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.

Infant conditions

Maternal conditions

Benefits of breast feeding

Breastmilk is the ideal food for infants. However, nearly 2 out of 3 infants are not exclusively breastfed
for the recommended 6 months; a rate that has not improved in 2 decades.
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

At 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.