Milk website to learn how to prepare and store breast milk safely for her infant.

The Patient Protection and Affordable Care Act (ACA) requires employers to support breastfeeding mothers to express breast milk for 1 year after each child’s birth by providing mothers with reasonable break time and a private, non-bathroom space to express their breast milk.

Does breastfeeding during a child’s vaccine injections help with pain management?

Parents who are breastfeeding should be encouraged to breastfeed children age 2 years or younger before, during, and after their child’s vaccination. Several aspects of breastfeeding are thought to decrease pain by multiple mechanisms: being held by the parent, feeling skin-to-skin contact, suckling, being distracted, and ingesting breast milk. Potential adverse events such as gagging or spitting up have not been reported. Alternatives to breastfeeding include bottle-feeding with expressed breast milk or formula throughout the child’s procedure, which simulates aspects of breastfeeding.

Does breastfeeding after a child’s rotavirus vaccine impact the vaccine’s efficacy?

There is not sufficient evidence to suggest that breastfeeding can have a negative effect on rotavirus vaccine efficacy. A previous study found that human milk from women who live in areas with endemic rotavirus contains antibodies that can neutralize live rotavirus vaccine virus. However, in licensing trials, the effectiveness of rotavirus vaccine in breastfed infants was comparable to that in non-breastfed infants.

CDC does not recommend restricting or discontinuing breastfeeding before or after a child receives the rotavirus vaccine. Breastfed infants should be vaccinated according to the same schedule as non-breastfed infants.

Research shows that breastfeeding offers many health benefits for infants and mothers, as well as potential economic and environmental benefits for communities.

Breastfeeding provides essential nutrition. Among its other known health benefits are some protection against common childhood infections and better survival during a baby's first year, including a lower risk of Sudden Infant Death Syndrome.

Research also shows that very early skin-to-skin contact and suckling may have physical and emotional benefits.

Other studies suggest that breastfeeding may reduce the risk for certain allergic diseases, asthma, obesity, and type 2 diabetes. It also may help improve an infant's cognitive development. However, more research is needed to confirm these findings.

In the United States, the American Academy of Pediatrics (AAP) currently recommends:

• Infants should be fed breast milk exclusively for the first 6 months after birth. Exclusive breastfeeding means that the infant does not receive any additional foods (except vitamin D) or fluids unless medically recommended.
• After the first 6 months and until the infant is 1 year old, the AAP recommends that the mother continue breastfeeding while gradually introducing solid foods into the infant's diet.
• After 1 year, breastfeeding can be continued if mutually desired by the mother and her infant.

The World Health Organization currently promotes as a global public health recommendation that:

• Infants be exclusively breastfed for the first 6 months after birth to achieve optimal growth, development, and health.
• After the first 6 months, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond.

Recommendations to Support Breastfeeding

According to the Centers for Disease Control and Prevention, the majority of new mothers start out breastfeeding, but only a minority still exclusively breastfeed by the time their infants are 6 months old. Many factors influence successful breastfeeding, including support from health care providers, family and community, and the workplace.

The 2011 Surgeon General's Call to Action to Support Breastfeeding makes 20 recommendations to support new mothers in their decision to breastfeed.

Every mother’s experience with breastfeeding is different. Whether this is your first baby or you are an experienced mom, each baby is unique. Breastfeeding will be a learning process.

Your baby is learning how to:

• Latch.
• Suck.
• Swallow.

You are learning how to:

• Position your baby to feed.
• Observe and follow his or her hunger cues.
• Manage your breast milk supply and breast health.

First Days and Weeks

Milk Coming In

At birth, your breasts will make a thick, yellowish substance called colostrum. Colostrum is packed with nutrients and other important substances that help your baby start building up his or her immune system. There will not be a lot of this liquid at first, but the amount will gradually increase over the first couple of days. Most babies will get all the nutrition they need through colostrum during the first few days of life. As you begin breastfeeding, your baby’s sucking will tell your body to start making milk. For most mothers, this thinner, whiter form of milk comes in by about 3 days after birth, but may take longer for first-time moms. You may notice your breasts feeling full, hard, and warm as this happens. Your baby may begin to want to breastfeed more frequently around this time. If you are concerned about your milk coming in, talk to a lactation consultant or your doctor or nurse.

Did You Know?

Pacifiers and your baby.

If you are breastfeeding your baby, you may want to wait to use a pacifier until breastfeeding is well-established. At that time, using a pacifier for naps and at bedtime can help reduce the risk of Sudden Infant Death Syndrome (SIDS).

