Recommendations on Breastfeeding Management for Healthy Term Infants

1. Exclusive breastfeeding for about 6 mo
 • Breastfeeding preferred; alternatively expressed mother’s milk, or donor milk
 • To continue for at least the first year and beyond for as long as mutually desired by mother and child
 • Complementary foods rich in iron and other micronutrients should be introduced at about 6 mo of age
2. Peripartum policies and practices that optimize breastfeeding initiation and maintenance should be compatible with the AAP and Academy of Breastfeeding Medicine Model Hospital Policy and include the following:
 • Direct skin-to-skin contact with mothers immediately after delivery until the first feeding is accomplished and encouraged throughout the postpartum period
 • Delay in routine procedures (weighing, measuring, bathing, blood tests, vaccines, and eye prophylaxis) until after the first feeding is completed
 • Delay in administration of intramuscular vitamin K until after the first feeding is completed but within 6 h of birth
 • Ensure 8 to 12 feedings at the breast every 24 h
 • Ensure formal evaluation and documentation of breastfeeding by trained caregivers (including position, latch, milk transfer, examination) at least for each nursing shift
 • Give no supplements (water, glucose water, commercial infant formula, or other fluids) to breastfeeding newborn infants unless medically indicated using standard evidence-based guidelines for the management of hyperbilirubinemia and hypoglycemia
 • Avoid routine pacifier use in the postpartum period
 • Begin daily oral vitamin D drops (400 IU) at hospital discharge
3. All breastfeeding newborn infants should be seen by a pediatrician at 3 to 5 d of age, which is within 48 to 72 h after discharge from the hospital
 • Evaluate hydration (elimination patterns)
 • Evaluate body wt gain (body wt loss no more than 7% from birth and no further wt loss by day 5: assess feeding and consider more frequent follow-up)
 • Discuss maternal/infant issues
 • Observe feeding
4. Mother and infant should sleep in proximity to each other to facilitate breastfeeding
5. Pacifier should be offered, while placing infant in back-to-sleep-position, no earlier than 3 to 4 wk of age and after breastfeeding has been established