Leaking

Your breasts may feel full and leak. Over time, the leaking may slow down as your body gets used to breastfeeding. If your breasts leak, you may find it helpful to put disposable or cloth pads in your bra.

Engorgement

Over the first few weeks after birth, your breasts may become larger, firm, warm, and uncomfortable as your body adjusts to making milk. This is called engorgement. As your breasts get used to filling and emptying as you feed your baby, this should improve. Feeding your baby frequently should help to prevent severe engorgement and relieve discomfort.

Sore Nipples

During the first few weeks of breastfeeding, your nipples may be sore or sensitive as they adjust to your baby’s sucking. If you have cracked or damaged nipple skin, or pain that is not improving over the first 1–2 weeks, talk to a lactation consultant or your doctor or nurse.

Pain While Breastfeeding

Although your breasts and nipples may be tender or uncomfortable, once your baby is well-latched, breastfeeding should not be painful. Sometimes pain can happen if you have an improper latch, a milk duct that is clogged with milk (plugged milk duct), a breast infection (mastitis), or other issues. If you have pain while breastfeeding, especially with a fever, talk with your doctor or nurse to figure out why.

As Your Baby Gets Older

Teething/Biting

You can continue to breastfeed once your baby starts to get teeth. Babies use their tongues, not their teeth, to breastfeed. If your baby is latched well and sucking, you should not feel the teeth while your baby is feeding. Once in a while babies might bite the nipple or breast, especially when they are teething. Talk to a lactation consultant for tips on how to teach your baby not to bite.

Refusing to Breastfeed

Sometimes babies will suddenly stop wanting to breastfeed. Many times it is hard to know why this happens. Refusing to breastfeed is usually temporary and your baby will start breastfeeding again within a few days. Some reasons your baby may refuse breastfeeding include teething, illness, stress, a change in environment such as a new childcare situation, or a major change in routine. This usually does not mean your baby is ready to wean.

To help your baby return to breastfeeding:

• Keep offering your baby the breast or breast milk from a bottle if bottle feeding.
• Spend extra time cuddling and holding your baby.
• Offer the breast in quiet spaces and when your baby is sleepy or relaxed.
• Pump or express milk frequently to keep your breast milk supply up until your baby starts breastfeeding again.

Distracted Breastfeeding

Your baby is starting to notice all the things going on around him or her. This can mean that your baby might get distracted while breastfeeding. Help your baby focus by turning off the TV, dimming the lights, or feeding in a quiet place.

Weaning

Although breastfeeding is recommended until your baby is at least 12 months old, weaning may happen before then. Learn about when and how to wean your baby from breastfeeding.

Every baby is different. How much and how often your baby feeds will depend on your baby’s needs. Here are a few things to know about how much and how often babies breastfeed during the first days, weeks, and months of life.

First Days

If you have questions about your baby’s growth or how much breast milk he or she is getting, talk with your child’s doctor or nurse.

• Your newborn baby’s belly is tiny. He or she does not need a lot of milk with each feeding to be full.
• Your baby may want to eat as often as every 1 to 3 hours. Frequent feeding helps increase your milk supply and gives your baby practice at sucking and swallowing.
• You may be able to hear your baby sucking and swallowing the breast milk.
• Most babies who are getting breast milk should not be fed infant formula in the first few days. If you are concerned about meeting your baby’s needs, talk to a lactation consultant, or your baby’s nurse or doctor, right away to find out how to address any breastfeeding problems and determine the best way to meet your baby’s needs.

Did You Know?

Some newborns may be sleepy and not interested in feeding.

At first, babies need to eat about every 2 to 4 hours to help them get enough nutrition and to grow.

This means you may need to wake your baby to feed. You can try patting, stroking, undressing, or changing the diaper to help wake your baby to feed.

If you have concerns about how much your baby is sleeping or eating, talk to his or her doctor or nurse.

First Weeks and Months

• As your baby grows, his or her belly also grows. Your baby will gradually be able to drink more breast milk at each feeding.
• Over the first few weeks and months, the time between feedings will start to get longer— on average about every 2 to 4 hours for most exclusivelybreastfed babies. Some babies may feed as often as every hour at times, often called cluster feeding, or may have a longer sleep interval of 4 to 5 hours.
• How often your baby feeds might change depending on the time of day. Some feeding sessions may be long, and others short. That is okay. Babies will generally take what they need at each feeding and stop eating when they are full. They should seem content and drowsy after feeding when they have had enough milk.
• Your baby will breastfeed about 8 to 12 times in 24 hours.

6 to 12 Months

• Breastfed babies’ feeding patterns (how often and how long they feed) vary and will likely change as they grow and start eating more solid foods.
• Continue to follow your baby’s cues and breastfeed when you notice signs of hunger (sometimes called “breastfeeding on demand”).
• If your baby seems to be less interested in breastfeeding after you introduce solids, try breastfeeding first before you offer solids.
• Your breast milk is the most important source of nutrition, even after you start feeding your baby solids.

12 to 24 Months

• The number of times a day a toddler breastfeeds varies. Some want to breastfeed only before bed or in the morning, while others continue to drink breast milk as a bigger portion of their daily diet. Continue to follow your child’s cues to decide when he or she is hungry and wants to breastfeed.

There are many mothers' groups, health organizations, and health care provider associations that provide very detailed information and support on how to breastfeed. The following overview is provided for information only—it is not meant to take the place of a health care provider or lactation consultant's advice or recommendation. Visit the Resources and Publications section to find the names of some breastfeeding organizations.

Know When to Feed Your Infant

Infants who are hungry will nuzzle against their mother's breast and make sucking motions or will put their hands in their mouths. During the first weeks after birth, you may nurse your infant often, perhaps as often as eight to 12 times in 24 hours.

Breastfeeding Tips: How to Get Off to a Good Start

After your infant is born, follow these tips for getting started:

• Breastfeed your infant for the first time as soon as possible after the infant is born.
• Ask at the hospital whether an on-site lactation consultant is available to assist you.
• Request that the hospital staff not feed your infant any other foods or formula unless it is medically necessary.
• Allow your infant to stay with you throughout the day and night at the hospital so that you can breastfeed often. If this is not possible, ask the nurses to bring your infant to you each time for breastfeeding.
• Avoid giving your infant pacifiers or artificial nipples so that the infant gets used to latching on to just your breast.

Bring Your Infant to Your Breast to Latch

Infants will naturally move their head while looking and feeling for a breast to feed. There are many ways to start feeding your infant, and the best approach is the one that works for you and your infant. The steps below can help with getting your infant to "latch" on to the breast for feeding.

• Hold your infant against your bare chest. Dress your infant in only a diaper to ensure skin-to-skin contact.
• Keep your infant upright, with his or her head directly under your chin.
• Support your infant's neck and shoulders with one hand and his or her hips with your other hand. Your infant may try to move around to find your breast.
• Your infant's head should be slightly tilted back to make nursing and swallowing easier. When his or her head is tilted back and the mouth is open, the tongue will naturally be down in the mouth to allow the breast to go on top of it.
• At first, allow your breast to hang naturally. Your infant may open his or her mouth when your nipple is near his or her mouth. You also can gently guide the infant to latch on to your nipple.
• While your infant is feeding, his or her nostrils may flare to breathe in air. Do not panic—this flaring is normal. Your infant can breathe normally while breastfeeding.
• As your infant tilts backward, support his or her upper back and shoulders with the palm of your hand and gently pull your infant close.

Signs of a Good Latch

A good latch is important for both effective breastfeeding and your own comfort. Review the following signs to determine whether your infant has a good latch:

• The latch feels comfortable and does not hurt or pinch. How it feels is a more important sign of a good latch than how it looks.
• Your infant does not need to turn his or her head while feeding. His or her chest is close to your body.
• You see little or no areola (pronounced uh-REE-uh-luh), which is the dark-colored skin on the breast that surrounds the nipple. Depending on the size of your areola and the size of your infant's mouth, you may see a small amount of areola. If more areola is showing, it should seem that more is above your infant's lip and less is below.
• Your infant's mouth will be filled with breast when in the best latch position.
• Your infant's tongue is cupped under the breast, although you might not see it.
• You can hear or see your infant swallowing. Because some babies swallow so quietly, the only way of knowing that they are swallowing is when you hear or see a pause in their breathing.
• Your infant's ears "wiggle" slightly.
• Your infant's lips turn outward, similar to fish lips, not inward. You may not even see your infant's bottom lip.
• Your infant's chin touches your breast.

How to End a Breastfeeding Session

To break the suction and end a breastfeeding session, insert a clean finger between your breast and your infant's gums. After you hear a soft pop, pull your nipple out of your infant's mouth.

How long should a breastfeeding session last?

You should allow your infant to set his or her own nursing pattern. Many newborns will feed for 10 to 15 minutes on each breast. If your infant wants to nurse for a much longer period—say 30 minutes or longer on each breast—he or she may not be getting enough milk.

Weaning is the process of switching an infant's diet from breast milk or formula to other foods and fluids. In most cases, choosing when to wean is a personal decision. It might be influenced by a return to work, the mother's or infant's health, or just a feeling that the time is right.

Weaning an infant is a gradual process. The American Academy of Pediatrics (AAP) recommends feeding infants only breast milk for the first 6 months after birth. After 6 months, the AAP recommends a combination of solid foods and breast milk until the infant is at least 1 year old. The Academy advises against giving cow's milk to children younger than 1 year old.

You may have difficulty determining how much to feed your child and when to start introducing solid foods. The general guidance below, as reported by the National Library of Medicine, demonstrates the process of weaning for infants up to 6 months of age. You should speak with your infant's health care provider before attempting to wean your infant to make sure that he or she is ready for weaning and for complete guidance on weaning.

• Birth to 4 months of age
  • During the first 4 to 6 months, infants need only breast milk or formula to meet their nutritional needs.
    • If breastfeeding, a newborn may need to nurse eight to 12 times per day. By 4 months of age, an infant may need to nurse only four to six times per day.
    • By comparison, formula-fed infants may need to be fed about six to eight times per day, with newborns consuming about 2 to 3 ounces per feeding. The number of feedings will decrease as the infant gets older, similar to breastfeeding.
• 4 to 6 months of age
  • At 4 to 6 months of age, an infant needs to consume 28 to 45 ounces of breast milk or formula per day and often is ready to start being introduced to solid food.
  • Starting solid foods too soon can be hazardous, so an infant should not be fed solid food until he or she is physically ready.
  • Start solid feedings (1 or 2 tablespoons) of iron-fortified infant rice cereal mixed with breast milk or formula, stirred to a thin consistency.
  • Once the infant is eating rice cereal regularly, you may introduce other iron-fortified instant cereals.
  • Only introduce one new cereal per week so that intolerance or possible allergies can be monitored.

Many new mothers wonder if they need to consume more calories (also called energy) during breastfeeding, but the answer is no. You can take in the same number of calories that you did before becoming pregnant. This strategy helps with weight loss after birth.

The Dietary Guidelines for Americans (DGAs) for caloric intake for all women 19 to 50 years old are based on activity level, as follows:

• Sedentary: 1,800 to 2,000 calories per day
• Moderately active: 2,000 to 2,200 calories per day
• Active: 2,200 to 2,400 calories per day

The increased caloric need for women who are breastfeeding is about 450 to 500 calories per day. Women who are not trying to lose weight following pregnancy should supplement the above DGA calories per day by 450 to 500 calories. Often an increase in a normally balanced and varied diet is enough to meet your body's needs. Whether or not to increase caloric intake during breastfeeding is a decision that should be made with the assistance of a health care provider.

Poorly nourished mothers, those on vegan diets or other special diets, and those with certain health conditions may require a supplement of docosahexaenoic acid (DHA) in addition to multivitamins to ensure complete nutrition for breastfeeding.

Women who are breastfeeding may have additional requirements for vitamins and minerals.

In special cases, women may be advised not to breastfeed. These instances include when a woman is taking certain medications or drugs, when she has been diagnosed with a specific illness, or when other specific conditions apply.

Medications/Other Drugs and Breastfeeding

Certain medications are known to be dangerous to infants and can be passed to your infant in your breast milk. Women taking the following medicines should speak with their health care providers before considering breastfeeding:

• Antiretroviral medications (for HIV/AIDS treatment)
• Birth-control medications containing estrogen, until breastfeeding has been well established
• Cancer chemotherapy agents
• Illegal drugs
• Certain medications prescribed to treat migraines, such as ergot alkaloids
• Mood stabilizers, such as lithium and lamotrigine
• Sleep-aid medicines

In addition, women who are undergoing radiation therapy should not breastfeed, although some therapies may require only a brief interruption of breastfeeding.

The above list of medications and other drugs is only a guideline. Before breastfeeding, you should speak with your health care provider about all medications that you are taking. These include prescribed medications, over-the-counter medicines, vitamins, and herbal therapies.

Medications that are safe during pregnancy may also be safe for you to continue while you are breastfeeding, although you should check with your health care provider to make sure they are safe before you breastfeed.

Contact your infant's health care provider if you see any signs of a reaction to your breast milk in your infant, such as diarrhea, excessive crying, or sleepiness.

Health Conditions and Breastfeeding

Women with certain illnesses and infections may be advised not to breastfeed because of the danger of passing the illness or infection to the breastfed infant.

If you have any of the following conditions, breastfeeding your infant is NOT advised. For more information, speak with your health care provider:

• Infection with HIV
• Infection with human T-cell lymphotropic virus type I or type II
• Untreated, active tuberculosis

If you are sick with the flu, including the H1N1 flu (also called the swine flu), you should not stop feeding your infant expressed milk. You should avoid being near your infant, however, so that you do not infect him or her. To avoid infecting your infant, someone who is not sick should give your infant your expressed milk.

If you have Zika virus or live in areas where Zika virus is found, the CDC recommends you continue to breastfeed your infant. Although Zika virus has been detected in breast milk, there are no reports of transmission of the virus through breastfeeding, and the benefits of breastfeeding are thought to outweigh the risks. NICHD is partnering with other NIH Institutes and the Brazilian research organization Fundação Oswaldo Cruz (Fiocruz) to study Zika virus transmission in 10,000 pregnant women and their infants. If possible, breast milk will be collected from the mothers.

Domestic and International Guidelines on HIV/AIDS and Breastfeeding

In the United States, the American Academy of Pediatrics and the CDC recommend against breastfeeding if you are HIV positive; the same advice applies in other developed countries. Without any specific interventions to reduce transmission, infants breastfed by HIV-positive mothers have an increased chance of acquiring HIV through the breast milk. This rate increases if infants are breastfed longer and for mothers with newly-acquired HIV.

Only HIV-positive mothers living in developing countries should consider breastfeeding their babies, especially if a safe and reliable source of infant formula is unavailable. This is because breast milk may protect against malnutrition and diarrhea, which are major causes of infant mortality in some areas of the developing world. If an HIV-positive woman decides to breastfeed her baby, research indicates that the risk of transmitting HIV to her baby is reduced if she exclusively breastfeeds (does not use a combination of formula and breast milk) and if she and her infant take antiretroviral drugs.

Other Considerations for Breastfeeding

In some additional situations, or if women or infants have certain health conditions, women may be advised not to breastfeed or may have difficulty breastfeeding.

• Women with certain chronic illnesses may be advised not to breastfeed, or will be advised to take steps to ensure their own health while breastfeeding. For example, women who have diabetes should monitor their blood sugar levels regularly, may need to reduce their insulin, and may need a snack containing carbohydrates before or during breastfeeding. Also, women who are underweight, including those with thyroid conditions or certain bowel diseases, may need to increase their calories to maintain their own health during breastfeeding.
• Women who have had breast surgery in the past may face some difficulties with breastfeeding.
• Women who actively use drugs or do not control their alcohol intake, or who have a history of these situations, also may be advised not to breastfeed.
• Infants who have galactosemia—a rare metabolic disorder in which the body cannot digest the sugar galactose—should not be breastfed. Galactosemia is detected by newborn screening, allowing proper treatment and diet to begin immediately. If not detected, the galactose builds up and becomes toxic for the infant, leading to liver problems, intellectual and developmental disabilities, and shock.

Pumping Breast Milk

There are many mothers' groups, health organizations, and health care provider associations that provide very detailed information and support on how to pump breast milk. The following overview is provided for information only—it is not meant to take the place of a health care provider or lactation consultant's advice or recommendation. Visit the Resources and Publications section to find organizations that provide information on pumping breast milk.

If you are unable to breastfeed your infant directly, it is important to remove milk during the times that you would normally feed your infant. Removing milk from your breasts is called expressing the milk. Expressing milk will help you to continue making milk.

Before expressing breast milk, wash your hands thoroughly. Only express milk when you are in a clean area. You do not need to wash your breasts or nipples before expressing milk. If you need help to get your milk flowing, placing an item of your infant's near to you often works.

There are three methods for expressing your breast milk:

• Hand expression: For hand expression, you use your hand to manually massage and compress your breast to remove milk.
• Manual pump: To operate a manual pump, you use your hand and wrist to operate a hand-held pumping device that removes milk from your breast.
• Electric breast pump: An electric breast pump runs on a battery or through an outlet plug. It can pump milk from one breast or from both breasts at the same time.

Storing Breast Milk

Breast milk can be stored in clean glass bottles or hard, BPA-free plastic bottles with tight-fitting lids. After pumping, refrigerate or freeze milk immediately. You should store milk in small batches (2 to 4 ounces), depending on the amount that you normally feed your infant at one time.

For refrigeration, storage for as long as 5 to 8 days is acceptable only for very clean expressed milk. If freezing, store the milk in small (2-ounce to 4-ounce) batches. Frozen milk is good for 3 to 6 months. After thawing, use milk within 24 hours and do not refreeze it because of the risk of contamination.

What is vitamin D supplementation for infants?

Although breastfeeding is the recommended method for feeding infants and breast milk provides most of the nutrients an infant needs, it does not provide infants with adequate vitamin D. Vitamin D is required to prevent rickets, a type of vitamin D deficiency. This disease is rare among breastfed infants but can occur if vitamin supplementation or exposure to sunlight is inadequate. (Exposure to sunlight helps the body to make vitamin D in place of supplementation.)

The current American Academy of Pediatrics (AAP)–recommended daily vitamin D intake is 400 IU per day for all infants and children beginning from the first few days after birth. Human breast milk contains a vitamin D concentration of 25 IU per liter (about 4 cups) or less. Therefore, to meet the 400 IU daily requirement, supplementation is required.

If an infant is weaned to a vitamin D-fortified infant formula and consumes at least 4 cups per day, then additional supplementation with vitamin D is not necessary.

When to Supplement Breastfeeding

Breastfeeding is supplemented by feeding an infant expressed breast milk from a bottle, formula, or breast milk from another mother. Such supplementation may be needed in the following situations:

In the Mother:

• Breast surgery or other trauma
• Primary breast insufficiency that prevents adequate milk production
• Physical separation from the infant
• Serious illness

In the Infant:

• Weight gain insufficient to maintain health (also sometimes called failure to thrive)
• Cleft lip and/or palate or other abnormality that prevents normal suckling ability
• Jaundice or liver problems
• Serious illness or prematurity that requires the infant to be cared for in a special nursery

Many of these conditions require a health care provider's care. You should always talk with your child's health care provider about whether to supplement your breastfeeding.

To keep supplementation from shortening or otherwise interfering with breastfeeding, you should supplement only after your infant is breastfeeding effectively and thriving on your breast milk.

Mixing Formula with Breast Milk

Mixing formula with breast milk in the same container is one way of supplementing breast milk. You may want to supplement your breast milk with infant formula if your milk supply is low or when you are physically separated from your infant.

Supplementing your breast milk with formula, however, may not be nutritionally the same as giving breast milk. Discuss the practice with your infant's health care provider before starting to mix formula with your breast milk.

Complementary Feeding

The term "complementary feeding" refers to giving your baby solid and liquid foods other than breast milk or infant formula. As babies grow, they have nutritional needs that breast milk or infant formula alone cannot meet. Complementary feeding helps meet those nutritional needs. It is also important for infants' jaw and muscle development and helps them develop speech later.

The AAP and the World Health Organization (WHO) recommend introducing safe, nutritious complementary foods into your infant's diet around 6 months of age. The exact timing depends on the infant's developmental readiness, meaning whether the baby can open his or her mouth and lean forward when interested in food. Studies show that introducing complementary foods before 4 months offers little health benefit to the infant and can increase the risk of food allergies and choking.

Some complementary foods are often called "baby foods" and can be pureed or mashed-up versions of meats, fruits, and vegetables. Different foods offer different nutrients. For example, around 4 to 6 months of age, babies' iron and zinc needs are higher than what breast milk or infant formula alone can provide. Complementary feeding of fortified cereals or pureed meats can provide these nutrients.

If you have any questions about complementary feeding, or if your family has a history of food allergies, talk to your infant's health care provider.

Like when you were pregnant, there are things you should limit or avoid while you are breastfeeding to keep your baby happy and healthy.

Limit caffeine. Drinking a small amount of coffee (up to 2 cups a day) or other drinks with caffeine is okay while breastfeeding. Too much caffeine can make your baby fussy or keep baby awake.

Avoid alcohol. It's best to avoid alcohol while you are breastfeeding. If you choose to drink, you may have a single alcoholic drink once in a while if your baby's breastfeeding routine is well established-and if your baby is at least 3 months old. Then, wait at least 4 hours after having a drink before breastfeeding.

Avoid smoking, drugs, and other medications. Talk to your doctor before taking any medicine (both over-the-counter and prescription) or dietary supplements.